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Psychotherapy Versus Pharmacotherapy: Is One Better than the other?

Kimberly Bibbo

One of the most startling things to me at the beginning of the Neurobiology and behavior course was learning about the existence of "reductionism." That is, those who do not believe there is a human soul or necessarily even a mind. Instead, as I understood it, reductionism says we are all a product of our neurons and the firings that take place in the brain and nervous system. Those scientists, from what we discussed, might claim that disorders that take place in human behavior (such as schizophrenia, obsessive-compulsive disorder, or even depression) are all functions of neurotransmitters and the firings of neurons in the brain. In order to cure ailments such as these, certain psychiatrists or doctors might rely heavily and solely on medication. This type of treatment is known as the pharmacotherapy approach, in which medication is the primary tool used for curing patients. However, this idea did not ring true as necessarily the best or only approach to human disorders, especially to a psyche major such as myself. I decided to then delve into the Internet to see people's views as well as actual statistics on which treatment, psychotherapy or pharmacotherapy, was indeed better. What I found was that a combination of the two seems to be the best bet in treating patients, and I will show evidence to support this as I talk about each topic individually, and then discuss their merits when used together. Also, in the scope of a paper such as this, I will look at both sides of the two treatments specifically for depression, since that is the best way to discuss specific statistics and for recovery. (3)

WHAT IS PSYCHOTHERAPY?

Just for a brief overview, psychotherapy is seen as a method of treating symptoms of distress in patients to help them return to a normal level of functioning. It is used as a medical tool to help a person overcome difficulties. Typical therapy is the kind most of us are familiar with, 50 minute sessions that are once a week with a therapist. The main focuses is for a patient to better understand their circumstances, the best ways to deal with them, and who they are as a person. Usually, if patients have a behavior specific problem, the APA homepage says sessions last an average of 16 visits. (APA homepage reference). Technically, the therapist has an interview with an individual to find out who they are as a person, their background, and then works from there to help heal and discuss the problems that have been affecting their daily functioning.

In pop culture, an often incorrect assumption is that going to see a "shrink" involves laying on a couch and talking about problems. Instead, psychotherapy starts out as a thorough medical examination as well as a psychiatric one. There is a great deal of deliberate method in psychotherapy, not just a random diagnosis. According to the APA, an estimated one out of five adults every year has a serious psychological problem that requires psychotherapy. The need for psychotherapy is just as crucial as any other treatment for a neurological distress or disorder. As the APA quotes, "Research shows that most patients who receive psychotherapy experience improvement." Later, I will cite a specific study, but for now, the question must be addressed as to what exactly Pharmacotherapy means. (1). {See References for specific location}

WHAT IS PHARMACOTHERAPY?

Essentially, Pharmacotherapy is the idea that drug therapy is the most efficient route to take in order to treat psychological disturbances or addictions. This route of drug therapy is excessively useful in addictions such as cocaine, alcoholism, and things that effect the body in a predominately biological fashion. It tends to look more at the chemistry aspect of the body, and the best way to fix or counteract drug differences or imbalances in the human body. Certain pharmacists who take this view feel that most disturbances in the brain can be cured this way, which places little value on psychotherapy. In the example of depression, specifically, I want to explore the actual statistics of how the two views on treatment appear to yield fairly equal results. This, then, should help show that the reductionism theory is one-sided. (4).

PHARMACOTHERAPY VERSUS PSYCHOTHERAPY IN SPECIFIC DISORDERS:

Which Yields the Best Statistical Results of Recovery?

In a paper of this scope, as I stated in the introduction, it would be near impossible to look at an effective gamut of examples that would examine the equal merits of pharmacotherapy an psychotherapy. Therefore, I will more specifically assert that pharmacotherapy and psychotherapy are equally effective and valuable in treating depression. At the very least, I would assert that the two in conjunction with each other is the only completely effective way to approach the clinical diagnosis of depression.

