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Medication? Psychotherapy? Or both?
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In May 2000, The New England Journal of Medicine published the results
of a study underscoring the importance of combining psychotropic medication
with psychotherapy.
In this study, 681 adults with chronic major depressive disorder were
randomly divided into 3 groups and treated for 12 weeks with either
(a) medication (b) psychotherapy or (c) both. Among the 519 subjects
who completed the study, the rates of positive outcome (remission
or satisfactory response) were 55% in the medicated group, 52% in
the psychotherapy group, and 73% in the combined treatment group.
These impressive statistics indicate that a combination of medication
and psychotherapy is far more effective than medication alone in treating
chronic major depressive disorder (N Engl J Med 2000;342:1462-70.).
Although medications promise rapid relief and provide a "floor," preventing
what can feel like a frightening emotional free-fall for distressed
individuals, psychotropic drugs can only relieve symptoms. The self
is unchanged, and the underlying conditions and psychological processes
that led to the emotional distress are still part of the personality
structure. If it were simply a matter of correcting chemical imbalances,
we would expect the results of the May 2000 study to show no significant
difference between Group A (the group receiving medication only) and
Group C (the group receiving both medication and psychotherapy). Instead,
the addition of psychotherapy produced significantly better results.
The current stream of scientific research goes even further than the
results published in the New England Journal of Medicine. We now know
that the human brain contains mechanisms that allow our neuronal connections
to shift and change. This "rewirability," basic to all learning -
including learning in psychotherapy - allows us to unlearn maladaptive
thought/behavior patterns and develop new associations and connections
that lead to emotional well-being, ultimately eliminating the need
for medication.
If you are currently on anti-depressant or anti-anxiety medication,
you might want to reflect on your characteristic defenses: withdrawal
and isolation, persistent irritability, helplessness (feeling victimized
by life), hopelessness (resignation), intellectualization (philosophizing
to avoid feelings), rationalization, avoidance, denial, procrastination,
or projection - to name a few. These defenses, most of which operate
out of conscious awareness, become the problem. They create a wall
around our ingrained maladaptive patterns and so prevent in-depth
examination and resolution.
Without a psychotherapist's challenge to the wall of defense and resistance,
one may be left with debilitating anxiety or depression that is only
masked - not resolved - by medication.
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