Integrating pharmacotherapy and psychotherapy

The two most powerful tools in the treatment of psychiatric disorders are psychopharmacology and psychotherapy. In most cases, patients greatly benefit from a combination of both; however, due to increasing specialisation, this is less and less provided by the same therapist. Instead, medical professionals such as psychiatrists often tend to focus more on treatment strategies based on drugs, whereas psychologists emphasise psychotherapeutic approaches. Therefore, close collaboration is required between the different therapists involved in the treatment of one psychiatric patient.

In the past years, the number of drugs used in psychiatry has expanded considerably. At the same time, a plethora of different techniques have been developed in the field of psychotherapy. Furthermore, while monotherapy with just one specific psychotropic substance is desirable, many patients need a combination of different drugs because of the severity of their symptoms. Similarly, modern psychotherapy typically does no longer adhere to just one “school of thinking”, but rather favours an eclectical approach combining different techniques of various methods, depending on the needs of each individual patient.

The clinically important issue of combining psychotherapy with pharmacological strategies is reflected in an ever increasing body of publications reviewing the state-of-the art in the treatment of stress and trauma, depressive disorders, anxiety disorders, dissociative disorders, personality disorders, post-traumatic stress-disorder (PTSD) and other neuropsychiatric conditions (Pratchett et al. 2011; von Wolff et al. 2012; Cuijpers et al. 2013; Gentile et al. 2013, 2014; Lam et al. 2013; Huhn et al. 2014; Zilcha-Mano et al. 2014; Hersh 2015).

During the 11th Hanse symposium which took place in Rostock from 7 to 8 September 2013, experts in the field discussed the possibilities of an improved integration of psychotherapy and pharmacotherapy, contributing with key lectures entitled “Optimizing treatments of schizophrenia and mechanism of antipsychotic drugs”, “The role of natural medicine in psychiatry”, “Chronotherapy in affective disorders and dementia”, “ADHD medication and its effects on the brain”, “Caveats of combination therapy”, “ACT (acceptance and commitment therapy), the third wave of behavioural therapy”, “ACT for inpatients”, “ACT in the preparation of teachers for an inclusion setting”, “ACT and its noble kinsmen”.

For this supplement, additional authors contributed, discussing various aspects such as “Depressiveness, symptoms of anxiety and cognitive dysfunctions in patients with asthma and chronic obstructive pulmonary disease (COPD): possible associations with inflammation markers: a pilot study” (Bratek et al.), “Does prior sepsis after subsequent circadian and sickness behaviour respond to lipopolysaccharide treatment in mice?” (Coogan et al.), “Multiplatform metabolome and proteome profiling identifies the serum metabolite and protein signatures as prospective biomarkers for schizophrenia” (Dudley et al.), “Repetitive transcranial magnetic stimulation (rTMS) in schizophrenia with treatment-refractory auditory hallucinations and major self-mutilation” (Höppner et al.), “Diurnal rodents as an advantageous model for affective disorders: novel data from diurnal degu (Octodon degus)” (Kronfeld-Schor et al.), “Polypharmacy in the treatment of subjects with intellectual disability” (Reis et al.), “Agomelatine: an agent against anhedonia and abulia?” (Thome et al.), “Detection of feigned attention deficit hyperactivity disorder” (Tucha et al.), “Novel putative mechanisms to link circadian clocks to healthy aging”, “Vascular cognitive impairment, dementia, aging and energy demand. A vicious cycle”, “Neurovascular remodeling in the aged ischemic brain”, “Mechanisms underlying the neuroprotective effect of brain reserve against late life depression” (Popa-Wagner et al.), “The potential of biomarkers in psychiatry: focus on proteomics” (Woods et al.).

With these contributions, the authors have considerably enlarged the thematic field on which the symposium had originally focused. Nevertheless, this collection of papers gives a fascinating overview of present-day developments in psychiatry and on how fundamental as well as clinical research can contribute to improving patients’ condition.

References

  1. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF 3rd (2013) The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry 12:137–148. doi:10.1002/wps.20038

    PubMed Central  PubMed  Article  Google Scholar 

  2. Gentile JP, Dillon KS, Gillig PM (2013) Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innov Clin Neurosci 10:22–29

    PubMed Central  PubMed  Google Scholar 

  3. Gentile JP, Snyder M, Marie Gillig P (2014) STRESS AND TRAUMA: psychotherapy and pharmacotherapy for depersonalization/derealization disorder. Innov Clin Neurosci 11:37–41

    PubMed Central  PubMed  Google Scholar 

  4. Hersh RG (2015) Using transference-focused psychotherapy principles in the pharmacotherapy of patients with severe personality disorders. Psychodyn Psychiatry 43:181–199. doi:10.1521/pdps.2015.43.2.181

    PubMed  Article  Google Scholar 

  5. Huhn M, Tardy M, Spineli LM, Kissling W, Förstl H, Pitschel-Walz G, Leucht C, Samara M, Dold M, Davis JM, Leucht S (2014) Efficacy of pharmacotherapy and psychotherapy for adult psychiatric disorders: a systematic overview of meta-analyses. JAMA Psychiatry 71:706–715. doi:10.1001/jamapsychiatry.2014.112

    PubMed  Article  Google Scholar 

  6. Lam RW, Parikh SV, Ramasubbu R, Michalak EE, Tam EM, Axler A, Yatham LN, Kennedy SH, Manjunath CV (2013) Effects of combined pharmacotherapy and psychotherapy for improving work functioning in major depressive disorder. Br J Psychiatry 203:358–365. doi:10.1192/bjp.bp.112.125237

    PubMed  Article  Google Scholar 

  7. Pratchett LC, Daly K, Bierer LM, Yehuda R (2011) New approaches to combining pharmacotherapy and psychotherapy for posttraumatic stress disorder. Expert Opin Pharmacother 12:2339–2354. doi:10.1517/14656566.2011.604030

    CAS  PubMed  Article  Google Scholar 

  8. von Wolff A, Hölzel LP, Westphal A, Härter M, Kriston L (2012) Combination of pharmacotherapy and psychotherapy in the treatment of chronic depression: a systematic review and meta-analysis. BMC Psychiatry 12:61. doi:10.1186/1471-244X-12-61

    Article  Google Scholar 

  9. Zilcha-Mano S, Dinger U, McCarthy KS, Barrett MS, Barber JP (2014) Changes in well-being and quality of life in a randomized trial comparing dynamic psychotherapy and pharmacotherapy for major depressive disorder. J Affect Disord 152–154:538–542. doi:10.1016/j.jad.2013.10.015

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Johannes Thome.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Thome, J. Integrating pharmacotherapy and psychotherapy. J Neural Transm 122, 1–2 (2015). https://doi.org/10.1007/s00702-015-1415-3

Download citation