How is treatment for psychiatric illnesses decided? And when to start medicines?
As a psychiatrist, one of the most common questions that is asked to me is “Cant this be cured with counselling?”
Patients often come to me and categorically state that they need counselling. Maybe it’s what they have heard from their friends and colleagues, or it’s what they have read online, but they come with a fixed mindset of taking counselling. As pointed out in our previous posts, there is a lot of Western influence regarding counselling and they hope to replicate the same process here, especially on the part of the therapist.
Let me take this opportunity to tell you, how as a psychiatrist, i/we decide upon the need for treatment.
Let’s take depression for example:
When a patient comes to us and describes his/her symptoms which fit into the depressive syndrome, the diagnosis of clinical depression is based on the following basis:
- The presence of symptoms as required by The DSM criteria
- The presence of symptoms for an adequate duration of time (at least 15 days)
- The presence of any symptoms which puts the patient’s life at risk (e.g. suicidal thoughts/intentions)
- Most importantly, the impact that these symptoms have on personal, professional and social life. Symptoms have to cause impairment on any or all of these fronts.
Once it is established that the symptoms meet all the above-mentioned criteria, treatment options are looked into.
Counselling or talk therapy can be used only when:
- There are mild symptoms, with minimal to no impact on routine actions/activities
- There is an external factor or component which is responsible for these symptoms. For e.g. social, personal discord
Its important to note that counselling can be utilised effectively only when the patient is willing to apply all of the techniques taught in real life and not just on the couch.
Now if your symptoms are not mild and there are no external factors that are responsible, then counselling would not be of any help.
These symptoms are due to a deficiency of certain brain chemicals such as Serotonin, dopamine and norepinephrine.
These brain chemicals need to be given externally in the form of pills or injectables and can not be supplemented by food or other vitamins. Medicines are decided based on the symptom profile and other aspects of an individual patient.
All patients are different and are treated in a different manner.
Thus the take home points include:
- Evaluate your depression
- Understand how severe it is
- Ask your psychiatrist about the various psychiatric treatment options
- Understand if there are external factors causing it or not
- Medicines are absolutely necessary for moderate to severe depression
- Counselling is equal to life style changes. It’s an add on treatment, not the only treatment.
- Counselling is of no value in psychotic illnesses.
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