Meds Vs. Therapy for Mental Illness

Medication and therapy both treated mental disorders effectively but could be better

(RxWiki News) There are two main ways to treat mental illness: medication and therapy. Often, these are combined, but other times patients choose one or another. Which is best?

A recent study compared the effectiveness of medication versus therapy for major psychiatric disorders.

Although the researchers reviewed more than 60 studies, the different medical trials differed too much from one another to determine that one treatment was better than another.

The authors concluded that both medication and therapy can provide benefit to patients but that both can also be improved or used together more effectively.

"Discuss your treatment plan with your psychiatrist."

This study was led by Maximilian Huhn, MD, of the Department of Psychiatry and Psychotherapy at Technische Universitat München (Munich Technical University) in Germany.

The researchers looked through four major medical research databases for all studies that reviewed various treatment types of mental illness.

These researchers sought comparisons between any of the following combinations:

  • medication versus placebo (fake medication)
  • therapy versus placebo ("fake" therapy or an alternate activity, such as exercise)
  • medication versus therapy
  • medication plus therapy versus using one or the other

Out of more than 45,000 original papers that they found, the researchers included the 61 that met their qualifications.

Combined, these systematic review papers included 137,126 participants and investigated 21 different psychiatric disorders.

The disorders included schizophrenia, bipolar disorder, depression, several anxiety disorders, several eating disorders, alcoholism and opiate addiction, among others.

The researchers found that the differences among the different trials made it difficult to compare them effectively.

For example, the trials involving medication tended to involve more participants than those involving therapy.

The medication trials also were more likely to have good comparison groups and to ensure that the patients did not know if they were receiving the real medication or the placebo, which improves the quality and reliability of the results.

However, the trials involving therapy tended to show a greater effect in terms of the difference between treatment and no treatment.

In other words, the improvement that a patient saw with therapy, compared to no therapy, tended to be greater than the improvement patients saw with medication, compared to no medication.

The trials involving therapy also had lower rates of participants dropping out, compared to the medication trials, and had longer term data on the participants.

Overall, the researchers concluded that both medication and therapy could effectively treat the various disorders studied.

In some cases, it depended on the disorder whether therapy or medication tended to be more successful.

For example, medication tended to work better for schizophrenia and mild chronic depression, but therapy was more effective for major depression and bulimia.

However, the researchers also noted that there is "a lot of room for improvement" for both therapy and medication.

Because there were too many differences between the studies to effectively compare medication and therapy, the authors recommended that more studies directly comparing the two treatment types be publicly funded.

They also recommended that more research look into how medication and therapy can be best used together to treat mental illness, "rather than debate the use of one treatment over the other."

In an editorial accompanying the article, Christoph Correll, MD, and Maren Carbon, MD, pointed out that there is also too little research on several disorders not included in this review.

"There were no meta-analyses that met the inclusion criteria for personality disorders other than borderline personality disorder, impulse control disorders other than trichotillomania, and substance use disorders other than alcohol and opiate dependence," they wrote.

"Also, there were no meta-analyses of psychotherapies for bipolar mania, depression and relapse prevention, or adult attention-deficit/hyperactivity disorder, and no pharmacotherapy meta-analyses for specific phobias," they wrote.

"Within the mental health community, mental health professionals are taught and practice what is called the 'bio-psycho-social' perspective for treatment," said Daniel Berarducci, MA, a Clinical Professional Counselor at Person-Holistic Innovations in Las Vegas, Nevada.

"Within this model, the individual and provider explore the biological, psychological, and social factors that may be contributing to concerns with a person's mental health at that moment in time. Within our understandings in mental health care, an individual can experience concerns within their biological, psychological, and social functioning with all three of these components being treated through the collaborative nature of various professionals within the mental health field," Berarducci told dailyRx News.

"Historically speaking, research studies have shown the effectiveness of psychotropic medication treatment in combination with therapy due to the combined nature of the 'bio-psycho-social' perspective while continuously exploring the individual's mental health concerns that are experienced," Berarducci said.

"Throughout the course of treatment, an individual should feel comfortable within the process of deciding what aspects of treatment to consider or move forward with for their own mental health care. Once the individual is able to establish a trust and rapport with all of their treatment providers, the individual will often notice an improved nature within themselves towards self-improvement," he said.

The study was published April 30 in the journal JAMA Psychiatry. The source of funding for this study was not provided.

Five of the study's authors have received speakers' fees, consulting fees or advisory board compensation from five or more of 14 major pharmaceutical companies.

Review Date: 
April 29, 2014