Therapy, Medication or Both (or Neither)?

June 30, 2015

I stumbled upon this brief piece in the Huffington Post about when patients should consider doing psychotherapy, trying medication, doing both at the same time or not doing anything at all.  I liked this article because it was short and to the point while giving some nice examples behind the answer to the question: “it depends.”

As a psychologist I have many patients ask for medications and I have many patients refuse my suggestion that they consider medications.  I work with only a handful of psychiatrists who I trust, and one of the things that I really like about them is that they don’t always prescribe medication on the first visit and sometimes they don’t prescribe at all.  Now days many psychiatrists have defaulted to the role of “prescription mill” and they just see patients on the quarter hour, back to back, writing scripts as quickly as they can.  I feel fortunate that I have good relationships with some very thoughtful and knowledgeable psychiatrists.

I also feel fortunate that as a psychologist I have the luxury of time to get to really know my patients, develop a strong therapeutic relationship with them and then help them improve various aspects of their lives.  One of my favorite things to do in therapy is to review my clinical notes with a patient when we’re close to terminating treatment.  I have found that when people are feeling better they often forget just how bad things were when they first came to me.  When we read through the chart together they are reminded of the incredible progress they made.

Should you really be scared of antidepressants?

November 11, 2014

For the past decade some of the “newer” antidepressants have had “black box warnings” that caution about a risk of suicidal thoughts and behaviors in young adults and kids.  Though there has been controversy about this, the benefits and risks of these easily misinterpreted warnings is finally being looked at a bit more closely again (but not by the FDA yet).  See the TIME story or an article in the New England Journal of Medicine for more information.

Need an antidepressant? Try exercise!

September 10, 2014

Research has shown that when depressed people exercise 3-5 times per day for 45-60 minutes per session and achieve a heart rate of 50-85% of their max heart rate, the exercise is as effective, if not more effective, than medication. The Atlantic published a nice summary of the research and relevant literature.

Psychotherapy is as good as (or better than) medication

September 13, 2013

Yet another article was published recently that touted the positive effects of psychotherapy.  In this study the authors noted that psychotherapy was as effective as antidepressant medication at treating and preventing relapses of depressive episodes.  Of course the side effects from psychotherapy are much less than those from medication, which is nice.  But what made this article special was that it was published in JAMA Psychiatry.  Yup, one of the best professional publications for psychiatrists said that medications are not better that psychotherapy.  This is great for several reasons.  First and foremost, it’s a wonderful demonstration that the ever-increasingly medicalized field of psychiatry is willing to acknowledge the benefits of non-medical approaches.  Of course the content of the article is great too; there are many people who cannot tolerate psychiatric medications or simply do not want to use medicine to treat their psychological issues, and this (and many other) article(s) supports these individuals in not caving in to popping a pill to rid themselves of psychological pain.  Now, please don’t get me wrong… in no way am I opposed to appropriate use of psychiatric medication.  However, I am very frequently disappointed by medical professionals who prescribe antidepressants, sleep aids and antianxiety medications without considering empirically validated better options first or at least in conjunction with the medications.

Overuse of Antidepressants

January 23, 2013

Look around the room and you’re likely to find at least one person who is on an antidepressant medication now.  I just did a Google search for the “top prescription drugs” and according to Drugs.com, one antidepressant and another psychiatric medication are in the top ten ranking.  I often perform this search with my patients and there have been times when three or even four of the top ten prescribed drugs have been antidepressants and antianxiety medications.

In a recent piece in The Daily Telegraph from the UK, a general practitioner spoke out about the overuse of such medications, often without adequate discussion about the potential side effects of these drugs.  I couldn’t agree more.  Now with that said, I should be clear: I often recommend (sometimes quite strongly) that some of my patients consider taking antidepressant and other psychiatric medications.  We should not be polarized in our thinking about such treatment… these meds are often quite effective and when properly prescribed can have limited side effects (or we can even “leverage” the side effects to our advantage by prescribing antidepressants that have a more sedating side effect profile to patients with insomnia or meds with a more activating side effect profile to folks having trouble getting out of bed in the morning).  But such medications should not be used instead of other treatments such as psychotherapy; they are typically most effective when used in conjunction with talk therapy.  For more information see some of my other blog posts such as APA Promotes Psychotherapy and Use of Antidepressants.

APA Promotes Psychotherapy

October 17, 2012

The American Psychological Association (APA) recently launched a new awareness initiative about the benefits of psychotherapy.  There are a couple cute videos (below) that mock the pharmaceutical commercials that we see too often.  Though I very much appreciate this approach, I do not fully agree with the claim that psychotherapy has no negative side effects.  I can’t think of anything we can ingest, be exposed to or do that doesn’t have some side effects; for example everything we do comes at the expense of something else that we otherwise could have done.  I speak often about “compromise formation” with my patients and consulting clients, and with this concept, I believe firmly that psychotherapy does have side effects, but that they are almost always “worth it” from a cost-benefit analysis perspective.

Enjoy the videos…

 

Use of Antidepressants

October 20, 2011

The CDC just put out a report about Americans’ use of antidepressants.  The paper has already gotten a bunch of press (Washington Post, CNN, Reuters to name a few).  Some of the key bullet points of the paper are:

  • Eleven percent of Americans aged 12 years and over take antidepressant medication.
  • Females are more likely to take antidepressants than are males, and non-Hispanic white persons are more likely to take antidepressants than are non-Hispanic black and Mexican-American persons.
  • About one-third of persons with severe depressive symptoms take antidepressant medication.
  • More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.
  • Less than one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.

Wow, that’s a lot of info to digest, but a couple points stand out for me: 1) only one third of severely depressed people take antidepressants, and 2) less than one third of people taking antidepressants have seen a psychologist, psychiatrist or social worker.  What this means is that the people who most need antidepressant medication are not taking any, and most people who are taking such medication don’t access services that can either replace, or serve as adjunctive treatment to, the antidepressant medication they are already taking.

Individual Therapy & Counseling

Through individual psychotherapy, I can help you improve your relationships with others in your life, stabilize your moods and cope with anxieties and worries.

Couples & Marital Therapy

If you and your partner are struggling to communicate with each other, having problems with romance and intimacy or even dealing with an affair, by engaging in couples therapy I can help the two of you refocus yourselves back onto improving your relationship.

Why Dr. Heitt?

I bring decades of experience working in a variety of settings and with a variety of people to my clinical practice. In addition to doing therapy with couples and individuals, I specialize in helping people like you deal with work-related problems.