Over the years in which I have attempted to find the right treatment for my mental health issues, an abundance of obstacles have stood in my way. Like many others I have been met with extensive waiting lists for therapy, trying different types of medication without much success and a whole host of general mishaps and problems. In my mind, it was these impediments that were preventing me from becoming the person I knew I could be. If only I could find the right treatment for my issues, I could then somehow learn how to live with my mental illness in a less self-destructive manner!
This is an important distinction to make – I was looking for a way in which to manage my symptoms as opposed to ‘curing’ them. The latter was a prospect that I realised was a flirtation with fantasy rather than a realistic goal once I reached the early stage of adulthood. Finally after about six years of searching and trying out different forms of help, from counselling to therapy to medication to self help techniques, I have found what works for me. Yet many people out there are still struggling to find what treatment works best for them. I hope that the information provided below is some use and that a better way of life is possible…
It goes without saying that there have been numerous studies carried out researching the effectiveness of therapy and medication-based treatment. So, before delving into the heart of this entry, it would be prudent to establish some basic premises and share some general information about the subject at hand.
When I refer to medication in this article, I primarily am referring to antidepressants (ADM). That is, a class of drugs that are generally designed to provide symptom relief from depressive disorders and when the ideal outcome is defined as a noticeable improvement of a patients state of mind. In the case of therapy, I am generally referring to cognitive therapy (CT), which is the most well-known and widely implemented of cognitive behavioural interventions. CT is based on the premise that inaccurate beliefs and flawed information processing help only to fuel someone’s anxious and depressive issues. As such, the ideal outcome is for this distorted way of thinking to be corrected and the symptoms of said patient’s mental illness to go into remission.
However, along with the underlying biological components of the human brain and some degree of scientific consensus on the use of medication and/or therapy, there is an even greater factor at hand that cannot and should not be underestimated – your freedom of choice. As an individual you have much power to decide how exactly you want your mental health to be treated and this is something that can be instrumental in attaining a greater quality of life!
So without further ado, let’s delve into the more intricate details of both these types of treatment for mental health problems and see exactly where each one stands in terms of their advantages and disadvantages as forms of treatment.
There are many benefits for opting to take medication over pursuing therapy, and going by the available statistics, it is certainly the most popular method! According to Psychology Today, the vast majority of people seeking treatment for depression and anxiety disorders prefer pharmacological to psychological interventions by a ratio of 3 to 1!
This would make sense considering that not only is medication much more accessible, but it also requires far less time investment and cognitive effort in order to be useful. It is also worth considering that the stigma regarding mental health issues may also play a role here; while progress is being made in eradicating outdated societal attitudes, many people are simply uncomfortable or unwilling to talk about their emotions with a complete stranger. Understandably the option to take pills which can help improve their quality of life (even if only by a small amount) might seem like a more attractive option.
‘It really does have to be a process of trial and error… because there’s no predicting people’s response to [antidepressants]’
Nancy Metcalf, a Consumer Reports senior editor and author of the survey
Nonetheless, the usefulness of treatment via antidepressants has been established in literally thousands of placebo-controlled clinical trials. In fact according to one of these studies, approximately one-half of all patients will respond to any given ADM irrespective of its class, and many of the other half will respond to another ADM or to a combination of ADMs. This lends credit to the theory that, at least in the short term, medication can have a positive mental impact on somebody’s life and subsequently diminish their need or desire to participate in therapy.
However, while medication may provide some temporary relief from the symptoms of depression and anxiety, there are some very important drawbacks to consider. Firstly, while they may be easily attainable, this is does not mean that they will be effectual in every person! In fact, it is quite common for many people to go through several different types of ADMs (as was the case with my experience) before they find one which works for them. Even then, there are a whole host of side effects to consider when you make the decision to begin a course of ADMs, many of which can be quite difficult to adjust to!
Secondly, keep in mind that medication never has been, and likely never will be a permanent ‘cure’ to your mental health problems; in this way ADMs seem to be symptom-suppressive rather than curative. Furthermore, no published findings to date suggest that ADMs reduce future risk of depressive episodes once their use is terminated! Essentially this means is that you need to ask yourself a series of important questions before choosing to begin a course of ADMs:
Why am I choosing to take antidepressants? How long do I intend to take them for? Am I okay with the possibility of being on medication for the foreseeable future?
