Psychotherapy vs. Psychopharmacology

Many patients seek medication for emotional discomfort, difficulty concentration, sleep disturbance, and somatic or physical manifestations of emotional discomfort. There is a tendency in our culture to treat illness with a pill—which drives this inclination, along with the continued stigma of being labeled with a mental illness—despite that so many people are on anti-depressants and anti-anxiety medications that their use is now “normal” to most people. Somehow being medicated for an emotional disturbance is not as stigmatizing as being in therapy for one. Additionally, there is a perspective that taking pills is easier (and cheaper) than seeking psychotherapy treatment. However, research on the effectiveness of psychotropic medication and psychotherapy show that many of these patients are doing themselves a disservice in this approach.

Overall, in early research the effectiveness of treatment of emotional disturbance (such as anxiety or depression) was shown to be roughly equal between psychotropic medication alone and psychotherapy alone for most common mental disorders. While there is a fair amount of research that has shown that combined therapy (medicine and talk therapy) is the most effective, more recent research has been suggesting that psychotherapy alone is as effective as combined therapy in the long run. Similarly, more recent research (focusing on long-term effectiveness, rather than immediate effectiveness) has shown that psychotherapy is more effective than medication with regard to long-term benefits. It turns out psychotherapy is advantageous compared to medicine in a number of ways.

Cumulatively, the research suggests that psychotherapy offers more long lasting benefits than medicine. Psychotherapy is actually shorter term. Even if one is in therapy for a number of years, people who begin antidepressants and anti-anxiety medication (without the additional benefit of psychotherapy) frequently end up on those medications for life—on account of the high relapse rates for medication alone. Ironically, studies have shown that across a lifetime, the cost of medication tends to exceed the cost of psychotherapy. Psychotherapy tends to be higher initial cost, but typically clients achieve a level of functioning that makes treatment unnecessary and the cost stops.

Psychotherapy additionally is safer. There are many dangerous drug interactions between psychotropic medicines and other medicines, while psychotherapy does not interact chemically with any medicines. Psychotherapy has few side effects—some initial increased emotional discomfort is common, but loss of sexual performance due to psychotherapy is extremely rare, for example. Likewise, sleeping disruption seems to be temporary and psychotherapy is not associated with unwanted weight gain—psychopharmacology cannot make those claims.

Ideal treatment for many emotional disturbances appears to be co-joint treatment with medication and therapy initially, with patients gradually reducing and terminating their medication as progress in psychotherapy provides symptom relief such that symptoms become tolerable in the absence of medication. However, there are some disorders, such as schizophrenia, ADHD, bipolar disorder, and dysthymia (chronic depression), for which psychotherapy is not as effective medicine. But even in these cases, there is also strong evidence that psychotherapy administered along with psychopharmacology is more effective than medication alone in treating these more severe mental disorders.
Of course, the downside is that psychotherapy is more work and requires actually looking at one’s pain (and sometimes the source of it), rather than covering it over. Psychotherapy functions with a goal of symptom removal, whereas medication frequently has the effect of symptom mediation. Of course, harder work also equals more meaningful reward though.