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Combination Treatment

Combination treatment is the use of medication in combination with psychotherapy. A common example is the use of antidepressant medication to treat depression and psychotherapy. Both medication and psychopharmacology can be effective treatments for depression; however, evidence has confirmed that, in certain cases, combined treatment may be more effective than each treatment alone.

At The Midtown Practice we take time to assess what you are feeling, your psychiatric symptoms (such as insomnia, loss of appetite, obsessive thoughts, etc) as well as your feelings and experience with medication. Using your history, our clinical experience, and your attitude regarding medication, we decide together whether or not to include psychopharmacology as part of your treatment. In other instances, an individual may start psychotherapy or medication for mood, but have an inadequate response. In this case, we change course and use combination therapy. In general, we recommend adding psychotherapy to most medication regimens, however, some of our patients find medication alone to be satisfactory for their needs. Others may find combination treatment offers them the best results.

When do we consider combination therapy?

The decision to recommend combination therapy may be made when a patient’s depression or anxiety is interfering with their ability to perform the activities of daily function like eating, sleeping and concentration. In other circumstances we may determine together that negative emotions interfere with the ability to be present in therapy and/or take action in their lives. In these cases, the patient may often benefit from medication. We often view medication similar to “training wheels.” Psychopharmacology can offer the necessary symptom relief and stability to while you learn the techniques and insight to combat life challenges. When symptoms are alleviated, greater insight and coping skills can be acquired. When appropriate, the “training wheels” come off and we taper off medication accordingly.

Why combine therapies?

Our experience has shown that combination therapy can frequently produce substantial relief of symptoms. As stated above, when patients are very depressed, anxious, or having other psychiatric symptoms, it can be difficult to be psychologically present and take full advantage of therapy. With medication, patients return more rapidly to a healthier level of functioning.

Medication temporarily relieves severe negative emotions, freeing up mental space to develop more resilience and psychological flexibility.

Do I have to take medication forever?

Absolutely not. Although many of the medications we use are extremely safe and can be taken across the lifespan, in general, we believe in the adage in less medication is better. We may recommend a trial of medication and decide together, after a certain amount of time, usually 4-6 weeks, whether it is helping.  Based upon your response, side effect and benefits, we may recommend optimizing your dosage or making other changes. Although the medications we select are widely tolerated, we realize medications can affect individuals differently. Our clinicians are available to you between sessions for questions, big or small. We try to identify endpoints for progress, and constantly reassess the need to continue medication, optimize dosage, taper pr change. Some of our patients stay on medication for months, others continue for years, and still others elect to stay on indefinitely.

While medication cannot fix your problems, effective medication can “take the edge off” challenging emotions permitting you to approach issues with a fresh outlook and more ease. Sometimes medication can be transformative. Our psychopharmacologists are skilled at maximizing the benefits of medication and minimizing the possible side effects. We are committed to working with you to help you choose when you may wish to use medication and when you may want to discontinue medication.

The use of combined treatment for common mental disorders can provide superior effects and is supported by the scientific evidence. However, at The Midtown Practice, we realize that one size does not fit everyone. Our skillful clinicians will tailor your treatment utilizing all resources available to provide the best results.

 

Resources

  • Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014 Feb;13(1):56-67. doi: 10.1002/wps.20089. PMID: 24497254; PMCID: PMC3918025.

 

  • Machmutow K, Meister R, Jansen A, Kriston L, Watzke B, Härter MC, Liebherz S. Comparative effectiveness of continuation and maintenance treatments for persistent depressive disorder in adults. Cochrane Database Syst Rev. 2019 May 20;5(5):CD012855. doi: 10.1002/14651858.CD012855.pub2. PMID: 31106850; PMCID: PMC6526465.

 

  • Steven D. Hollon, Robert J. DeRubeis, Jan Fawcett, Jay D. Amsterdam, Richard C. Shelton, John Zajecka, Paula R. Young, Robert Gallop. Effect of Cognitive Therapy With Antidepressant Medications vs Antidepressants Alone on the Rate of Recovery in Major Depressive Disorder. JAMA Psychiatry, 2014; 71 (10): 1157 DOI: 1001/jamapsychiatry.2014.1054

 


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