Treatment Choice: Psychotherapy, Medication, or Both
by Vivian Campbell, M.D.
Modern mental health care offers a variety of treatments. In general, the combination of psychotherapy and medication treatment is complimentary. However, there are some conditions for which psychotherapy is the primary treatment, and others for which medication may be the primary treatment.
Psychotherapy is ideally suited to treatment of the “stress response syndromes” such as adjustment disorders, bereavement, and PTSD. (1) Additionally, psychotherapy is the best treatment approach for modifying chronic thoughts and behaviors that result in distressful emotions and difficulty getting along with others in a variety of life situations. Eating disorders and hoarding are treated primarily with psychotherapy.
Psychotherapy encompasses a variety of approaches from individual therapies to group therapy, and family therapy. Cognitive and behavioral therapies are helpful with thelong term improvement of some conditions in which medication is often used early in treatment, such as anxiety disorders and Obsessive Compulsive Disorder.Psychotherapy may be tried first in mild to moderate depression, or to avoid potential risks posed by medications such as in treating young children and pregnant women.
There are conditions for which medication is considered thebest primary treatment. These include severe depression, bipolar disorder, schizophrenia, and severe forms of anxiety disorders. Medication treatment may speed recovery, avoid disability and hospitalization, and provide symptomatic control that promotes participating in psychotherapy. Substance abuse treatment centers may use medication in early treatment to ease withdrawal, but psychotherapy or group support is advised to help avoid relapse to substance abuse.
Many mental health conditions respond well to psychotherapy or medication, and often best to combination treatment. Begin with a thorough evaluation, followed by a discussion of treatment goals and available treatment options.
- Horowitz, Mardi Jon; Lanham, MD. Stress Response Syndromes: PTSD, Grief, and Adjustment Disorders (3rd ed.)Jason Aronson, USA: 1997
- Depression and Bipolar Support Alliance website