It has long been detrimental for physicians to prescribe antidepressants and anti anxiety meds without strongly recommending psychotherapy at the same time. In my practice I have found that the combination is the most effective.

Although medication may often kickstart a process of healing, pills don’t teach skills. And medication don’t change the situation! There will always be a place for approaches that work on the cerebral cortex rather than the brain stem.

Being a masters level clinician in a community mental health setting I have seen the persistent pendulum swing towards psychotropics as the treatment of choice for the majority of folks seeking behavioral health treatment.It does appear that psychotherapy is still in favor with more middle class clients while indigent or lower class clients favor medication.

Drugging clients. Interesting to say.
There is a talk by Ken Robinson on the website RSA.com, "Changing the Paradigm of Education". In it he says that we are drugging our children, and he shows a map of where ADD is prevalent. Children live in the most stimulating times ever and we ask them to sit in schools for far too many hours and pay attention to boring work. When they can't sit still we deem their behavior a problem and medicate them. Is the same thing happening with depression?
I will suggest that the field of psychology needs to change it paradigm as well. The advent of Neuroscience will at some point incorporate psychology. Far too many mental illness may not be illnesses at all. As Howard Gardner suggested 20 or more years ago, we are all differently oriented, we are not the same. We must begin to understand others as we now understand people with different sexual orientations, which was also once a diagnosed "illness." The is not psychology which needs treatment, but social psychology which needs educating.
One thing seems certain, if we react to someone as if they're behavior is the problem it will be.
T A Hoppe dustproduction@gmail.com

I am a person that has benefited from both medication and therapy. At first I just had therapy. It was helpful, but I continued to have mood swings. When I went on medication, therapy was even more helpful because I was stable enough to apply what I was learning, instead of always being in a crisis. In my earlier years, my doctor tried to get me off the medication a number of times, and the results were not good. I would much rather be on medication and sane, than drug free and "crazy". I am now a therapist, and believe both are important.

As person who deals with long-term disability and pain, I am so thankful that many years ago my family practice physician said that pain and depression exacerbate one another. I'm an LIMHP and with several meds have been able to have a stable, good life with friends, family, and amazingly satisfying work. Help from professionals like he, who work with the whole individual without preconceived ideas of what helps EVERYBODY, has saved my life many times over. I'm a fan of psychotherapy for lots of folks, too; but for me, as well as for some of my clients, "fixing" our situations with counseling alone isn't an option. I hope we can all continue to listen carefully to folks, let them know about the options available, and assume that almost everybody should decide what's best for him/her at the time.

I am enjoying this conversation. Thanks, Rich. My pet peeve about this topic is that it is so often offered in the language of drugs “vs” psychotherapy. It’s not a contest. Our job is to become knowledgeable enough and creative enough to discover and implement the best course of treatment for each individual client. In my experience, the way to do that is to think expansively, not in the constrictive terms of “either/or’s.”

I just read an article from the New York Times regarding a study that stated 31% of college students are so depressed it is difficult to function. What are the implications here? Are most going to start a lifetime of medication beginning at the student health center, or find other ways? The article alluded as well to hopelessness among almost half of the students questioned. On another note, I have never forgotten the depression management group I ran as an intern using basic CB techniques and the vast improvement of most of the clients.

As a person recovering from depression and anxiety, I found that a combined approach worked best. Today I am able to stay in a positive frame of mind by watching what I eat - sugar and wheat lead to definite down feelings, taking nutritional supplements - theanine by Thorne is really helpful right now, continuing in "talk therapy" for support, Using ESM (Emotional Self Management - an energy psychology) and working with an Applied Knesiologist. My primary care doctor has been helpful by signing for blood tests that track improving health. I tried drugs for a couple of years for anxiety and depression and felt they were only mildly effective. Fortunately, my AK doctor muscle tested a bunch of samples and we found the one that was helpful to my body. This saved a lot of time and frustration with experimentation.

