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 the best 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.
1. Horowitz, Mardi Jon; Lanham, MD. Stress Response Syndromes: PTSD, Grief, and Adjustment
Disorders (3rd ed.)Jason Aronson, USA: 1997
2. Depression and Bipolar Support Alliance website