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I am a 33 year old female. I recently started treatment for clinical depression with a psychotherapist. She referred me to a psychiatrist for medication (Celexa), but wanted me to continue weekly sessions with her. The psychiatrist told me that I do not need to continue treatment with her if I am undergoing treatment with him once every two weeks. I like the psychiatrist’s straight forward methods a little better, but I want to make sure I’m getting the help I need to get through this. This is very confusing. It was a big step for me to initiate therapy to start with, as I was having trouble even getting out my front door. Now I feel like I’m obligated to both of them and don’t know what to do. Is it counterproductive to undergo treatment with two different people who have different orientations? What type of treatment would you recommend for clinical depression?

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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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.

You raise an interesting question that has no clear-cut answer. Have you ever heard of the “mind-body problem”? The mind-body problem is an old philosophical question about the nature of human beings that has been asked for thousands of years, “Is our true nature mental (spiritual)?, or physical (body, animal). If we are both, how is that possible?”. Our ancestors had this thing about making us choose between being spirit or body. The best answer available today is that the question is poorly formed and that there is no reason for us to have to choose between being minds or bodies – we are both at the same time. The division of mental/spiritual things from body things continues to plague us, however, in the form of the division of labor in the health professions (with psychiatrists who do body stuff and psychotherapists who do mental and behavioral stuff).


p>Depression, like many mental health problems, is neither a purely medical/body problem nor a purely mental/behavioral problem. Rather, depression is both a medical problem and a behavioral problem at the same time. The medical and behavioral systems are totally connected. If you give drugs to change someone’s mood, you will also change their behavior. If you can get a person to change their behavior, you will change their mood and the underlying chemicals that support that mood.


p>The ‘right’ treatment for depression will depend on what your resources are and how you want to proceed based on your own take on these issues. You’re taking medicine for depression is a good thing – medicine will almost surely help you to feel better. But no amount of medicine will help you to work on the things that helped you to become depressed in the first place. Rather, medicine will serve as a means of support only – something which will keep you from becoming depressed again only so long as you continue to take the medicine. ‘Psychotherapy’ has a better chance of helping you to learn how to not become depressive again (or to become less so anyway) but it is more variable in nature, and takes longer to work. The best treatment package for most persons is to do a combination of both approaches at once. Also – it is important for you to figure out what you are most comfortable with (medications or therapy or both) – your preferences are an important factor in your treatment!.


p>If you do decide to continue with both clinicians, it is best if they can find a way to work together. Since your psychotherapist seems to be willing to work with the medical doctor (good for him or her!) – I’d ask your medical doctor why he/she is not willing to coordinate treatment with the psychotherapist. This is very much standard practice in most parts of the world.

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