Therapy vs Medication: Your Decision-Making Guide

Depression can range in severity from mild seasonal changes in mood to severe symptoms that can limit your ability to function and take care of yourself.

Fortunately, no matter what kind of depression you have, you have options. The research shows that both medication and therapy can effectively treat mild, moderate, and major depression.

When it comes to medication versus therapy for depression, results vary. Some studies show that therapy is more effective. Others show that medication is more effective, while several studies show that both are equally effective.

So, it wouldn’t be right to say that either therapy or medication is the “winner” or the best choice for everyone. The World Health Organization (WHO) makes it clear that either is a valid option: They say that both are effective evidence-based treatments for depression and personal factors should play a role in which you choose.

If any consistent result has come from the research, it’s that both therapy and medication are good options for treating depression and that you should choose based on your circumstances.

For example, consider whether you want to take medication long-term. The effects of therapy persist after therapy has ended, while antidepressants generally only continue to work as long as you take them. (Both can work well together if you’re able to use therapy to help you address the life issues contributing to your depression while you’re taking ADMs.)

It’s also important to consider which option appeals to you most. It’s easier to stick with—and get effective results from—something you like doing.

Ultimately, your best bet is to tell a mental health professional about your unique history, symptoms, preferences, and circumstances and get a personalized recommendation from them.

Research shows that therapy and medication are both effective treatments for anxiety. Which is the best for you depends on which one you prefer and which anxiety symptoms you have.

Anxiety can be treated with different kinds of medications. The most popular anxiety medications are sedatives and antidepressants with anti-anxiety properties. The most popular sedative medications for anxiety are benzodiazepines.

Many people can take benzodiazepines as prescribed and benefit from them without significant complications or side effects. However, they come with many risks, which include:

• Chemical dependency or addiction
• An increase in impulsive or reckless behavior
• Dangerous interactions with other medications
• Overdose and blackout episodes (especially when mixing benzodiazepines with alcohol)

For these reasons, not all doctors and psychiatrists are comfortable prescribing them, especially to people who have co-occurring anxiety and substance use disorders.

Selective serotonin reuptake inhibitors (SSRIs) and other medications that were originally formulated as antidepressants are also effective in treating anxiety. Antidepressants come with their own risks and side effects, but they are generally milder than those associated with benzodiazepines.

For this reason, many physicians prefer prescribing SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) over other medications for anxiety.

Research shows that therapy for anxiety can be as effective as medication. In some cases, it may be even more effective. A large meta-analysis that reviewed multiple studies with over 13,000 participants in total found cognitive behavioral therapy was the most effective treatment for social anxiety disorder. Other studies have replicated this result.

Other anxiety disorders also respond well to therapy. A 2019 study found that tailored CBT techniques were effective in reducing worry, the core symptom of generalized anxiety disorder (GAD), and in facilitating overall recovery from GAD.

A type of CBT called Exposure and Response Prevention is recommended alongside medication as the most effective treatment for obsessive-compulsive disorder (OCD). Therapy is particularly recommended if your OCD symptoms have not responded to medication.

You usually need medication to successfully treat psychotic and bipolar disorders.

Therapy isn’t as effective as antipsychotic medications in controlling psychotic symptoms like hallucinations and delusions. It’s also not as effective as medication in controlling manic symptoms or preventing manic episodes.

While therapy isn’t a sufficient alternative to antipsychotic medication for most people, it can still help. Studies show that CBT can effectively treat medication-resistant positive symptoms of psychosis like hallucinations and delusions, even in early psychosis.

Therapy can also address the negative symptoms of psychotic disorders (like flat emotions and social withdrawal), which don’t respond as well to antipsychotic medications. Specialized CBT techniques that target worry can reduce delusions, anxiety, and paranoia.

Overall, the research shows that if you have a psychotic disorder, therapy promotes better long-term recovery than medication alone.

If you have bipolar disorder, therapy can help by addressing symptoms that aren’t well controlled by mood stabilizers. Interpersonal therapy, CBT, and psychoeducation can help you track and manage moods and identify warning signs and triggers for new mood episodes. Therapy facilitates faster recovery from depressive episodes and can help prevent symptom relapse.

So, while medications are usually necessary, therapy also plays a role in treating bipolar and psychotic disorders. It’s especially helpful if you don’t respond to medications for these conditions or find that the medications you take don’t fully control your symptoms. But even if you do respond well to medication, you can often benefit from the addition of therapy to support and enhance its effects.

Some mental health conditions don’t respond well, if at all, to medications. For example, while medications can sometimes help you manage specific symptoms of personality disorders, therapy is the best option, as it is the only treatment that addresses the core causes of these conditions.

Similarly, while some medications, particularly SSRIs, can treat mood or cognitive symptoms in post-traumatic stress disorder (PTSD), therapy is recommended as the first-line treatment for PTSD.

Research on PTSD and other trauma-related conditions has led to the development of effective trauma-oriented therapies including cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR).

Insomnia is often treated with medication, but that’s not your only option. A newer form of CBT, cognitive behavioral therapy for insomnia (CBT-I), has proven so successful that the American College of Physicians now recommends it as the first-line treatment for insomnia.

As with adults, there is no one-size-fits-all approach to choosing between therapy or medication for children. Some conditions require medication to successfully treat, while others respond better to therapy.

Research shows that combining therapy and medication can improve outcomes for a range of childhood mental health conditions including depression and anxiety disorders. Therapy can help even very young children address and improve psychiatric symptoms and associated behavioral problems.

Medications can play an essential role in stabilizing severe psychiatric symptoms that put children at risk of harm. However, lack of certainty about how psychiatric medications affect a child’s developing brain intensify the dilemma of therapy versus medication for parents and clinicians. What should you do when a child is not in crisis, but is experiencing symptoms that are disruptive or painful?