The main article on the Internet that I use as a reference can be found at (2). Essentially, this article in 1995/1996 was a precursor to new findings that are now known about the effectiveness of pharmacotherapy versus psychotherapy. This article discusses how, for the most part, depression is seen as a biological disorder, and many drug therapies such as tricyclic antidepressants or Selective Serotonin Reuptake Inhibitors are useful in curing depression. Tricyclic antidepressants work in most people, but only certain patients can be guaranteed no danger to their health. The tricyclic antidepressants are linked to severe, if not fatal cardiac problems. In addition, the most common problems are quoted as follows in the journal article: "Better results can be achieved with these drugs if patients are seen weekly during the first month of treatment for dosage adjustment, reassurance, and monitoring for the development of hypotension and cardiac conduction defects." Essentially, drugs require just as much monitoring and care as psychotherapy might, not necessarily making it the most effective treatment (depending on the drug, of course).

Selective Serotonin Reuptake Inhibitors, SSRI's, are another popular antidepressant that prove more effective in a wider range of patients than tricyclic antidepressants, but the side effect are still fairly drastic in certain cases (see the article for details, they were too numerous to list). The main point I want to convey from this article is that drug treatments for depression are useful in a wide range of cases. However, psychotherapy is crucial in equally as many cases, for any of the following reasons stated: "Common reasons for psychiatric referral include lack of response to acute treatment, suicide risk, recurrence of symptoms during maintenance treatment, development of new co-morbid condition, patient's desire to discontinue maintenance treatment, and pregnancy or the desire to become pregnant." In short, the article takes the view that one type of treatment or the other, drug versus clinical therapy, is not necessarily better, but each have their own merit and importance in treating depression.

At the very end of the article, the author mentions the RAND institute, in Santa Monica. They were set in 1996 to do a study for the next two years that would truly compare the statistics between drug therapy versus psychotherapy: the scope of the project was as follows: "The aim of the project, called Partners in Care, is to assess three types of intervention in primary care group practices: care as usual (control), an enhanced medication intervention, and a psychotherapeutic intervention." In my Abnormal Psychology class, we actually discussed this study, and when the statistics were all in, they found that, indeed, the two methods of treatment for depression were equal, and worked excellently when in accord with one another.

Thoughts From Readings

Essentially, after reading many cases on the web, and seeing the statistics, I feel it is safe to say that both psychotherapy and pharmacotherapy have very individual merits, but tend to show the most long term results when used together. Many disorders like depression are now indeed thought to be biochemical in nature, and treated well with drug-therapy (pharmacotherapy). Things such as cocaine addiction, as mentioned earlier, alter the action and chemicals in the nervous system and brain. In instances such as these, pharmacotherapy can be used to prescribe drugs that will hopefully counteract the negative effects of the illegal (cocaine) or harmful (alcohol) drugs. However, the flip side I discovered in the reading is what caused me to make the assertion that psychotherapy is equally important.

Many times, the reasons for using and abusing drugs or developing disorders such as depression comes from difficult or unmanageable life situations. Ridding oneself of underlying turmoil is often one of the only ways, in conjunction with drug therapy, to assure that a disorder or addiction will not resurface. Psychotherapy offers patients the opportunity to discuss the roots of what might potentially be causing the disorders cognitively. Without this support or verbal assistance in the cases of more severe disorders or habits, relapse or reoccurrence was statistically higher (Abnormal Psychology). Essentially, from all the facts learned in my other class and a general common sense supported by statistics, the assertion that pharmacotherapy and psychotherapy are equally important held true. Of course, in cases of mild depression or difficulties, psychotherapy might not be as necessary. But in most instances, the giving of a drug is best accompanied by the basic emotional support almost all people need to make sure they remain healthy and learn how to cope without solely relying on medication.

WWW Sources

1) APA Homepage , This site will only list the main page. You will have to use the search engine; Psychotherapy, Public Information.

2) Psychotherapy versus Pharmacotherapy in Treating Depression

3) Psychotherapy and Pharmacotherapy Integrated

4) Pharmacotherapy




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