Psychotherapy versus medication

Following initial assessment, including evaluation of potential suicidality, support systems, and need for inpatient versus outpatient treatment, MW was hospitalized briefly, then followed in the community on medication along with psychotherapy. She has abstained from illicit substances and has returned to her job. She has responded well to treatment with sustained-release lithium carbonate 900 mg once daily at bedtime with a snack. Steady-state 12-hour serum lithium concentrations have stabilized at 0.9 mEq/L (0.9 mmol/L). She now returns to clinic for routine followup. She has tolerated the lithium except for a mild tremor and a gain of 7 pounds (3.2 kg). She is willing to accept these side effects for now, but asks about how long she must take medication since she is now feeling well. 

Specific Sociai Anxiety Disorder, Acute Phase Treatment. Different strategies have evolved for treating specific social anxiety disorder versus generalized social anxiety disorder. Less complicated is the management of the specific subtype. Exposure-based psychotherapy is a mainstay of treatment, and as-needed medication doses prior to scheduled performances are also widely used. Preferred agents for performance anxiety are alprazolam or propranolol. 

Although most controlled trials lasted only weeks, the longitudinal study of the effect of psychotherapy versus drugs by May et al. ( 20, 21) is particularly germane. Schizophrenic patients were randomly assigned to either antipsychotics or no medication. After 6 months or more, the initial nonmedication group was then given... 

After several recurrences, substantial evidence indicates that maintenance treatment is necessary. Patients who have had many episodes but make a good recovery from the acute exacerbation benefit most from maintenance medication. Those who have the least drug-psychotherapy versus no treatment difference tend to benefit least from maintenance pharmacotherapy (219). For example, Prien and his colleagues (212, 220, 221) found that chronically hospitalized patients maintained on low-dose antipsychotics had fewer relapses than those who needed more medication (relapse percentages by categories of medication dose and chronicity Table 5-19). 

Antonuccio, D., Danton, W., 8c DeNelsky, G. (1995). Psychotherapy versus medication for depression Challenging the conventional wisdom with data. Professional Psychology Research and Practice, 26, 574-585. 

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