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Should I Continue With Therapy?

Question:

You said that a someone with bipolar disorder should continue with therapy. I was diagnosed with recurring depression. Should I continue with therapy even though my medication is working? I feel better than I have in a long time.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
  • Dr. Dombeck intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
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  • Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.
Answer:

Good question. Excellent question. Before I answer the question, let me make a clarification: where you are asking whether you should continue with ‘therapy’ you are asking specifically about psychotherapy, and not whether you should continue with medication for depression. The clarification is important, I think, because often psychotherapy is just called ‘therapy’ for short, but both psychotherapy and medication are forms of therapy.

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p> The general principle at work here is that people should remain on a therapeutic regime sufficient to control their symptoms so long as that therapeutic regime is necessary to maintain their quality of life. By ‘therapeutic regime’ I mean either medication, or psychotherapy, or both. I’m using the phrase ‘therapeutic regime’ to indicate therapy in the general sense of actions taken to remediate disease.

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p> Because Bipolar illness does not really remit, but rather is a chronic lifelong illness, some level of therapy is necessary at all times. That therapy could be medication alone (if that was sufficient to reduce symptoms to manageable levels), or it could be medication in combination with other therapies (e.g., psychotherapy, diet, etc.). In the case of the Bipolar patient whose question I answered in my November, 2002 column, medication alone was not sufficient to maintain this individual, by her report. Psychotherapy in combination with medication can be more effective than medication alone for this patient, in part because the therapist can make judgments as to when treatment needs to be changed (hospitalization, more or less medicine, etc.) that the patient cannot make in the event that something goes seriously wrong for the patient. Also (and not trivially) the psychotherapist can be a teacher of coping skills and a source of advice for this patient. Because Bipolar illness can be truly dangerous (Bipolar patients can suicide or behave very recklessly while in a depressed or manic state) it would be unethical and insufficient treatment in my view to remove the supportive net of psychotherapy from this particular patient’s treatment plan.

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p> If your depression is being satisfactorily managed by medication alone, and you don’t feel you are deriving any additional benefits from your psychotherapy (and your significant others concur – remember, if you are depressed, your judgment may be impaired and you wouldn’t necessarily know whether psychotherapy was helping) then you may be quite safely able to stop your psychotherapy – at least until you need it again. You should ask your doctor and your therapist for their opinions before making any precipitous decisions. As a rule, it is best to be conservative in these matters and to error on the side of too much therapy rather than too little.

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