Conservative Prescribing and the Importance of Psychotherapy

We are very enthusiastic about the excellent article, “Principles of Conservative Prescribing” by Schiff et al,¹ which appeared in the September 12, 2011, issue of the Archives.¹ We plan to assign this article to all of our residents who are learning the principles of psychopharmacology. However, we were surprised to find that the article did not mention the therapeutic importance of psychotherapy. Even in the first principle, “seek nondrug alternatives first,” there is mention only of “counseling” but not of psychotherapy itself. Given that selective serotonin reuptake inhibitors are among the most commonly prescribed drugs and that the majority of these prescription are written by primary care physicians (as opposed to psychiatrists), all physicians should be aware that (1) there is strong evidence that for many psychiatric disorders, psychotherapy alone is as effective as psychopharmacology alone, and (2) there is strong evidence that many (if not most) psychiatric disorders are best treated by a combination of psychotherapy and medication. Even though most primary care physicians are not trained in psychotherapy, they are in the unique position of seeing the most patients with psychiatric illness. All the more reason why psychotherapy should be high on the list when physicians are advised to “think beyond drugs.”