David Godot, Psy.D.

Psychotherapy vs. Medication Management

Rose writes:

Can I get treated for depression? I’ve just been prescribed new antidepressants and sedatives and I’m really frightened but feel I have no alternative as I can’t function normally.

 

Thanks for writing in, Rose. Your question touches on an issue that has stirred up a great deal of controversy over the last hundred years: the “talking cure,” as Freud called psychotherapy, versus pharmacological intervention. Personally, I think that both can be very useful if applied appropriately.

It sounds like you’re struggling with feelings of both depression and anxiety, and have a lot of ambivalence about whether you should seek help with those feelings. So the first thing I’d like to put out there is that everyone is entitled to feel okay. There is no reason why anyone should have to go through their life feeling sad or fearful. Life is for enjoying. Few people would think twice about seeing a doctor for physical pain, but emotional pain has a stigma attached to it in our culture. People tend to feel guilty or inadequate when they find themselves suffering from depression and anxiety.

The problem is that we’re assuming that we somehow have control over the way we feel emotionally. So then when we feel bad we act as though it were our fault, or as though we deserve it. The fact is, the average person has no greater level of control over their cognitive or emotional functioning than they have over their autonomic or endocrine functioning. Neurologically, your thoughts, feelings, and even your actions originate outside of your awareness.

The good news is that human consciousness is extremely flexible, and you can use that to your advantage. You can learn to gain awareness of things that were previously very deeply unconscious, and you can also learn to change the way that those unconscious processes work. Psychologists can use techniques like biofeedback to teach you to control involuntary physiological functions like heart rate, blood pressure, and circulation. Techniques like neurofeedback can teach you to exert direct control over otherwise involuntary neurological functions. And psychotherapy can teach you how to understand and control your emotional life. None of these are things you will probably ever be able to do without special training. Psychologists are people whose job it is to scientifically investigate and implement ways of training people to accomplish feats that are essentially comparable to yoga.

The problem I have with using medications to manage things like depression and anxiety are that the medications teach you nothing. They chemically alter the way that your brain processes your experience, but the experience itself remains largely the same. Please don’t get me wrong on this, a lot of people genuinely benefit from taking psychiatric medication, and if they have been prescribed to you then you should probably either take them as prescribed or seek a second opinion. Especially if you feel you’re not able to function normally.

However, some very good research has shown that people who receive psychotherapy in addition to medication tend to achieve much better long-term results than people who just take the meds. To me, this is completely unsurprising. I believe that people feel things for good reasons, that all of our thoughts and actions serve a purpose for us. You can suppress or modify the biological mechanics of what’s going on with drugs, but it won’t do anything about the underlying psychological reasons for what you’re experiencing. So, what happens a lot of the time is that people will either feel fine until they go off their meds, or do well on new antidepressants until they start developing other types of psychological symptoms.

In my opinion, anyone who is suffering with uncontrollable thoughts or feelings should absolutely find a psychotherapist and commit to treatment. The value of psychiatric medications is that they can alleviate your symptoms in the short term, so that you’re able to regain a higher level of functionality while you address the real, underlying issues in therapy. And, to answer your question, psychotherapy is a very effective treatment for both depression and anxiety. Just be sure that you follow the guidelines in the article I linked to above about selecting a therapist who you can trust in and identify with enough to develop a good working alliance.