Fascinating as this discussion is, it fails to consider the reality that the kind of depressed clients who walk upright into our private practices seeking help are a very tiny fraction of the much larger population of depressed and otherwise mentally ill individuals, most of whom are chronic, dysfunctional and incapable of asking for much of anything, let alone help to get well. The idea that these individuals can assist in their own recovery may be true for the limited few of these who understand that the concept of recovery actually applies to them and who have the resources (cash, insurance, a support system) to access therapy and who also recognize that there is a normal (beyond their current state) that is attainable by them. However, by definition, these are the highest functioning souls.
Having worked with these populations in a variety of settings, I could rail with the best of them at the failure of the systems that are designed to care for these individuals and, instead, suck them dry and further deprive them of hope for anything better. And I could declare with absolute certainty that most meds are over prescribed and create dependency and often further disable clients because of their side effects.
Or, I can tell you that these individuals are my heroes. They get up every day and come together in programs where they form, on however limited a basis, community. I laughed with them, I cried with them and I hope I supported their process. I gave them my presence and shared theirs, to the extent that it was possible to do so. We shared human contact. Anything else was mere happenstance and, possibly, ego (mine!).
I can also tell you that, no matter my skills and good intentions, none of them would ever attain what we might describe as "wellness." And few if any could have even begun to consider such concepts as "cause" and "effect" as it might have related to their current condition.
So, when we speak of helping our depressed and otherwise mentally ill clients, we must first be prepared to be present with them and hope that they will come to trust us enough to let us in. Their world is not like ours and, when invited in, we must be gracious guests. When someone is 7'5" tall, my telling him/her to think short thoughts is meaningless, to say nothing of useless, especially if the only entrance into my purportedly normal (and thereby desireable) world is designed for people no larger than 3'2" in height. In my experience, depressed patients do better in group therapy than in individual therapy. They don't need to feel sick so much as they need to find/form community.
When clients show up, that tells me they are motivated. It is possible that meds will be helpful, or not. Unless they want meds, I am willing to work with them as is. Is this always successful? No. But it's a place of beginning and that is crucial. Once the client engages, then it may be possible to consider other potential treatment options.
Unless my client represents harm to self or others, I am not the decider about my client's decisions. At best, my input may be sought and considered. My task is to create and maintain an airspace, a cushion of relative comfort, a sacred space where the client can think, reflect, consider and make decisions for him/herself.
On a good day (and I've had some), this approach works well for me.

Caryn, Oxnard, CA

It is also important to assess for potential medical causality regarding depression. For example, some pituitary tumors and other neuroendocrine disorders often present with depression, anxiety, and even look bipolar (often misdiagnosed as such). Neither therapy nor psychotropics will fix such cases. Few of the psychiatrists I know assess for such things and even fewer therapists are aware of the prevalence and impact of these disorders.

How can you say that therapy has no side effects? Where is the conclusive research that shows that? Certainly, therapy that is less than fully effective has a lot of side effects, including disinclining people to turn to therapy again and, perhaps, increasing the length of suffering when medications may have been helpful for that particular individual. Neither medications nor psychotherapy are anywhere near as effective, today, as we would like (or as we pretend). The unexplained variance is generally at least as great as the explained variance, if not greater. With regards to depression, evidence suggests a similar outcome, given enough time, of therapy, meds, or neither. As research moves (hopefully) from linear to complex and dynamical analyses we may understand more, including the meaning of initial conditions, but for now our methods are much to crude and ineffective. Choosing between psychotherapy and psychopharmacology, today, is like choosing between a rock or a stick.

I've found that clients find their concerns about side effects are often minimized or ignored by their doctor. To assist my client's in their journey I've reframed the medication as an emotional pain medication to allow the real problem to be addressed more easily. Another thought, when was the last we heard of a client going through 1 years or more of withdrawal from therapy? Anti-drepressants, well, it happens all too often.