Medication
Although psychologists receive training in psychopharmacology (psychotropic medication that addresses psychological symptoms or disorders), psychologists in the state of California are not presently licensed to prescribe medication. These medications (i.e., Prozac, Zoloft, Xanax) are generally prescribed by psychiatrists or primary care physicians. As I am often the first mental health professional consulted by individuals who are starting psychotherapy, I am frequently asked what role, if any, medication should play in their treatment.
I would like to offer some ideas from my clinical experience about the use of anti-anxiety and antidepressant medication in successful psychotherapy. Anxiety and depression are unhealthy emotional states; they are warning signs that there is a problem internally, in the way we relate to people, or respond to events and circumstances around us. Anxiety and depression are not part of the natural and healthy spectrum of human feelings such as fear and sadness. Many individuals seeking therapy are mobilized by the pain and discomfort of anxiety, depression or both.
For a majority of individuals who have mild to moderate symptoms, psychotropic medication will not be necessary. In most cases it is important to initiate therapy without psychotropics as medication brings symptom relief only. Psychotropic medication alone does not bring insight or emotional growth. If medication for anxiety or depression is initiated prematurely or in place of therapy, one can lose the motivation to address and work on the underlying causes of their symptoms. If these underlying dynamics are not addressed in therapy we are at risk for a resurgence of unhealthy and impairing mood states, thinking, and behavior. It is important to note that if symptoms do not alleviate or become worse as a well-conducted therapy progresses, it may become important to discuss medication as an adjunct to therapy as well as any other resource that might be of benefit. As is sometimes the case with primary care physicians who have not had specialized training in psychiatry and psychotropic medication, anti-anxiety or antidepressant medications can be prescribed too automatically, casually, and without needed specificity.
For those who are steeped in a severe depression or suffer from acute anxiety to the point that they cannot function in their daily lives, medication may be needed early in treatment. Some reduction in anxiety or alleviation of depression may be necessary for a person to be able to cognitively and emotionally absorb and process the benefits of therapy.
Resistance to taking medication is not uncommon and some fear that 1) they will become dependent or addicted, 2) they will experience unpleasant side effects, 3) the medication will be ineffective (often based on a previous experience), 4) they will undergo an unwanted personality change or that their mind will be controlled (i.e., that an antidepressant is a “happy pill” or that anxiety medication will make them a “zombie”), and 5) some individuals are simply resistant to the idea of using any medication. Some of these concerns are valid and some need to be dispelled. It is important to note that an experienced psychotherapist or prescriber of psychotropic medication will address these concerns.
Copyright © 2016 Bruce A. Howard, Ph.D. All rights reserved.