(P) Medication or psychotherapy?

by Dr. Emilian Voiculescu – Psychiatrist and Psychotherapist Since the beginning of my practice, both as a psychotherapist and as a psychiatrist I have come in contact with a lot of myths about drugs and psychotherapy. On the one hand I met people who were totally against drugs. Drugs were seen as the result of a reptilian-corporate conspiracy to make people addicted, to turn them into vegetables, without having a real effectiveness. On the other hand I met the diametrically opposed version, kind of a technical , that only pills are scientifically proven to be effective, while psychotherapy is nothing but empty words. I would like to briefly clarify these two myths. Imagine that we have a computer which started to operate slowly or produce errors. We have two possible causes and two possible solutions. The causes could be either a physical defect to the CPU or other components or problems with the software on which the computer runs. Given the two possible causes we have two possible solutions. The first would be to increase the operating frequency of the processor, making it run faster (the equivalent of drugs). The second would imply interfering with the software and identify potential errors at this level. Unfortunately, in medicine things are not so clear, in the sense that in almost any disorder we see changes in brain functioning and mutually – in any brain damage we see a "soft" disorder. Yet, what do we know? We know that in certain mental disorders psychotherapy works at least as well as medication. We know, for example, that in depression and anxiety psychotherapy produces visible changes in terms of neuroimaging of the same intensity and in the same brain areas like medication does. We know there are certain mental disorders (especially those that involve a loss of contact with reality) for which medication is essential, as psychotherapy alone does not bring enough benefits. We know that the combination of the two methods is often much more effective than either method taken separately. Most psychiatric medication does not result in addiction. Even those drugs that may cause addiction, if used correctly, are highly secure. So, how do we choose the form of treatment? First, the form of treatment must be chosen in collaboration with the patient and following an accurate briefing on the costs and benefits. So, let us see the benefits and disadvantages of each treatment modality. Medication advantages:

• low cost on the short term
• the effect occurs rapidly (2-4 weeks in most cases)
• the patient’s only task is to take their medicine

Medication disadvantages:

• it only works as long as it is taken
• does not prevent the problem from recurring after treatment discontinuation