SHOULD PROZAC BE USED INSTEAD OF PSYCHOTHERAPY OR IN ADDITION TO IT?
The relationship of medication to psychotherapy has been debated endlessly. Although it would be difficult to find a psychoanalytically trained psychiatrist who never prescribes medication or a psychopharmacologist who never recommends therapy, it is nonetheless true that most psychiatrists fall on one side or the other of this great divide. Either they passionately believe that psychotherapy (or another form of talk therapy) is die preferred treatment, or they believe, that medication should generally come first.
The issue is particularly important in terms of the treatment of depression. Few would argue the importance of medication for illnesses such as schizophrenia or severe manic depression. But people often feel different about depression, especially if it is mild or moderate. Increasingly few professionals question die necessity of medication in cases of moderate to severe depression. However, there is still a tendency, to blame the victims, to believe that if they will only get themselves together, confront their issues, and deal forthrightly with their fears either in treatment or by themselves, they would feel less depressed— without medication. Medication, in this sense, is seen as a weak second choice to be made only when therapy has failed.
But often that doesn’t happen. There are too many patients who, after years of weekly or twice-weekly appointments, are still struggling with depression. And even when the therapy has been declared successful and the depression appears to have exited forever, it is merely dormant, awaiting its biological cue for spontaneous recurrence. In an enormous percentage of patients, depression returns.
It doesn’t have to. For an extraordinarily large number of patients who are now being given psychotherapy alone for various forms of depression, overt or hidden, Prozac or another antidepressant is the treatment of choice and should be given either in conjunction with psychotherapy or instead of it. Ideally, medication should be accompanied by some form of psychotherapy especially in the first three or four months. But if it is necessary to pick either medication or therapy, the choice is clear. Medication can return a depressed patient to a normal emotional state by eliminating symptoms, including the urge to commit suicide. If the patient wants to enter psychotherapy in addition to taking medication, so much the better, a number of studies have now demonstrated that patients recovering from acute episodes of major depression do better when they are receiving both therapy and an antidepressant drug than they do with medication alone.
*103\22\4*
