Friday, September 5, 2008

Drugs vs. Therapy

As I touched on in my previous posting about depression, there are interesting studies comparing the treatments of medications and psychotherapy/counseling. One sees medication ads almost any tie you turn on the TV, look in a magazine, etc. Research proves that the advertising works. Increasing numbers of people are taking medications for depression, stress, etc. The number of people seeking counseling may be decreasing.

Many of the studies with depression, even severe depression, show them to be about equally effective. Therapy has been shown to have greater durability, with lower relapse rates following the end of treatment. There are also lower drop-out rates for therapy, due to medication side-effects. It is common practice for people to receive both treatments. One might think this to be more potent than either treatment by themselves. Some studies do support this, but other studies do not.

There is some evidence that therapy may be the better choice for those experiencing panic attacks. One study "found higher treatment effect sizes, lower attrition rates, and favorable cost profiles for talk therapy as compared to medication treatment for this disorder." There are fewer studies for panic than for depression. Therefore, one should be slower to declare a conclusion.

It may be surprising (including to many mental health professionals) that therapy can also be very helpful in the treatment of schizophrenia. An examination of many studies (a meta-analysis) "found that people treated with talk therapy in addition to medication were significantly better off than those treated with medication alone."

There are several other interesting findings from the huge muti-site research on depression. More effective therapists focus less on medications. Also, that the relationship with the psychiatrist is predictive of how helpful medication will be. There was a parallel with some behavior therapists, years ago. The parallel is that the medication or behavioral treatment are what is important and that the relationship is not. Behavior therapists have come to understand this. Some psychiatrists still have this lesson to be learned.

What can one conclude? First, that treatment works for most people. Second, the relationship with any mental health (and probably non mental health) providers is critical. Third, that the drug companies have great influence on what treatments people seek. This posting is not intended as anti-medication. I have encouraged numerous individuals to try medications for a variety of conditions. Rather, medications are not the only choice and sometimes the lesser choice. Lastly, if you are unhappy with your provider, try to make your complaints known to that person.

Best wishes,

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