Psychotherapy vs. Medication for Depression, Anxiety and Other Mental Illnesses
Two interesting and disturbing findings were recently published about the fields of psychology and psychiatry. For one, fewer patients are electing to go for psychotherapy than ever before. Yet, when surveyed, people reported that they preferred psychotherapy for anxiety and depression instead of medication. How can this contradiction be explained?
For one thing, many people are hesitant to take psychotropic medications because they fear the impact they may have on their personalities and their sense of identity. In other words, there is a fear that medication may alter who they are in some fundamental and negative way. There are also fears that psychotropic medications are addictive and that, if taken, will become impossible to come off of. At the very same time, there are fears that, if medication is taken and things improve, patients will once again have depression and anxiety once taking medication ends. One of the questions patients frequently as me is "how long will I need to take medication." The people who ask me this question are in psychotherapy with me but have started medication because of the depth of their depression. What they really want is to feel better and reach that time when they will need neither medication nor psychotherapy.
Yet, if people prefer psychotherapy to medication why is the number of people choosing psychotherapy declining? Despite the fact that many are wary about taking medication, there is always the American belief that a pill of one type or another, a "magic bullet," as it is sometimes called, will cure everything without the long process of psychotherapy. Add to that the fact that therapy can be very expensive and that many insurance programs will not reimburse for it, there is real hesitation about psychotherapy.
There is another matter to consider. This is one that psychologists tend to focus on and worry about. It is what is referred to as evidenced based treatment. Psychiatrists and the companies who manufacture psychotropics, are able to demonstrate the fact that medication relieve depression and anxiety. Yet, it is difficult to prove that is true for psychotherapy. Psychologists insist that Cognitive Behavior Therapy is evidenced based and is proven, in research, to relieve depression and anxiety even better than medications. The problem with this assertion is that many people are skeptical about that and even about the research studies that prove it's efficacy. In fact, there are many therapists who use other therapeutic techniques than CBT who do not agree with CBT or it's efficacy. They point to weaknesses in the research and in the assumptions that followers of CBT insist makes it evidence based. For one, there is an assumption that all CBT therapists practice in the same way. However, therapy is not surgery, leaving a lot to the individual practitioners style and personality. In other words, does CBT mean the same thing to all providers?
Whatever the arguments for or against medication and psychotherapy, I want readers to understand that both medication and therapy are useful, helpful and successful in helping people overcome depression and anxiety. In fact, it is my belief that therapists, in actuality, now use a combination of CBT and other therapies to help patients. I can state, in no uncertain terms, that patients get better with psychotherapy alone or with medication.
What are your thoughts about this issue?
Allan N. Schwartz, PhD