Medication and CBT

CBT therapists have not always been accepting of the role of medication in treatment. It remains a fact, despite this, that the majority of patients who are treated by CBT in a psychiatric hospital and a significant minority treated by CBT in general practice will be on at least one psychopharmacological agent.

In 2012, an international panel of experts reported some guidelines on the psychopharmacological treatment of anxiety disorders, OCD and PTSD in primary care (Bandelow et al, 2012). This group of eminent psychiatrists and others concluded that selective serotonin reuptake inhibitors (SSRIs) were useful in all conditions; serotonin-noradrenaline reuptake inhibitors (SNRIs) for anxiety disorders (not OCD) and pregabalin for generalised anxiety disorder only. A combination of medication and CBT including exposure therapy was shown to be a clinically desired treatment strategy.

The benzodiazepine experience

The first benzodiazepine, chlordiazepoxide, was introduced for the treatment of anxiety in the late 1950s. Thereafter a large number of similar compounds came on the market. Unlike their predecessors, the barbiturates, these were considered to be safe and not to produce dependency and withdrawal syndromes. Throughout the 1960s and 1970s they were widely prescribed in general practice and hospitals for mild anxiety, bereavement, insomnia as well as all psychiatric disorders.