Discuss the advantages and disadvantage of combining drug treatment and psychological treatments in the management of a psychiatric illness.



Although there is a long traditional in medicine, stretching back to Hippocrates, which views the mind and body as inextricably linked, the scientific approach to medicine has tended to focus on the physical to the exclusion of psychological components of illness. Psychiatric illness is different from community medicine. Psychiatric illness is mainly the cure of personality and psychological change. There are two types of psychiatry, the Organic Mental Disorder and the Functional Disorder. Depression, Schizophrenia, Anxiety, Alzheimer’s disease falls into the category of the psychiatric illnesses.

Psychology methods are part of all psychiatric treatments, in some cases used alone, in others combined with drugs. Psychological treatments can help you if you are suffering from anxiety, panic, obsession, phobias, some forms of depression and other less serious illness in which you do not lose touch with reality and are able to examine.

Depression is common in primary care and affects many people. The NSF gives figures of more than 100 depressed patients per GP list, but says that 50% of these patients may be unrecognized. 1 Depression is a major risk factor for cardiovascular disease. 2 In addition, patients with depression are much likely to die before the age of 70. Some commentators say depression may impair function and well being as much as diabetes.

3 Three studies found that most patients preferred to receive psychotherapy rather than drug treatment. 3 The first study indicates that 1 of the 27 patients thought unequivocally that antidepressant drugs had helped them. 3 Second study shows that some others thought they help but only in the short-term. 3 The final studies states that the majorities of patients were critical of drugs and felt “fobbed off”.

There is good evidence from trials that antidepressants are effective in acute treatment of all grades of depressive disorders. 4 In addition, no clinically significant differences in effectiveness have been shown between different kinds of antidepressant drug. 4 On average, people seem to tolerate selective serotonin reuptake inhibitors (SSRIs) little more than older drugs, but this difference is too small to be grounds for a policy of always choosing an SSRI as first-line treatment.


One study confirmed that tricyclic antidepressants (TCAs) tend to be used in lower than recommended doses in general practice. 5 Antidepressants were commonly given for short and probably ineffective durations. However, they seem to be safe in the doses used in clinical practice.



6 Discontinuation syndromes can occur with any antidepressant; they usually start abruptly within a few days of stopping the drug and resolve quickly (usually within 24hours) if the drug is restarted. Symptoms may include abdominal pain, nausea, vomiting, diarrhoea, flu-like symptoms, fatigue, anxiety, agitation and nightmares. Other reported symptoms are dizziness, lethargy and headache, anxiety, balance problems, tremor, sweating and insomnia.

Depression is a difficult diagnosis to make in general practice. Depression tends to be under recognized. Non-drug treatments should be offered but access to these in primary care may be an issue. Drug treatment: choice of drug should be tailored to the individual patient.

Psychological treatments are approximately as successful in treating depression as drugs. Although evidence is somewhat inconsistent, it appears as if combining drug and psychological treatments enhance success. It is suggested that the combination provides short-term relief from drug therapy and longer term results from psychological therapies.

Another combination treatment which shows promise is schizophrenia. In the January issue of the journal Neuropsychopharmacology. Portland Veterans Affairs Medical Center researchers and colleagues have found that combining the anticonvulsant drug divalproex with either olanzapine or risperidone-two commonly used antipsychotic drugs-significantly enhanced and hastened responses in patients suffering from acute psychotic episodes of schizophrenia.

Study leader Daniel E. Casey, M.D., Associate Director of Research for the VA Northwest Network\\

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