Of course, these questions may be tricky to answer in some ways, and damn near impossible in others. Yet it is always worth keeping in mind, seeing as terminating the use of prescribed medication early (or even worse, without a doctor’s prior consent!) can have catastrophic results on your state of mind.
There is also the financial side of things to consider – while some people who suffer with poor mental health have the resources to pursue whatever avenue they wish in order to try and get better, the options can be more limited for those who are not as fortunate in their economic status. In this case, prioritising your list of concerns and weighing up the available options is certainly worth considering!
Arguably the most beneficial advantage that partaking in therapy has over using medication is its more proactive and self-reflective approach towards your mental distress. This is because it not only encourages you to identify the thoughts and images that accompany your negative thoughts, but it stresses the importance in dissecting those thoughts – this is to see if there is any real evidence behind them. If there is none (which there often is not) you can then begin to see things from an alternative, healthier perspective.
‘Therapy is a commitment of time and money, and it’s not a quick fix […] but the rewards are great. Getting to understand yourself and learning to experience the range of one’s emotions helps to create more options in your life’
Jayne Bloch, a certified psychoanalyst in private practice in New York City
This is almost unsurprising, seeing as it not only does CT enable you to learn the life skills necessary for managing inappropriate emotions, it also counters negative thought patterns and allows for the possibility of forging closer, more productive relationships between yourself and others. This is something that medication, for all of its positive benefits, is unable to give you. As a result, there is the increased likelihood of avoiding a relapse when undertaking therapy sessions!
The second benefit of therapy is that it often costs less than medication for two reasons. The first is that therapy with a psychologist is sometimes covered by insurance reducing the cost. The second reason is that therapy often costs less in the long-term because treatment takes less time. If on the other hand you are trying different kinds of medication in an effort to deal with your symptoms, it can take a while to say the least!
However, as insightful as engaging in CT can be, it can also be a double-edged sword, seeing as many managed care programs limit mental health treatment to 10 to 12 sessions. While this may be sufficient for those whose symptoms are mild enough not to require further assistance after their allotted time is up, it may deprive people whose symptoms are more severe of the treatment and help that they so desperately need.
Furthermore, the waiting lists for psychological treatments such as CT have a tendency to be lengthy to say the least, and for some people this can prove to be just too much of a price to pay. This would explain the surge in numbers of those people who have attempted suicide while on the waiting list for therapeutic treatment!
There is also the chance that no matter how much you try to engage with therapy and control the irrational thoughts and impulses that accompany anxiety and depressive disorders, alone it might not be enough! This is where you may need to consider a number of factors:
Are you truly attempting to engage with the therapy? If so, have you considered that perhaps it is simply the wrong kind of therapy for you? Do you find yourself not building a rapport or sense of trust between you and the therapist that you have come to expect at this point?
It could be any, or even all of these factors that are preventing you from getting something useful out of these sessions, and it is likely you’ll need to re-evaluate exactly what your next move should be!
So which is better?
As you may expect, the answer to this question is far from clear cut. Yet there are certainly some points to bring to light before you come to a decision about whether to try one of these treatments over the other.
Firstly, there seems to be a consensus amongst psychological literature surrounding the effectiveness of partaking in both a course of ADMs and CT at the same time. For instance, it is generally accepted that in the short term, both forms of treatment provide roughly equivalent benefits in terms of their therapeutic value. They both also have approxiamately the same effectiveness with 30 to 40 percent remission rates when each treatment is used alone.
Secondly, many of these studies used MRI scans to analyse the brains of those who engaged in either a course of therapy or medication, so as to gauge how a participant’s brain structure changes over time (12 weeks in this case) in response to treatment. The general result of this practise was that functional connectivity between the brain regions was found to play a substantial role in the outcome of these studies. More specifically, people who displayed more connectivity between the brain regions had an increased likelihood of having success with therapy. In comparison, those with negative or absent connectivity were more likely to respond to treatment based around medication over the same time period.
‘What comes through overall – there are many routes to good care, but it takes flexibility and persistence to get there […]the more committed to your own care, the better off you’ll be’
Nancy Metcalf, a Consumer Reports senior editor and author of the survey.
However, beyond the scientific jargon and biological components involved with testing the utility of therapy and medication, who you are as an individual and what you want out of one or both of these treatments is equally as important!
First of all, think about your own circumstances. It goes without saying that when dealing with mental health problems there is no one-size-fits-all solution. So in this light things must be decided on a case by case basis, whereby you and your doctor can agree on the best course of action for your welfare. I would also urge you to take time to reflect on your own personal qualities and your past experiences. Specifically try and think about your strengths and weaknesses and how they may either enhance or impede your chances of getting the right form of care for you.
