Medications Role in Therapy

Mental health treatment often combines medication with therapy. The two are used together because they address different things: medication works on the symptoms, and therapy works on the psychological difficulties underneath them.

Understanding how the two treatments fit together makes it easier to take part in decisions about your own care.

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Understanding Medication in Mental Health Treatment

Purpose of Medication

Medications in mental health are primarily used to manage symptoms that interfere with day-to-day functioning. By steadying those symptoms, medication can make it easier to engage in psychotherapy. Where anxiety is severe, for example, medication may reduce it to a level at which the underlying difficulties can be worked on in therapy.

Types of Medications

A. Antidepressants

How They Work: Antidepressants act on neurotransmitter systems involved in mood, appetite and sleep, particularly those using serotonin and noradrenaline. Exactly how this produces a change in symptoms is not settled, and the older account of depression as a simple chemical imbalance is not supported. What is clearer is that, for some people, antidepressants reduce the symptoms of depression and anxiety enough to make daily activities and therapy more manageable.

Common Types: SSRIs (Selective Serotonin Reuptake Inhibitors) such as sertraline and fluoxetine are commonly prescribed first, as they are generally better tolerated than older antidepressants such as the tricyclics.

B. Antipsychotics

How They Work: Antipsychotics are used primarily to manage symptoms of psychosis, which can include delusions (fixed beliefs not shared by others) and hallucinations (seeing or hearing things that others do not). These medications act on dopamine signalling in the brain, which can reduce those symptoms.

Common Types: There are two main groups: typical (older) and atypical (newer). Atypical antipsychotics, such as risperidone and olanzapine, are widely prescribed. They are less likely than the older medications to cause movement-related side effects such as shaking, tremor, muscle stiffness and spasm, but they carry a greater risk of weight gain and other changes to physical health. This is a trade-off rather than an improvement across the board, and it is one reason a physical health check is done before antipsychotic treatment starts and repeated during it (NHS, 2023).

C. Mood Stabilisers

How They Work: Mood stabilisers are used in the treatment of bipolar disorder, evening out the extreme highs (mania) and lows (depression) of the condition. They are used both to settle an episode and to reduce the likelihood of further episodes.

Common Types: Lithium is one of the oldest and best-established mood stabilisers. Others in regular use include valproate and lamotrigine. Valproate carries serious risks in pregnancy and its use is restricted accordingly, so this is worth raising directly with your prescriber.

D. Anxiolytics

How They Work: Anxiolytics are used in the treatment of anxiety disorders. They typically work by enhancing the effect of a neurotransmitter called GABA (gamma-aminobutyric acid), which dampens activity in the nervous system and so reduces the physical and mental experience of anxiety.

Common Types: Benzodiazepines, such as diazepam and lorazepam, are a well-known class of anxiolytics. Because of the risk of tolerance and dependence, they are generally prescribed for short-term use only.

How Medication and Therapy Work Together

Enhancing Therapeutic Outcomes

Medication and therapy are often used together, and where medication reduces the intensity of symptoms, the emotional work of psychotherapy can become more possible. This shows up in a few practical ways:

In adult depression this combination has been studied directly. A network meta-analysis of randomised trials found that psychotherapy combined with antidepressant medication led to a treatment response more often than psychotherapy on its own or medication on its own, while the two single treatments did not differ from each other (Cuijpers et al., 2020). That finding is about averages across trial participants, not a prediction for any one person, and it applies to depression rather than to every condition on this page.

• Tolerating difficult emotions: Discussing traumatic or distressing material in therapy can be very hard to bear. Antidepressants or anxiolytics may reduce the intensity of the emotional response enough for that material to be approached and worked through, including in approaches such as talk therapy or EMDR (Eye Movement Desensitisation and Reprocessing).
• Making cognitive behavioural therapy (CBT) workable: Severe anxiety can get in the way of CBT, which asks a person to examine and change patterns of thought and behaviour. Where anxiolytics lower anxiety, it can become possible to challenge fears, take part in exposure work, or practise new behavioural techniques taught in sessions.
• Steadying mood so therapy can continue: For people living with bipolar disorder, mood stabilisers reduce extreme mood fluctuations. A steadier mood makes it more likely that sessions can continue without the interruption of an acute episode, and continuity matters for the work therapy is trying to do.

Medication as a Support, Not a Solution

Medication manages symptoms. The aim of therapy, where it is possible, is to address what sits underneath them. Medication does not resolve those underlying difficulties; it can create conditions in which therapy is easier to use.

This is why the two are best coordinated rather than run in parallel by people who never speak to each other, with the plan adjusted to your particular situation.

