Psychotherapy or medication? The question cannot be answered in general and is actually wrong. Because often the right treatment for psychological problems is not one or the other, but the intelligent combination of both.
Is it worth waiting a long time for an appointment with a psychotherapist? This depends above all on the type and severity of the mental disorder. Current studies show: Sometimes talking is gold, sometimes psychotropic drugs can be the better alternative. Often the combination of psychotherapy and drug therapy promises the best help.
“In the end, psychotherapeutic treatment and a drug have a similar effect on the brain,” explains our seasoned specialist. “In both cases, the brain is neurobiologically altered, either by chemistry or by interaction with the therapist. The only difference is the access route – and the effort: “To swallow a pill takes much less time than to make a weekly appointment with a psychotherapist.
Medicines prepare the ground
According to the expert, whether pills or conversation are the remedy of choice depends on many factors: “Different clinical pictures respond differently to psychotherapy or medication”. And psychotropic drugs that calm, such as benzodiazepines, often reduce tension and insomnia in acute phases. These drugs prepare the ground for further psychotherapeutic measures. According to the expert, another criterion is the severity of the disease. “Roughly speaking, the more severe the disease, the more likely it is to be treated with medication. And often the combination of medication and psychotherapy works particularly well.
No differences in efficacy
Due to the different methods used in psychotherapy research and drug research, however, indirect comparisons are problematic. In addition: In the few studies in which both therapy methods were directly compared, no differences in efficacy were found. “We have only investigated therapies that comply with the guidelines,” explains Maximilian Huhn. “However, there are many new methods in the field of psychotherapy that certainly also have their qualities. But there is a lack of data to be able to assess how effective they are in comparison with older established methods such as behavioural therapy”.
Our colleagues were able to identify scientifically significant differences in only a few of the 21 clinical pictures examined: In schizophrenia, drug therapy was superior to psychotherapy in a direct comparison, but the study found that the combination of drugs with cognitive behavior therapy is even better than swallowing pills alone. Combination therapy is also best for depression, social phobia and panic disorders. The same applies to eating addiction (bulimia), where a direct comparison showed advantages for psychotherapy.
Combination of psychotherapy and drug therapy
US researchers at Vanderbilt University in Nashville have investigated which patients would benefit from additional behavioural therapy for depressives: In the case of severe depression with pronounced symptoms, the combination of psychotherapy and drug therapy is superior to taking antidepressants alone, they concluded.
They had treated around 450 patients for a maximum of three years – half of the study participants received only medication, the other half additionally received cognitive behavioural therapy. In patients with mild depression, the scientists found no significant differences. Chronically ill patients also do not seem to benefit from additional behavioural therapy.
The time factor is also decisive for effective therapy: “The longer you wait and carry the depression around with you, the more difficult it becomes,” says Maximilian Huhn. “If you’re in a bad mood for a day or two, it’s certainly not depression. But if it lasts longer, you should get help.”