An issue that has been discussed for many years is: Should we use long-term or short-term therapies? Is it better to maintain patients on medication, or should we take them off medication and monitor them closely instead?
Long-term therapy
Long-term therapy is defined as continuous medication. It has been shown to be more effective than short-term therapy, especially for chronic diseases like schizophrenia, bipolar disorder and major depression. In contrast, short-term therapy should be used for acute illnesses such as panic disorder and posttraumatic stress disorder.
In general, long-term therapy should be preferred over short-term wherever possible. However, it is a different story when discontinuation of medication can result in a greater risk to the patient. In that case, patients should stay on their medication.
It is crucial to recognize when a patient would be better off on long-term therapy so that medication is not discontinued too early in the treatment process. Patients with a history of high psychiatric morbidity, a chronic medical condition and a poor social situation being under continuous supervision are more likely to benefit from long-term therapy.
A number of factors contribute to poor compliance with medication, such as comorbid medical illness, substance abuse, and psychotic decompensation. In these instances, long-term therapy is highly recommended. In contrast, reasons for early discontinuation include side effects or a lack of effect.
It was found that while patients on long-term therapy were more likely to develop a substance abuse disorder, the risk of relapse was higher for patients with schizophrenia when they were on short-term therapy.
Very good adherence to medication has been shown to reduce symptoms and prevent relapses in patients with major mood disorders. When monitoring patients on long-term therapy, physicians should take into account variables such as sex, age, number of previous episodes, psychiatric history and comorbid medical conditions.
Short-term therapy
Short-term therapy is the appropriate treatment for acute illnesses. It should be combined with psychotherapy when possible. The key to success with this approach is early diagnosis, combined with adequate interventions that lessen suffering and speed up remission.
Patients should be reassessed within the first few weeks after the beginning of therapy for their condition to determine if changes in treatment are needed.
On the other hand, it is clear that one can’t use short-term therapy as a stand-alone approach for chronic illnesses like bipolar disorder or schizophrenia without decreasing the risk of relapse. Patients with bipolar disorder who were on placebo relapsed as often as those on medication, but medication-treated patients had a lower rate of relapse than those on placebo.
Where to find affordable therapy?
It is important to understand how much therapy will cost you. Some health insurance plans offer mental health coverage, while others do not. If your insurance does not provide adequate coverage for the type of therapy you need, there are still options available:
1) You can talk to your therapist about what your financial situation is and ask if they work with your budget. They may be able to provide a sliding fee scale for you, offer an interest-free payment plan, or maybe even lower their rate.
2) Many employers sponsor Employee Assistance Programs (EAPs). These are sometimes small groups that meet with a therapist who is contracted through the company. You can often find out more information about your EAP through your employee handbook or by talking to your HR department.
3) You can search for low-cost therapy facilities in your area on websites like washingtoncitypaper.com/article/534154/best-online-therapy. Many of these sites offer services at affordable rates.
4) If you are seeing a therapist for an eating disorder, addiction, or self-harm concerns, you can check out your local chapter of Narcotics Anonymous (NA), Overeaters Anonymous (OA), Sex and Love Addicts Anonymous (SLAA), or other support groups in your area. Your therapist may be able to give you more information on these resources.
Long-term therapy is usually more effective for chronic illnesses and short-term therapy should be reserved for acute conditions. However, we need to consider variables such as previous psychiatric history or medical comorbidity in deciding which is the appropriate treatment. Patients who have a high risk of relapse should probably stay on long-term therapy, whereas those with milder symptoms might benefit more from short-term therapy and close monitoring.
