Should I Take
Therapy or Pills?

1 Jun 04

Therapy or pills? Which should it be. Which is obviously better. You don't want to be on the pills because that is an admission that you need a crutch to go about your life. Certainly you are stronger than that. On the other hand, therapy makes it sound as if it is all in your mind. You're faking it or seeking attention. Better to take pills and admit to everyone that the problem is physical - or else the pills wouldn't be working.

Or...you don't like taking pills, right. And the last therapist you went to wasn't really interested and you didn't like how they treated you. Let's just ignore it all - maybe it will all go away.

Let's get a grip. You do need to do something. But which is better, the therapy or the pills.

My experience is that both medication (pills, meds) and psychotherapy (therapy) are useful but for quite different reasons.

Thus far, although I can control my hypomania episodes relatively well without medication most of the time, I have found therapy alone cannot prevent me from getting depressed or even lift my mood somewhat. Antidepressant pills are the only thing that are effective in lightening my depression or delaying the onset of a depression episode.

So the meds have it, right? Well...no.

The meds do a decent job of helping me with depression, but they do not do a great job. I still get depressed, even if the episodes are further apart and generally less intense.

Spending time with my psychotherapist, however, has been useful in permitting me to come to terms with suffering from depression. I have spent the time with my therapist discussing:
Who the real me is,
Working out whether I am actually manic depressive or just looking for attention,
Working to increase my self confidence,
Working to reduce anxiety and guilt, and
Working out coping systems for when I am depressed and for dealing with the aftermath of a depressive episode.

The meds are more effective in relieving the symptoms of depression, but the therapy is more effective in the larger sense of allowing me to structure my life so that I am more relaxed and more productive. Happier too.

Neither works alone - but I would argue that the antidepressant medications are a subset of therapy - merely one of the many actions for dealing with being depressive or bipolar.

If you have the capability, have both a therapist and a psychiatrist. Use the psychiatrist to handle the exploration of which medications work best to handle your mood swings. Use the therapist to discuss the wider problems, to help you cope with the existing problems that being bipolar may have caused, and to help you develop coping strategies for now and the future.

If you can only go to a psychiatrist, make sure (s)he spends enough time with you to discuss the wider problems you are having. Do NOT accept a psychiatrist who won't take the time to help you learn to cope with living with bipolar disorder and depression. Taking the medications alone will NOT necessarily resolve them.

For therapy, a twenty minute session is not sufficient. A session should last 45 minutes to 1 hour at least. Don't settle for less. At the beginning, sessions twice a week would be nice, but therapy should be at least once a week until you feel that you have a handle in the disruption that being bipolar or depressed causes.

Don't forget to take your pills too. Regularly.

An addendum
About.com's Mental Health Resources section had an interesting article titled "Medications or Psychotherapy for Depression?" The basic idea in the article is that your treatment may depend on who attended to you. If you went to a psychiatrist, you generally got pills. If you went to a therapist, you got therapy. It didn't seem to matter what treatment you actually needed. Check out the original article.

In addition, the article also states
"Studies agree that both antidepressants and psychotherapy are effective treatments for depression. There is even agreement that a combination of the two may be more effective than either alone...The art and science of psychology and psychiatry are not yet refined enough to be able to predict which treatment will be more effective for a given person."

Basically, don't assume that one is better than the other without trying both. And you may find that doing both therapy and taking pills is better than doing one or the other.

The second page of the same article is called "Recommendations Based on the Psychology Literature." I've found that these recommendations are correct, and that they more or less reflect my statements above. However, the recommendations offer no reasons for their existence and therefore provide no proper guidance for either a psychotherapist or psychiatrist to usefully provide help for a patient.

The American National Institute of Mental Health's section at About.com also has a section on treatment using medication and therapy. However, that section has the same problem - it provides correct suggestions without explaining why the suggestions work or discusses them in medical terminology that is confusing.

I know that the average person searching for information would not easily understand either of these two sources of information (I didn't) and I'm not at all sure that the therapists out there would be able to use the recommendations provided to develop meaningful treatment methods either.

One thing is for certain. At the end, the real therapists are us bipolar and depressive persons. We spend all our time with ourselves and so we are best poised for both observation of ourselves and application of ideas that may allow us to cope better. We also have the most interest in making sure we function better and are happier.

Recommendations that tell us what to do without explaining why they exist and what they hope to achieve (in a way that we can easily understand) will leave us out of the healing process. That doesn't seem to be a good idea to me.