Must Medication Be Discontinued for Psychoanalysis to Be Successful

If medication is to be used with patients in analysis, must medication be stopped in order to demonstrate analytic success? While effective analysis leads to greater capacity for self-understanding and emotional modulation (see below) it remains unclear whether this protects from the recurrence of Axis I disorders. Patients with obsessive-compulsive disorder gain relief of symptoms with medication but typically relapse once medication is stopped. Most evidence suggests that psychodynamic therapies are not helpful for obsessive-compulsive disorder, although there is evidence for benefit from cognitive-behavioral strategies (Foa and Franklin, 2000). Patients who have had more than one episode of major depression have a risk of recurrence in excess of 80 percent, and medication treatment generally prevents recurrences. The benefits of psychoanalysis or analytic psychotherapy might confer protection against such recurrences, but there is no data as yet to support this theory. No studies have been carried out using long-term depth psychotherapy or psychoanalysis in patients with depression or obsessive-compulsive disorder. A definitive answer to the question could come from use of standardized diagnosis, and prospectively collected long-term outcome data regarding whether successfully analyzed patients with a history of major depression or obsessive-compulsive disorder have a lower risk for recurrence compared with a control group of unanalyzed patients with the same diagnoses.

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