Medication and Therapy—When Are Both Appropriate?

Let’s face it: Starting therapy can be a scary process. It takes a great deal of courage when you realize that things just aren’t right—and aren’t getting any better—to pick up the phone and call someone for help. Add to that the event of walking into a perfect stranger’s office for the first time and being comfortable enough to unload. Establishing rapport between you and your therapist can take several sessions, and getting to the point where you’re really comfortable with telling him or her all about your life, plus what your deepest fears and insecurities are, takes time—and a lot of trust.

Having established that rapport, though, you may find that things between you and your therapist are going swimmingly and that you’re systematically working your way through your issues. But—what happens when one of your issues is something like ongoing depression, anxiety, ADHD, OCD, or something similar, and therapy alone is just not taking care of everything you thought it would?

In cases like this, sometimes it can be necessary to add medication to help with these issues so you can really start to feel better and get everything you need out of the therapeutic process. Don’t get me wrong, here. Not everybody needs to be taking a psychotropic drug. Not by far! But, in cases where one or more of your issues have been ongoing for several months (or longer), it is a distinct possibility that some of this can be due to organic issues within the brain and that starting on some type of medication will do what it takes to help you feel better. There are countless studies in the research literature that have included people with one or more mental health diagnoses and have asked the question: “Which works best? Therapy by itself or medication by itself or both?” In the vast majority of cases, where it is true that people have had ongoing issues with a diagnosis such as depression, anxiety, or ADHD, the answer to that question has been a resounding “BOTH.”

This is not to say that everyone who walks through our doors needs assistance in the form of pharmaceuticals. That’s far from true. For many people, the simple act of participating in therapy for several months or even a couple of years is more than enough to help them deal with their problems in a healthy way and resolve their issues. For some folks, though, this just isn’t the case. This can be especially true in cases where close family members have suffered with the same diagnoses or the prominent issue at hand has been going on for months and months—or sometimes years. In cases like this, adding a medication may well be the key to someone “getting over the hump” and really beginning to feel better and cope better with the things going on around them.

A common argument that therapists hear often is, “I don’t want to have to take any medicine” or “I don’t want to get on something that’s going to change my personality” or even “I don’t want to be on meds for the rest of my life.” My first response to this is to ask the patient, “If you were diabetic and needed insulin, would you refuse that?” In most cases the answer to this question is a resounding NO. But that’s different—or is it?

Our brain is designed to do many wonderful things, but in order to do all that it needs to do efficiently, its special chemicals, called neurotransmitters, have to be able to make the rounds inside of our brains and get where they need to go efficiently. In cases where someone is suffering from long-term depression, anxiety, OCD, ADHD, and the like, the neurotransmitters are NOT making the rounds and getting where they need to go. Sometimes this can be caused by one or more traumatic events, or sometimes the chemicals in the brain just don’t function as well as they should, and in cases like this, medicine which assists these neurotransmitters to do the job they’re designed to do becomes necessary.

That’s all that the majority of psychotropic medication does, and when we are able to find one (with the help of a psychiatrist or a psychiatric physician’s assistant or a psychiatric nurse practitioner), we find that within a few weeks, we really do feel a lot better—and more like “ourselves” versus someone else with a different personality. And for many of us, taking medicine for 6 months to a year or two is all that we need; for others, it can mean a lifetime of commitment. It just depends on who you are and how severe your symptoms are. And again, family history can play a big role in this, as well.

When I refer patients to someone who can assess them and help with prescribing an appropriate type of psychotropic medication, I always tell the patient not to be scared—that this is no different than going to the doctor to get medicine for high blood pressure, diabetes, or high cholesterol. The main difference here is that this type of medication is to help the brain to do what it was designed to do—regulate our thoughts, moods, and emotions. And, not surprisingly, most of my patients who do start on a certain type of medicine see astounding results. I often hear things such as, “The constant dialogue in my head has finally stopped!” or “I’m not sad all the time these days” or “I just don’t feel anxious all the time like I used to.”

As therapists, our goal is to help you to feel better, feel more in charge of your life and the decisions you make, and find healthy ways to cope with your problems. Trust me when I say that none of us starts treatment with a patient with the idea of getting him or her on some sort of medication. However, if needed, most of us certainly don’t hesitate to bring it up with our patients or recommend that they see someone who can better assess them and make that judgment call better than we can. It’s all part of continuity of care and the idea of beneficence—that we should be doing our very best for the patients we see.

So, as someone in therapy, you may be a candidate for the extra “boost” that certain medication can provide, or you may not be. Don’t be afraid to speak candidly about your thoughts and fears about this if your therapist happens to bring up the subject. Do your homework, but don’t play “Dr. Google.” Whatever you read online on the subject, make sure it is from peer-reviewed research articles and not sites such as drug company websites or dot com websites. The best and most unbiased information can be found in professional journals, not on random websites or in pop psychology magazines.

In conclusion, I would urge you to trust your therapist. They have years of experience with seeing patients with symptoms just like yours, treating patients with these symptoms, and knowing when therapy alone isn’t quite enough to resolve someone’s symptoms and issues. They don’t take lightly to recommending that a patient see a professional to discuss the possibility of medication, and they truly want what is best for you and want you to feel as good as possible from the therapeutic experience.

Laura E. Gray, LPC, NCC, PhD