Medication? Therapy? Both?
One of the most common questions that I receive regarding the treatment of children and adolescents is if/when to use psychotropic medication to treat emotional and behavior problems. There is no simple answer to these questions as each individual case is unique. Generally speaking, many psychological issues can be and have been treated successfully with psychotherapy alone. For example, Clarke (2005) found that a therapeutic strategy called cognitive restructuring was more effective in the treatment of adolescent depressive symptoms that the use of a certain class of medication called Selective Serotonin Reuptake Inhibitors (SSRI’s). Similar results have been found in treating anxiety disorders, trauma, Asperger’s Syndrome, and Oppositional Defiant Disorder.
There are some diagnoses, however, where both medication and psychotherapy is recommended and necessary. For example, when Bipolar Disorder is appropriately diagnosed, the most successful treatments incorporate both the biochemical treatment options as well as the talk therapy to develop appropriate self-awareness and coping skills. The same is true with treating the symptoms of severe AD/HD.
In general, I am typically not a proponent of medication as the first treatment option (unless the diagnosis clearly calls for it). In my practice, a thorough assessment is conducted, diagnostic considerations are made, and therapy commences. If I feel that treatment is not going as planned or progress is not being seen, I will generally make a referral for medication evaluation to be conducted by a trusted colleague.
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