Just more than a generation ago, the typical tandem of medication therapy and psychotherapy and other forms of counseling seemed unattainable. Psychiatry was opposed by political and ideological struggles between biologic psychiatry and psychoanalysis, particularly in the United States. Psychoanalysts from the said country were inclined to consider psychopharmacology as a mediocre therapy that covered over issues instead of tackling them head-on. They agreed that indications inhibited by medications would gradually be substituted by others that are similarly debilitating.
In turn, advocates of biologic psychiatry frequently see psychoanalysis as a type of trickery that was an expensive waste of time at best and increased suffering that psychopharmacologists were attempting to improve.
Pros Of Combined Counseling and Medication Therapy
Ever since, several studies have found combined therapy for depression to have a lot of pros compared to single-modality therapy. This applies to psychodynamic therapy and interpersonal therapies, which is a manual descendent of psychodynamic therapy. The indications were not very clear for cognitive behavioral therapy, with numerous previous studies revealing only insignificant tendencies towards an advantage of combined therapies. It seems, however, that this might suggest restrictions in study designs common of that period. Some studies have also shown a benefit to using pharmacotherapy and cognitive behavioral therapy.
So does this indicate that every patient manifesting with depression must be encouraged to have psychotherapy in conjunction with medications? In a typical world with limitless resources, this could be possible. Conversely, considerations must be made about the cost/benefit ratio. Although combined therapies are more effective compared to stand-alone treatments, the effects are largely unassertive. Statistically substantial disparities might not be clinically relevant. With the extra tension and stress of giving combined treatments on inadequate mental health services, it might be more advantageous to offer medication therapy and counseling and other forms of psychotherapies to individuals who have a higher likelihood of showing significant outcomes.
Patients Who Respond Better To Combined Therapy
Though evidence on combined therapy is still quite small, some guidance has been seen regarding which individuals with depression have a higher likelihood of gaining remarkable benefits. Patients with major depression, dysfunctional cognitions, and chronic depression all present more clinically significant and strong responses to medications combined with psychotherapy.
An insufficient reaction to single-modality therapy is another reason to take into account combine therapy. Individuals with depression that does not respond well to antidepressants alone present an increased response when the treatment is combined with psychotherapy. In addition, those who do not respond to psychotherapy gain extra benefits when complemented with antidepressants.
It is important to note that these classifications of patients usually get therapy from psychiatrists. With more and more antidepressants being prescribed by medical professionals who are not psychiatrists, the psychiatrists usually see patients with more chronic, major, and therapy-resistant illnesses and those with treatments convoluted by maladaptive personality types and unusual behaviors.
What Makes It Better?
Experts have yet to know more about the superiority of combined therapy. Some benefits may ensue merely from additive effects. Every therapy is effective in itself. Hence, complementing the efficacy of each offers a collective impact. There could also be collaborative effects that have led to the superior effectiveness of combined therapy. For instance, pharmacotherapy might make more individuals more accessible for therapy by alleviating treatment-intrusive issues like debilitating anxiety, depression, and psychosis.
Current evidence implies that there could also be other more directly biological effects. Among the neurobiological effects of antidepressants is apparently increased neural turnover, with trimming of dendritic synapses and increasing sprouting. This interesting research indicates that antidepressants might make for increased plastic neural channels, which could, in turn, permit for more fast learning, like in psychotherapy.
Psychotherapy and other forms of counseling could also improve the efficacy of medication therapy. One method where this may happen is by enhanced compliance. Numerous studies have established that patients receiving psychotherapy and medications have a reduced amount of medication treatment cessation. Simultaneous therapy could also enhance the therapeutic alliance and augment patient approval with treatment.
The therapeutic union, in turn, does have a profound impact on the effectiveness of antidepressants. Furthermore, the psychosomatically anxious patient vulnerable to negative medication responses could gain attention to psychological backgrounds or somatic responses.
Combined therapy has been proven to be more efficient than single-modality therapies and adequately more effective for specific types of patients. Still, more research needs to be performed to confirm whether or not there are other categories of patients suffering from depression who would gain from combined therapy.
There is ultimately a lot more to learn about particular factors, such as treatment combination, that may lead to increased therapy effectiveness or combined therapy.