A common question that patients therapy ask is “do you think I should consider medication?”. My answer is usually an unsatisfying “it’s hard to know”.
In this meta-analysis (a type of research that combines the results of multiple studies) from 2013 comparing the effectiveness of psychotherapy and medication in the treatment of depressive and anxiety disorders, there really wasn’t a difference in the effectiveness of psychotherapy versus medication for most disorders. Medication was more effective for dysthymia (a kind of long standing low-level depression) while psychotherapy was more effective in treating OCD.
Research is important when evaluating treatment alternatives. But a word of caution about research: Trials for medications usually rule out patients with multiple issues. In “the wild” one almost never encounters a “pure” diagnosable disorder. For many people, depression is mixed with anxiety alongside issues in relationships, a lack of direction in life, or troubling symptoms that linger from a traumatic event years ago.
Consider a metaphor. Imagine that you break your arm. The pain is pretty bad and only gets worse the longer it goes unattended. You make an appointment with your PCP. She examines you and then prescribes an opiate pain medication. She explains how the medication will bind to opioid receptors in the brain and reduce your perception of pain. The explanation makes sense and you quickly feel better. However, you still have a broken bone and as it heals incorrectly, other problems and pains will develop.
An opiate may very well be appropriate in this scenario, but unless the cause of the pain is addressed and attended to, the medication is only masking the real issue. In many instances the same can be said of medications for depression and anxiety.
If crippling fears of humiliating oneself in front of others are leading to social anxiety, medication can help calm anxiety, but therapy may be able to help you examine the origins of these thoughts and fears and find ways to move past them.
Your depression may stem from an intense loneliness and a feeling that nothing in life has worked out the way you thought it should. An SSRI may ease the symptoms, but may not help you examine how you got to this point in your life and what you may do to change it. In some situations, psychotherapy together with medication can be helpful.
Depression and anxiety are human experiences often mixed up with existential fears and the problems inherent to the human condition. Change is difficult, sometimes slow, and often comes in ways one doesn’t expect. There are many ways to feel better. But beware of any treatment, therapy or medication, that claims to be a quick and easy solution to issues we’ve wrestled with since the beginning of human existence.