Depression treatments should include offering a client either counselling or medication initially, or in treatment resistant cases, a combination of both. Research studies into Interpersonal Psychotherapy in the 70s found that medication and counselling treatments were equally effective.
What is IPT and CBT?
Interpersonal Psychotherapy (IPT) and Cognitive Behaviour Therapy (CBT) are counselling methods that have been used extensively with depression. Most psychologists are familiar with both. I’ve reviewed the basic concepts of both which I’ve found to be helpful with psychology students and clients who are keen to learn more.
Both types of therapy are time limited and delivered in typically about 10-12 sessions. This is why our medical treatment system in Australia (Medicare) supports 10 sessions supported by Medicare rebates. In both forms of therapy the therapist helps diagnose, formulate and guide the process of recovery. In IPT clients are diagnosed with difficulties in role conflict, life transitions, grief or lacking social confidence (skills deficits), in CBT depending on the theory clients are given an analysis of dysfunctional thoughts.
Both therapies will expected clients to utilise new strategies at home between weekly visits, to reinforce learning and provide more detailed accounts of the problems encountered. At the end of therapy a psychologist will evaluate the effectiveness of the treatment with a questionnaire or interview questions and provide an analysis of the pre and post test results to the client.
IPT and CBT have strategies for problem solving, provide emotional support and work well when your GP or psychiatrist are actively involved. Both therapies deal with current issues and tend to not delve deeply into the psyche or past events, unless there is an identifiable trauma. Both work with or without medication.
How are IPT and CBT different?
The roles of the IPT and CBT therapist are a little different in theory. A CBT therapist tends to work in a more directive manner, and a CBT therapist is the an “expert” role. An IPT therapist works with a less directive style and more collaboratively demonstrating the desired roles and communication styles that leads to effective management of roles. In practice I believe the therapist is possible more or less directive by nature and would probably deliver either treatment with the same way.
In CBT clients would write their thoughts into a diary for analysis and consider the behaviours that linked to the way they think. Treatment focuses on changing the thoughts and core beliefs that underlay the behaviours that occur. In IPT clients would be encouraged to practice communicating differently, with more affiliation and moving away from dominant and submissive behaviour and towards communicating in an way that respected the roles of both in the conversation.
What should I do with my Medication?
Psychologists can analyse your risks by considering the factors involved in the development of depression and the family history of depression. Psychologists would encourage you to decide what to do with your medication as this is an topic that is contracted between the client and prescriber. Psychologists do not prescribe, so we are not the ones contracting with you over the decision to take medication.
As a general common sense approach, it is a good idea to tell your GP or psychiatrist before you plan to change or stop any medication. Have a conversation about the risks and benefits. Some psychologists like myself have attended extra courses and have sort professional training or supervision in the area of psycho-pharmacology. If you decide that you want to change or cease medication there are many hints and tips you may wish to use about “how” to do that from your prescriber. Sometimes if the prescriber chats with the psychologist they can work out a plan to minimise the side effects of medication changes. Just a few tips learnt the hard way by a few of my clients:
- If you are taking an SNRI anti-depressant, some are particularly painful to change or stop. Like some anti-anxiety medications, slow and steady wins the race.
- Do not plan to change or cease medication if you have major life changes occurring. IF you are someone who might have serious side effects from changing medications you will need extra time to “chill out” and be nice to yourself.
- Familiarise yourself with the website of the National Prescribing Service, rather than Dr Google. The NPS has wonderful fact sheets listing side effects and information on medication. I totally support being well inform by the most up to date information. They have apps and all sorts of excellent info on managing medication.
- Start therapy first and gain your psychologists assessment of the risks and benefits of trying therapy instead of medication. Sometimes we can clearly identify a depression risk factor that can be managed, other times we can’t. Therapy works best when the thing that causes depression can be managed (e.g. exercise, relationships, work hours, parenting, poor sleep, etc)
- It is reasonable for the typical case of depression to try either medication or therapy and if that does not work after a 1-2 months, the use both together. If medication works, then I tend to suggest that we end the therapy process as the problem is resolved and attendance has no purpose.
If you have treatment resistant depression and would like a review of factors I’m happy to provide an assessment and comprehensive feedback to your and other in your family or treating professionals. Because I’m a psychologist, I don’t have a script pad and therefore cannot prescribe medication. Therefore my strategies are primarily counselling strategies focusing on relationships, diet and exercise, motivation and lifestyle. Medication is the second option IF the counselling doesn’t work. I’m also keen to assess which therapies you have tried and offer something you haven’t tried.
Medicare rebates are available with a referral from your GP. Many of my clients use private health and consult with me first to see if they might need a mental health plan or not.
Author: Vivian Jarrett MAPS, MAICD, B Psych (hon), GCert (ResCom)
***Finalist Telstra Business Women’s Awards Qld – Entrepreneur
Vivian Jarrett is a psychologist, passionate about providing high quality psychology services to Australians from all walks of life.
She has worked extensively with women, especially during pregnancy and the ante-natal period.