Medicines can bring symptom relief, which can be very welcome but is often limited. To illustrate. Shedler (Aftab, 2020) reported on a a recent, comprehensive study by Cipriani et al. (2018). This study was a meta-analysis including 21 antidepressants. It found that, although there had been some improvement with the medications, the average patient was still clinically depressed enough to met the qualifications to join another study as a depressed patient.
An article by Campolonghi and Orru' (2024) cautioned against the long-term use of psychiatric medicine to treat certain psychological disturbances where there is no objective medical evidence of an abnormal brain. The drug-centered approach is based on symptomatic relief. The possibility of defects in neurotransmitters as causative agents is an assumption rather than a scientific fact. Drugs can help, they say, in certain acute conditions, but long-term use can interfere with the healthy function of neurotransmitters and can create a chemical imbalance instead of resolving an imbalance. The new imbalance can be diagnosed as a relapse needing an increased dosage or can be diagnosed as the sign of an additional diagnosis for which more drugs are prescribed. Consequently, the drug-centered treatment has potential problems of its own if it actually worsens a situation.
Another kind of comparison between psychotherapy and medication involves a passive-active dimension. Taking medication is a passive process for the recipients, who put pills in their mouths, swallow, and experience their effects. Psychotherapy needs an active approach to work. The therapist doesn't provide the treatment while their patients, in turn, sit there and accept it. The patient must at least make an equal or better contribution. As Shedler (Aftab, 2020) said in his conversation with Aftab, "A therapist may suggest connections or raise hypotheses for consideration, but it is a mutual process of discovery. The patient is the final arbiter of his own experience, always (p.?)" (I deal with this issue on the page Therapy Partners and its Update on my Blog).
Campolonghi and Orru' (2024) suggested that psychiatry would best return to its roots within psychological theory and practice for some problems rather than continue to hold on to a rigid association with medicine. Research has repeatedly shown that the effects of psychodynamic therapy are considerable, long-lasting, and even increase over time after therapy has been terminated (Shedler, 2010).
REFERENCES
Aftab, A. (2020) Psychoanalysis and the re-enchantment of psychiatry: Jonathan Shedler, Ph.D. Psychiatric Times, July 29, 2020.
Campolonghi, S., & Orru', L. (2024). Psychiatry as a medical discipline: Epistemological and theoretical issues. Journal of Theoretical and Philosophical Psychology, 44(4), 300-311. https://doi.org/10.1037/teo0000256
Cipriani, A., Furukawa, T. A., Salanti, G. et al. (2018). Comparative efficacy and acceptability of 21 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. Lancet, 391(10128), 1357-1366.
Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109.