Are you at a stage of absolute crisis in your life? Is enduring every moment of every passing day a drain on your sense of self-worth and character? Perhaps you have even indulged in suicidal thoughts or acts of self harm? If any of this seems reminiscent of your mindset at this moment in time, I would urge you to consider the possibility of going on medication, even if only to offset these negative and emotionally turbulent thoughts for the meantime.
Alternatively, you may be at a stage in your life where you feel able enough to sacrifice your chances of happiness in the short term in return for contentment further down the road. In which case, therapy might just be the best route for you to down. However, if your mental distress is painful enough that the idea of having to wait for this treatment seems unbearable, perhaps trying medication (at least in the short term) would be the best solution also.
‘I see many people in my practice who would not have sought out therapy had not their doctor recommended it as a first line of treatment. The exception is with severe cases, sometimes medication and therapy in conjunction is best. But again, I think medication alone is a disservice’
Shannon Kolakowski, a psychologist and author of the book When ‘Depression Hurts Your Relationship’
It also may not be unreasonable to assume that combining both therapy and medication could be in your best interests. Of course, you would have to liaise with your doctor about this, but as there is plentiful of evidence to suggest that for many people, receiving both of these treatments can be highly effective, it is unlikely such an approach would be discouraged.
It is also worth putting in your own research in regards to what else is out there if you remain unsatisfied with your doctor’s handling of your situation. If have even an inkling of doubt about their recommendations then make sure you do not settle for a prescription or some vague promise of treatment further down the line. Ensure that not only are you given the full range of options for your problem, but more importantly go into that room prepared, with your research complete and with an idea of what you want from your appointment.
On the other hand, also be willing to be flexible about the forms of treatment available and contemplate the possibility that your preference may not be right for you . Intriguingly, going by the results of the study mentioned above, patients treated with their non–preferred approach seemed to fare equally as well as those treated with their preferred approach. However, the same study also concludes that people treated with their preferred approach were more likely to complete treatment, so perhaps someone’s choice in treatment is not to be undervalued after all! After all, dropping out of a course of medication and/or therapy could potentially do more harm than good in the long run!
Thus while there are several complexities surrounding this issue in regards to biological differences, access to treatments and your own personal circumstances, what you can do about it is actually quite simple. All in all the most important thing is that you feel empowered with both the necessary knowledge and degree of inner confidence to ensure you get the treatment you deserve! It’s easier said than done, but can’t this be said for anything worth fighting for in this life?
Did you know?
Professor Aaron T. Beck developed Cognitive Therapy for depression back in the 1960s. By 1979 he and his colleagues had codified the treatment in a detailed manual.
In 1995, less than half of people getting mental health treatment — 40% — got drug therapy. Now 68% get drug treatment, and 80% of those treated for depression or anxiety get drug treatment.
As of 2016, the American College of Physicians recommended that for insomnia, cognitive behavior therapy should be the first line of treatment, rather than medication, since it has better scientific evidence behind it.
In one study, researchers proposed that the history of trauma in early life is linked with the shrinking of the hippocampus, the region of the brain critical to memory and learning. Those who are depressed with a smaller hippocampus may show improvement with talk therapy because it involves active learning. Antidepressants cannot achieve this effect.
Antidepressants and anti-anxiety medications are among the leading prescription drugs not only in the US but around the world!
Almost all (95%) of the federal dollars spent on mental health research go to drugs, not psychotherapy, in clinical trials.
Treatment from primary care doctors was effective for people with mild problems, but less so for people with more severe ones. Treatment by mental health specialists yielded significantly better results for people who started out in poor shape.
What are your thoughts on this debate? Have you attempted to seek out help for your mental health issues via therapy and/or medication? If so, which one did you find more successful and why? Let me know of your thoughts in the comment section below!
Note: I am not a medical professional. Nor do I have any experience or training in this field. The above article is the result of my own research and informed opinion, so please ensure that you are thorough with your own inquiries before deciding on what kind of treatment to pursue!
Emotional support helplines:
Samaritans :116 123
Rethink Mental Illness advice line 0300 5000 927 (Monday to Friday 09:30-16:00; local rate)
Sane Line:0845 767 8000
Mind also has a useful guide of support and services, which can be found by clicking the link right here