Should Medication be Part of Therapy for Depression or Anxiety?

I’m frequently asked by clients who are feeling depressed and anxious if they should take medication. Sometimes they have been prescribed medication prior to coming to see me and their feelings of depression and anxiety are only slightly improved, unchanged, and occasionally worse. Except in situations where there are more severe symptoms such as loss of appetite and sleep disturbance, the research literature does not show clear and consistent benefits of medication.

Roger P. Greenberg, Ph.D.,  writing in The National Register of Health Service Psychologists Register Report  (“The Return of Psychosocial Relevance in a Biochemical Age”2014) points out that in fact,  an analysis of outcome research on antidepressant medication indicates that “… the benefits of antidepressants for most patients do not significantly exceed the benefits that they might receive from placebo treatments.” Despite this, antidepressants are among the top ten drugs prescribed in the US. Insurance companies support medications because they are cheaper in the short term than psychotherapy. Most research strongly indicates that psychological treatment, whether or not medication is also taken, does result in improvement. This improvement is also much less likely to be subject to relapse after treatment ends,  as opposed to when medication is the only treatment.

All this being said, I believe people should have the choice of treatment they prefer. When clients ask about medication, I make several suggestions to them:

  1.  Discuss with your prescribing physician what target symptoms the medication is being prescribed for.  What specific symptoms should improve?  How do you know if it is working?
  2. In discussing potential benefits, it is also important to discuss common side-effects of the medication. Mild memory and concentration difficulties, “feeling foggy”, sexual problems, sleep problems and “weird” dreams are among frequently reported side-effects. There may be other contraindications based on your particular medical history.  You should weigh potential benefits against potential risks.
  3.  Also it is important to discuss with the prescribing physician what symptoms  might occur if the medication is taken irregularly or abruptly discontinued.
  4. There should be a plan to safely discontinue the drug if it is either not helpful or if side-effects are producing more stress and discomfort than help.

When properly prescribed and monitored, medication can be beneficial, especially when symptoms are substantially interfering with one’s daily life, relationships, and functioning. In this context, they may even enhance one’s capacity to more rapidly benefit from psychotherapy. I would encourage clients to make an informed decision by talking with your physician and therapist and continuing to ask questions regarding your experience with medication throughout treatment.