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  • Kim WD, Psych NP

Do I Need Therapy – or Can I Just Use Medications?

Finding a path through the mental health and wellness landscape can be confusing. You (or a loved one) may not be feeling comfortable, may be feeling stressed or overwhelmed, or may be having trouble functioning. You feel it’s time to seek help. But how do you know whether these challenges are a therapy issue – or whether they might be better handled with medication?

Therapy. You probably know people who have done well in talk therapy (also known as psychotherapy). They see a counselor or therapist on a regular basis. Over time they work through issues and find a better quality of life for themselves.

Medications. You may also know people who are prescribed mental health medications (also known as psychotropics). These medications seem to be helping them with their emotional balance. So which way do you turn? How do we know when a person’s mental health can be improved through the use of talk therapy, and when it can be improved through the use of medications? Can some people benefit from both?

Accurate psychiatric assessment

This is where an accurate assessment by a psychiatric-mental health (PMH) provider can be valuable. During a psych assessment, your provider will employ a number of tools and resources. They will review your previous records, and ask you questions (sometimes gazillions!) about your past. They’ll talk with you to explore what’s going on now. You may be asked to fill out questionnaires, or take a computer test. You may even be asked to schedule a physical exam or lab tests. With a thorough assessment, your PMH provider will be able to decide which is the right course for you.

During this process you and your PMH provider will explore a lot of territory. The answer to your question – whether you need therapy, medications, or both – will often depend on the type of mental health concerns that are uncovered. These decisions will be based on your needs and priorities, and your psychiatric-mental health provider will also take into account the most current science and published studies, an approach known as evidence-based practice.

Anxiety disorders

When a person is trying to deal with anxiety, studies have shown that therapy, antidepressant medications and anti-anxiety medications may all be helpful. In general, psychotherapy is more effective than medications for anxiety, and adding medications does not significantly improve outcomes over psychotherapy alone.

Depressive disorders

When depression has become a problem, there can be benefits from psychotherapy – especially cognitive-behavioral therapy (CBT) and interpersonal therapy. In many cases, antidepressant medications have also been shown to be helpful. For a number of people, a combination of psychotherapy and medications may be more effective than either treatment by itself.

Alcohol and drug use disorders

When alcohol or drug use have become a problem for a person, studies support both psychotherapy and peer-support programs (e.g., AA, SMART Recovery, or other addiction management programs) as being helpful. But what if a person’s substance use problems are severe? If that’s the case, they are likely to benefit from a combination of talk therapy and medications that reduce cravings or minimize the intoxicating effects of drugs and alcohol.

Eating disorders

When a person seeks help for an eating disorder, that person’s physical well-being takes priority. Medical management – and even hospitalization – may be necessary in order to maintain their physical safety. Several different modes of therapy (e.g., CBT, DBT, interpersonal psychotherapy) and antidepressant medications have been shown to be helpful. There is also evidence supporting a combination of psychotherapy and medications, which may be more effective than either treatment alone.

Thought disorders, psychosis, and bipolar disorder

Schizophrenia, another psychotic disorder, and bipolar disorder can interfere with a person's ability to think or behave appropriately. When there is a serious breakdown in the ability to think, feel, or act clearly, most people will require treatment with antipsychotic or mood-stabilizing medications. Studies suggest that adding CBT or family psychotherapy to a person's medication treatment can improve functional outcomes.

ADD/ADHD

For children 6 years of age and older, national recommendations include medication and behavior therapy together – parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents.

Adult ADHD is best approached with a multimodal strategy. While each person is different, a combination of complementary approaches that work together is most likely to reduce symptoms. Studies suggest that the ideal combination may include medication, nutrition, exercise, behavioral therapy, participating in CBT, and joining an ADHD support group.

Relationships and parenting

Problems with parenting, marriage, child-rearing, situational stressors, or adjustment, psychotherapy is usually the first recommendation. Talk therapy can help you build and hone the skills you need to respond more appropriately to stressors.

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