Depression: pills or psychotherapy?

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Depression: pills or psychotherapy?

Antidepressants significantly relieve symptoms of depression. But can they replace psychotherapy?

More than 25 years ago, “pills of happiness” appeared, which completely changed our attitude towards depression.

Antidepressants in the US and Europe have long been a part of the lives of many people. Russia is moving in the same direction: about a third of Russians, our experts say, have at least once resorted to sedatives and antidepressants.

The drugs of the new generation are doomed to success: they have fewer side effects, and people with symptoms of depression who can not cope with everyday stress – much more. Does this mean that now you can do without psychotherapy?

Alleviate the condition

Antidepressants and anxiolytics are often a solution. If a patient comes with complaints of depression, the doctor first of all asks: “What do you mean by depression?” Usually he hears the answer: “I always feel tired, I have no energy, I sleep very bad, I have lost appetite”. More serious complaints are possible: “I am not worthy of anything in life, I am overcome with very gloomy thoughts.”

After one consultation, such a patient usually leaves with a prescription, since he has six of the characteristic symptoms listed in the Diagnostic and Statistical Manual of Mental Illness *. On this basis, medication may be chosen.

“Perhaps such a patient also needs psychotherapy, which will make the treatment effect deeper and more stable,” says the head of the Clinic for Psychotherapy and Psychiatry of the European Medical Center (EMC), psychiatrist Natalya Rivkina. “The current standard in treating depression, anxiety disorders, and stress reactions is a combination of drug therapy and psychotherapy.”

Drugs relieve symptoms, and psychotherapy, working with a psychologist helps to solve an internal conflict

For someone who is in a depressed state, having neither the strength nor the desire to work with a psychologist, antidepressants can provide invaluable help. Little by little, when his well-being improves, against the background of a gradual drug withdrawal, he will be able to start working with the psychological cause of his depression.

“The main indication for prescribing a course of antidepressants is depression, but they also help those who live actively, work hard and can not cope with constant overloads,” said psychiatrist-psychotherapist Alexandra Yalta. “Drugs alleviate symptoms, and psychotherapy and working with a psychologist help to uncover the internal conflict that led to psychological difficulties and achieve a lasting effect.”

Back to life

Some people, even suffering from depression, categorically refuse to take medicine. Some have an irrational fear of them, someone considers the effect of “chemistry” on his personality unacceptable, for others there is something humiliating in taking pills that reduce anxiety, irritation, aggressiveness.

It’s not easy to depend on a medicine that makes you feel psychologically better. Therefore, a more acceptable, liberating path is a course of psychotherapy. Some psychotherapists also object to taking antidepressants, not considering the organic nature of their patient’s psychological problems. The idea that they cannot solve the patient’s problem without pills is insulting to them. And only when a psychiatrist and a psychotherapist take a mutually open position, value each other and understand the meaning of common efforts, does it benefit their patients, helping to find a way out of the impasse.

Thinking and responsible doctors and psychotherapists are unanimous: psychoactive drugs are a partial solution that will be more effective in combination with therapy. “I honestly tell patients that medication is the bridge between“ I feel bad ”and“ I feel good, ”says clinical psychologist Ronald Pais. “And a person must go from one shore to another.”

* Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Publishing, 2013).

Psychotropic drugs: what are they for?

Tranquilizers (anxiolytics). Having anti-anxiety action, relieve tension, a sense of anxiety. Some also have sleeping pills, others do not (daytime tranquilizers). Taking these drugs for more than a month can be addictive.

Sleeping pills. Increase the duration and quality of sleep. Accelerate the process of falling asleep or make sleep stronger. Preparations of a new generation do not cause morning drowsiness, do not affect memory, solve the problem of night awakenings. They can be taken for a long time.

Antipsychotics (antipsychotics). They have a therapeutic effect in case of impaired perception, hallucinations or delirium. They are also prescribed for the treatment of anxiety, mood swings, and insomnia. The drugs have side effects: coordination difficulties, weight gain, tremor. Categorically you can not take them yourself, without medical supervision.

Antidepressants. They are used not only for depression, but also for panic attacks, chronic pain, eating disorders. A positive effect occurs after 10-14 days. They are usually prescribed for at least 3-6 months. Increase stress resistance, endurance, improve mood. The use of certain drugs can disrupt the concentration of attention, reduce libido.

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