Supporting Medication Adherence through Therapy

Sometimes the relationship runs the other way. In conditions such as schizophrenia, severe depression or bipolar disorder, the medication regimen usually needs to be followed consistently for the condition to settle. Therapy can support that. A therapist can go over the reasons a medication has been prescribed, make room for fears or misgivings about taking it, and help work out how it fits into an ordinary day.

Therapy can also be a place to deal with side effects, which are sometimes difficult to live with. Raising them openly in sessions makes it more likely that practical adjustments are found, and that decisions about continuing, changing or stopping a medication are made with your prescriber rather than alone.

Role of Healthcare Professionals

Collaboration Between Psychiatrists and Therapists

Treatment usually involves collaboration between the psychiatrist, who prescribes and manages medication, and the therapist, who provides psychotherapy. Where the two are in contact, with your consent, each can take account of what the other is seeing, and the plan can be adjusted accordingly.

Monitoring and Adjustments

Regular monitoring of a medication's effects and side effects is an ordinary part of treatment. Doses are adjusted, and medications sometimes changed, as treatment progresses and as your response becomes clearer.

Patient Involvement and Education

Informed Consent and Understanding

You are entitled to be well informed about any medication you are prescribed: what it is for, its likely benefits, its possible side effects, and how it interacts with other treatments and medicines. Your psychiatrist should give you that information clearly and answer your questions, so that consent to treatment is genuinely informed.

Active Participation in Treatment

Taking part also means saying how the medication is actually going, including side effects and concerns. That information is what a prescriber needs in order to adjust the plan, and it keeps you in the position of a participant in your care rather than a recipient of it.

Challenges and Considerations

Managing Expectations

Some medications take several weeks before any benefit is apparent, and the first one tried is not always the one that suits. Knowing this in advance makes an early lack of change less discouraging, and allows a fair trial of the medication before a decision is made.

Cultural and Personal Beliefs about Medication

Cultural and personal beliefs shape how psychiatric medication is regarded. In some communities there is stigma attached to taking it, and many people hold reservations of their own. These are reasonable things to bring into therapy rather than to keep to yourself, and talking about them openly tends to make the decision a clearer one either way.

Key Takeaways

• Comprehensive treatment: Medication and psychotherapy are often used together. In adult depression, trial evidence shows the combination produces a response more often than either treatment alone (Cuijpers et al., 2020). For other conditions the balance between the two varies, and so does what suits a particular person. Medication can steady symptoms so that therapy becomes more usable.
  
• Collaborative care: Treatment commonly involves both a prescriber and a therapist. Coordination between them keeps the plan coherent.
  
• Educated participation: Being informed about your medications, their effects and their place in the plan puts you in a position to take part in decisions about them.
  
• Adjusting expectations: Medications take time to work, and the plan may need to change depending on how you respond.
  
• Cultural sensitivity: Beliefs about medication, personal and cultural, affect whether people take it and how they feel about doing so. Discussing them openly is part of good care.

FAQ

How do I know if I need medication in addition to therapy?

Discuss your symptoms and the options with your therapist and a psychiatrist. The severity and type of your symptoms will inform whether medication is likely to help.

What should I do if I experience side effects from the medication?

Report side effects to your prescriber promptly. Doses can be adjusted or medications changed. Do not stop on your own without discussing it first.

Can I stop taking medication if I feel better?

Speak to your psychiatrist before changing anything. Stopping abruptly can cause withdrawal effects, and symptoms may return. If you want to come off a medication, it can usually be done, but it is done gradually and with support.

How long will I need to be on medication?

This varies with the condition, your response and your general health. Your psychiatrist can give guidance for your situation.

How does medication work together with therapy to treat mental health disorders?

Medication can reduce symptoms to a level at which psychotherapy becomes workable, and therapy addresses the difficulties underlying the condition.

What happens if medication doesn't work for me?

Several medications are available for most conditions, and finding a suitable one can take time. If the first does not help, another may. Keeping your prescriber informed is what makes that process work.

Is it safe to use medication long-term?

Many people take psychiatric medication over the long term under the supervision of a psychiatrist. Regular review and physical health monitoring are part of that, and the balance of benefit and side effects is reconsidered over time.

References

• NHS. Treatment: schizophrenia. Last reviewed 13 April 2023.
• Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C.H., Cipriani, A. & Furukawa, T.A. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 2020, 19(1), 92-107.
• American Psychiatric Association. Psychotherapy.
• Psychology Today. Psychopharmacology. General-audience overview of psychiatric medication classes and how medication is used alongside psychotherapy.
• HelpGuide.org. Treatment.