Medication can help you get the most out of therapy — a psychologist and neuroscientist explains how

There is a growing recognition in the scientific community that combining different treatment approaches for mental illness can produce benefits that are greater than the sum of its parts.

As a clinical psychologist and neuroscientist, I work to integrate insights from both fields to expand treatment options for people suffering from depression, anxiety, and related disorders.

Developing a treatment plan that pays careful attention to the sequencing and dosing of both biological and behavioral therapies could bring new benefits to people that neither approach can achieve alone.

Anxiety and depression are the most common mental illnesses worldwide.

Approximately 280 million people worldwide suffer from depression, and up to one in three will meet diagnostic criteria for an anxiety disorder at some point in their lives.

There are many effective treatment options for both disorders, including medication, psychotherapy, lifestyle changes, and neurostimulation.

Doctors and therapists recommend that many patients seeking mental health care try multiple approaches, such as medication and therapy, at the same time.

This is based on the idea that if they responded well to any of the treatments prescribed, they would feel a net benefit faster or more than if they tried each one in turn.

However, researchers in the past have studied each approach in isolation. Most research has focused on comparing individual treatments individually to a control, such as a placebo pill or a psychotherapy waiting list.

Neuroplasticity and Treatment

Recent advances in the scientific understanding of depression, anxiety, and other stress-related disorders suggest that changes and impairments in neuroplasticity are key contributors.

Neuroplasticity refers to the brain’s ability to flexibly adapt to an ever-changing environment – it is a crucial component of learning.

In animal studies, deficits in neuroplasticity are viewed as changes in molecular and neuronal pathways, such as a reduced number of synapses, or contact points between neurons, as a result of chronic stress.

These changes could be related to mental patterns and symptoms of depression and anxiety in people, for example when patients report a reduced ability to think, feel and act flexibly.

They may also be related to the fact that thinking, remembering, and interpreting information tends to be negative.

Research has shown that many effective biological treatments, including drugs and neurostimulation, can improve or alter neuroplasticity.

Certain lifestyle changes, such as regular exercise, can have similar effects. Scientists consider this key to relieving symptoms. Unfortunately, symptoms often recur when these treatments are discontinued.

Relapses are particularly evident with medication. With both older and newer antidepressants and antianxiety drugs, relapse rates begin to rise soon after patients stop treatment.

In contrast, behavioral treatments such as psychotherapy create new skills and habits that may last longer. The benefits remain even after the end of the most intensive treatment phase.

Regular meetings with a therapist over a period of months can help many patients learn new ways of dealing with negative symptoms and life circumstances.

However, this learning depends on neuroplasticity to make and maintain these new, helpful pathways in the brain.

Researchers posit that enhancing or modulating plasticity through a biological intervention such as medication could not only alleviate symptoms but also offer the opportunity to make behavioral interventions such as psychotherapy more effective.

Learning-based interventions such as cognitive-behavioral or exposure therapy, if properly timed, could take advantage of the enhanced neuroplasticity that biological interventions evoke and improve long-term outcomes.

Think of the pathways in the brain as roads. Biological treatments are transforming a sparsely connected network of roads — made up of just a few beaten paths that reflect unhelpful thoughts, fears, and habits — into a denser network of interconnected, freshly paved roads.

Behavioral treatments can be likened to repeatedly navigating a specific subset of new roads that lead to more balanced perspectives on yourself and the world around you, and learning them until you can navigate them with ease, without the need for GPS.

This ensures that the paths you are already familiar with are available to you in the future and protects you from the recurrence of anxiety and depression.

Synergies in the combined treatment

The development of combined treatments to explicitly promote synergy is relatively new and there is growing evidence to support this. A few concrete examples are noteworthy.

First, some studies have shown that D-cycloserine, an antibiotic used to treat tuberculosis, can make exposure therapy for anxiety more effective by helping patients manage their fears.

D-cycloserine may also enhance the antidepressant effects of a type of neurostimulation called transcranial magnetic stimulation, which uses magnetic fields to stimulate nerve cells.

Several studies suggest that combining neurostimulation with cognitive behavioral approaches such as cognitive behavioral therapy or cognitive control training may result in longer-term reductions in depression and anxiety.

Likewise, low doses of ketamine, a drug used in general anesthesia that has a rapid antidepressant effect, can be used to prime the pump for new, helpful learning.

A study my team and I conducted found that doing 30 to 40 minutes of daily computer-assisted exercise for four days after a single dose of ketamine resulted in a nine-fold increase in the duration of antidepressant effects—90 days with fewer symptoms—compared to ketamine alone. resulting in 10-day symptom relief.

Finally, there is increasing interest in using other drugs with psychedelic properties to support psychotherapy.

The therapeutic benefit of taking these psychedelic-assisted therapies under medical supervision has been attributed to the rapid neuroplasticity-enhancing and mind-altering effects of drugs like psilocybin and MDMA.

Researchers believe that these short-term effects encourage new insights and perspectives that psychotherapists can help patients integrate into their long-term worldview.

There is great potential for neuroscience-driven ways to combine treatments.

However, it is important to note that different treatment approaches can occasionally work against each other, which can limit the long-term benefits of psychotherapy alone.

For example, a study of panic disorders found that patients who learned psychotherapy techniques while taking anti-anxiety medications had a higher risk of relapse after they stopped taking them than patients who only received psychotherapy.

Carefully designed clinical trials and long-term follow-up are required to fully understand how to combine biological and behavioral aspects to develop treatments that are efficient, accessible, safe and durable.

Written by Rebecca Price. The conversation.

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