Dear Therapist:

I have struggled with anxiety and depression on and off for years. Recently, after a stressful medical situation, my symptoms became worse, and I returned to therapy.

My therapist has recommended medication. I have always been somewhat hesitant because of concerns about side effects and personality changes. My husband is also strongly opposed to medication, believing it can alter personality and cause emotional “numbness.”

How do clinicians determine when medication is appropriate for anxiety and depression versus therapy alone? And what does the research actually show about how these medications affect personality and emotional functioning?

Response:

I’m sorry that your anxiety and depression have worsened. Hopefully, proper therapy can help alleviate your symptoms and help you deal with life issues in a more adaptive way.

With regard to medication, unless your therapist is also a prescriber, they should not be specifically recommending medication. Each practitioner has their area of expertise. Just as you wouldn’t ask a psychiatrist without therapy training for therapeutic guidance, you should not expect a non-prescribing therapist to advise you about medication itself.

Perhaps your therapist recommended a psychiatric consultation. That can be appropriate when a therapist believes medication may be indicated. In your position, one important question to consider is whether your therapy is adequately addressing your needs. There are times when the therapeutic process itself needs to shift or expand.

There are various therapeutic modalities, such as CBT, psychoanalysis, humanistic therapy, and trauma-focused approaches. An eclectic therapist draws from different modalities as appropriate. Studies have shown that eclectic therapy is often quite effective, which may seem somewhat self-evident given that different people and needs respond to different approaches. However, proper eclectic therapy can be complex and often requires significant experience in identifying and applying the right techniques at the right times.

Therapists are human and not infallible. Even very good therapists can sometimes become stuck, complacent, or frustrated. If your therapist focuses heavily on one modality, you might ask whether other approaches could be explored. If you feel that the recommendation for psychiatric consultation may reflect your therapist’s frustration with the therapy process, it is reasonable to ask for further discussion and clarification.

If, however, you trust your therapist and feel that the therapy has generally been appropriate and helpful, your main concern may simply be your hesitation regarding medication. While it is not within my professional purview to discuss medication in detail, I can speak generally from professional and personal experience.

I have known many people who are—or have been—on medications for anxiety and depression. A significant percentage of people in the United States will take some form of psychiatric medication at some point in their lives. (Recent surveys place current usage at about 25% and lifetime usage at closer to 50%.) This means that many people you know are likely taking, or have taken, antidepressant or anti-anxiety medication. In my experience, what people sometimes describe as “personality changes” are often simply the result of reduced anxiety or depression. However, this is anecdotal and not a medical opinion.

When I encounter someone who is reluctant to consider medication, I often remind them that there are many steps between considering the idea and actually taking medication. There is no harm in speaking with a psychiatrist and asking questions. Then you can decide whether to schedule an appointment. If you keep the appointment, you can ask additional questions and better understand the psychiatrist’s recommendations. Even if you are given a prescription, you can decide whether to fill it. And if you choose to begin taking medication, you can always discuss dosage adjustments or discontinuation with the psychiatrist.

These decisions are ultimately yours to make. If you decide to consult with a psychiatrist, it is both your right and your responsibility to gather the information you need in order to feel comfortable with whatever decisions you ultimately make.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 adjunct professor at Touro University

 Graduate School of Social Work

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200