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Suzie Darling, LCSW Suzie Darling, LCSW
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Therapy or medication? Consider both when seeking mental health help

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Therapy or medication? This is a question many suffering with anxiety, depression, and other mental health disorders must confront. While there is evidence that psychotherapy is more effective than medication in addressing some of these conditions, a combination of the two has been shown to produce better outcomes compared to each treatment alone. 

So why are U.S. physicians prescribing medications for mental health conditions at rates that far exceed those in other countries? And why, despite a 2013 study that concluded that adults with anxiety and depression prefer psychological treatment (therapy) to medications at a rate of 3 to 1, has demand for therapy in the U.S. dropped over the past decade? Are Americans pill-happy and seeking a “quick fix?” Has the psychotherapy industry not done a sufficient job at promoting itself as a viable alternative to psychiatric medications? Or are there other factors at play?

There are many reasons why one might opt to take a medication versus engage in therapy. Some feel it is easier and more efficient to take a pill while others express that medication comes with less of an emotional burden and workload compared to therapy. Some find the use of medications to be more socially acceptable, less invasive and stigmatizing.

When I talk to people about my work, I often hear people say they have tried therapy and it “didn’t work” for them. First of all, research shows that the quality of the “therapeutic relationship” is often a significant factor in determining whether one progresses in therapy. The therapeutic relationship is the relationship between the client and the therapist. Feeling comfortable with your therapist and their approach is essential. There are many therapists out there, all with different personalities, approaches, and styles. What works for one person doesn’t always work for another. Some worry they will hurt the therapist’s feelings if they express discomfort or request a referral to another provider. Others are hesitant to ask questions at all. While I can’t speak for all therapists, most therapists I know want their clients to succeed and are happy to find another more suitable provider for them.

Psychotherapy has come a long way in terms of establishing evidence-based practices for a number of mental health conditions. Evidence-based practices are those that have been tested repeatedly in clinical trials and have been found to be effective. Unfortunately, not all providers utilize these practices. If you feel like you’re having a conversation with a supportive friend during a therapy session, it is unlikely your provider is using one of these practices. While you may feel better subjectively after a session, the evidence shows that “supportive psychotherapy” does not reduce symptoms. Most people who succeed in therapy do so because they are willing to do the work required by evidence-based practices. It is often very difficult work. There may be homework assignments and you may be asked to things that are outside of your comfort zone. With evidence-based practices, the therapist’s office is the classroom and your life is the canvas upon which the new skills are applied. So, if you have worked with a therapist that doesn’t use these practices, it’s not that surprising it wasn’t helpful. 

Furthermore, in recent years, stigma has become more, rather than less, of a barrier for people with mental health symptoms considering psychotherapy. In many circles, mental illnesses are not considered “real” illnesses, and those seeking treatment are afraid to be labeled as “crazy,” “weak,” “lazy” or “violent” - all misconceptions perpetuated by the press, by Hollywood, and other influential social platforms. As a therapist, it is heartbreaking to hear of people who do not seek treatment for this reason and it is shocking how often I hear clients tell me how difficult it was to walk through our doors. While it is understandable why people feel this way, most who muster the courage to defy these stereotypes are happy they did.

Others prefer therapy over medication because they feel uncomfortable putting a “chemical” in their body, they worry about side effects, or the expense of the medication is just too much to manage. Some express concerns that they will become dependent on the medication, which will lead to additional problems. Psychotherapists have opinions, too. They often feel that while medication can be effective in treating psychological conditions, they alone do not specifically address the underlying cognitive, behavioral and interpersonal problems that often develop and habituate during periods of profound emotional distress. Taking a medication may improve mood, or reduce anxiety, however unless underlying factors are also addressed, a resurgence of symptoms is nearly inevitable.

Unfortunately, we are not able to clearly predict who will respond well to psychotherapy or medications. Mental health treatment is not a one-size-fits-all proposition and there is no simple answer as to what is best for you. For some, medication is absolutely essential. Ultimately, you have to decide what feels right for you. Keep in mind that your preference is important! A growing body of evidence suggests that individuals who receive their preferred treatment have improved follow through with treatment and better clinical outcomes.

So how should one proceed if they are experiencing emotional distress? The first suggestion would be to speak with trusted family, friends and medical providers. As uncomfortable as this may seem on the surface, many are surprised with the feedback they receive. I have heard plenty of stories from my patients who have been surprised to learn that close friends or family have had excellent treatment results from specific medications, or specific psychotherapy providers. While this does not mean you will too, it provides an added layer of resources you can explore to make an informed treatment decision. When it comes to speaking with your primary care provider, discuss with them a range of treatment options-not just one. Before accepting a prescription, inquire as to the provider’s experience with the medication; discuss possible side effects and how to proceed if you experience them. Ask about reputable therapy providers they have relied on to assist their patients in the past. Do the therapists use evidence-based protocols and are they timely in communicating with the primary care provider so your care with them will be seamless?

As a provider of mental health services, it is upsetting to see people suffer when effective treatment is so readily available. Please don’t make this your story.

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