A confluence of factors likely drove the growing use of pharmacological treatment during this decade. In specialty settings, managed care organizations had an incentive to substitute medications for psychotherapy, in part because they were not required to pay for drugs under capitated contracts (3). In primary care settings, availability of new medications, particularly selective serotonin reuptake inhibitors, made it easier for generalist physicians to treat common depressive and anxiety disorders. Across all settings, marketing efforts by the pharmaceutical industry helped drive both provider behavior and consumer demand. During that decade, spending on drug promotion grew at an annual rate of more than 10%; with new guidelines promulgated by the Food and Drug Administration in 1997, this spending for the first time included direct-to-consumer advertising of drugs on television and other broadcast media (4).