Therapy Alone or Therapy Plus Medication?

Therapy Alone or Therapy Plus Medication?


Psychiatric screening for an imbalance of brain chemistry should take place only if the patient and the therapist agree that medication should be considered.


Most mental health clinicians, whatever their background, believe in a Biopsychosocial Model. Specifically, we are taught to try and put together many different factors (life stresses, coping styles, family and community systems and brain chemistry) into an understanding of why a person is emotionally uncomfortable. The goal is to understand where and why “it hurts” in order to alleviate that discomfort.

A significant percentage of patients can have biological imbalances in brain chemistry that can make their emotional problems - and their therapy - even more of an uphill effort. These disorders of brain chemistry, usually “mood disorders”, often do not “fit the mold” described in the textbooks - and are frequently subtle and not readily detectable. In many cases, neither the person suffering with an imbalance of brain chemistry, nor their family, are even aware that they have a problem. It may, therefore, be of great benefit to consider a screening consultation with a psychiatrist, particularly one skilled in detecting subtle mood disorders.
This is not really different than a primary care doc (whose job is assessing the person as a whole) noting a problem with vision and making a referral to the eye doctor. The question that the primary clinician is asking of the ophthalmologist is: “Are the patient’s eyes and vision normal?”. It may be “putting the cart before the horse” if the patient does not accept the referral because of their feelings about possibly wearing glasses.
I believe one of the first determinations in people having common symptoms of mood problems (including nervousness, excessive worry, anger issues, trouble concentrating, sleep disturbances, depressed mood, etc.) should be: “In addition to any characterological, family and life issues, is there a co-existing, diagnosable biological disorder present - or not?”
If not, then medication intervention is usually inappropriate. However, if there is evidence of a diagnosable disorder of brain chemistry, then the psychiatric consultation can serve to enable an informed discussion between the therapist and the patient about the patient’s feelings about the diagnosis, the likely prognosis and possible medication treatments available to complement the ongoing therapy.
If we only entertain the possibility of a disorder of brain chemistry after the patient has been in therapy for a time, we may not be availing the patient (and the patient-therapist collaboration) of the most effective combination of treatments to alleviate suffering.


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