Nowhere is the debate more intense than over how to treat children with attention-deficit hyperactivity disorder (ADHD).

Prescription rates for stimulants used to treat attention-deficit hyperactivity disorder (ADHD), including methylphenidate (Ritalin) and amphetamines (Adderall and Vyvanse), have risen over the years in the United States. These medications effectively manage symptoms of ADHD for many children and adults, but they don’t work for everyone, and side effects can be significant.

Fortunately, therapy is an effective treatment for ADHD as well. In fact, the Centers for Disease Control and Prevention (CDC) recommend behavior therapy as “the first line of treatment, before medication is tried” for children under six years of age.

For children of all ages and young adults, research suggests that therapy may be more effective over the long term than medication for ADHD, and that combining both can be especially effective.

Research shows that specialized CBT for ADHD symptoms can improve outcomes if you’re an adult with ADHD. This finding supports the growing consensus that combining therapy and medication works well for ADHD.

Something important to consider when you’re comparing therapy and medication is timing. In general, medications take effect faster and have stronger effects right away, while therapy takes longer to make an impact but yields lasting effects that grow stronger over time.

These effects can be complementary and are why you might want to use both therapy and medication if both are effective treatments for your condition. Medication can help you stabilize more quickly after a mental health crisis, while therapy can improve your chances of long-term recovery and reduce the risk of relapse when or if you stop taking psychiatric medication.

Some studies show that combining therapy and medication actually impairs long-term recovery, but other studies show the opposite result. Once again, it depends on your particular symptoms and other personal factors.

The best way to find the right option for you is to speak with an experienced mental health professional who can assess your unique circumstances and make a recommendation based on your specific case.

Research shows that many kinds of therapy are effective and that universal factors like the relationship between you and your therapist play a more important role in the effectiveness of therapy than the method a therapist uses.

Nonetheless, cognitive behavioral therapy (CBT) has been studied more intensively than any other form of therapy and is the therapeutic method with the strongest evidence base.

Its measurable and powerful effects may reflect how CBT, in its own way, is like medication—with its laser focus on symptom relief, it can take effect and produce measurable results faster than other therapeutic methods.

It’s also effective in treating a range of conditions. Cognitive behavioral therapy was originally developed to treat depression and anxiety. Since then, specialized forms of CBT have been developed to treat trauma-related conditions, personality disorders, and insomnia as well. All have been found to be effective in treating the conditions they were developed to treat.

This doesn’t mean if you feel drawn to a type of treatment that isn’t as well-researched as CBT, you shouldn’t choose it. All that the research on CBT really shows is that it’s generally effective. Just how effective it is, and under what circumstances, and if it’s truly superior in both the short- and long-term over other therapeutic methods, is another matter.

Ultimately, the most important research is your own. Take notes on what works for you and do what you can to study and learn about the issues and symptoms that affect you.

New insights emerge each year, and the best way to ensure that you’re receiving evidence-based treatment is to review the latest developments in the research.

By reading mental health news, you can not only learn about new methods and medications, you can also learn tips and tricks that will help you adjust your approach and make it more effective.

The severity of your symptoms is another important factor to consider when you’re deciding what type of treatment is right for you.

Severe symptoms, especially when they reach a crisis point, can put you at risk of harm. If you’re in crisis, medication and intensive treatment like inpatient or day treatment programs are usually recommended to make sure you stabilize as quickly as possible.

Fast-acting medications can stabilize severe symptoms and keep you safe before therapy has had time to work (or before you’re mentally ready for therapy).

The severity of a mental health condition or symptoms can change over time—sometimes rapidly.

What might start out as a vague sadness can develop into a severe major depressive episode. On the other hand, it’s possible for a long-standing mental health condition to resolve to the point you’re ready to move beyond treating symptoms to work on personal growth goals.

So, consider whether you’re seeking immediate relief from severe symptoms or if your symptoms are mild or managed and you feel ready to invest in other aspects of your treatment. Medication works best for symptom control or management, while therapy is a multifaceted approach that can help you address a range of issues and personal goals.

If you have moderate symptoms that respond to both medication and therapy, consider combining both. If you have mild or no active psychiatric symptoms but want to make changes in your life, therapy may be the best fit for your needs.

Again, though, it depends on your unique situation. Talking to a mental health professional will help you find what’s right for you.

As we know all too well, the cost of therapy is a deciding factor in whether it’s a valid option. Medication can often be more immediately financially accessible, especially if you have insurance.

But it’s important to consider long-term as well as short-term costs when making your decision. Research suggests that while both medication and therapy are similarly cost-effective, therapy may be more cost-effective over the long term than medication.

If you can get medication for free or for a minimal co-pay, and you only need to go to a single annual appointment with your primary care physician to maintain your prescription, medication may be the more affordable and sustainable choice. And if it’s more affordable, you’re more likely to maintain it over time, which is an essential factor in long-term recovery.

Quality control is also a little bit easier with medication than with therapy. While primary care doctors usually aren’t as good as psychiatrists at adjusting medications, and some medications that work well for some people don’t work at all for others, the effect of medication is generally more predictable than the effect of therapy. Some bad therapists can do more harm than good and it can take some time to find a therapist who’s the right match.

On the contrary, if therapy fits into your budget and schedule, the lasting skills and lessons you gain from it can help keep you mentally well and prevent relapse long after you’ve stopped going, making it more affordable in the long term.

Whether you have access to a therapist who has expertise in using a specific method or working with clients similar to you can also determine whether therapy is the most effective choice for you. Working with a therapist who doesn’t know how to address your particular needs can be a huge waste of time and money.

Ultimately, personal factors will determine what form of treatment is most affordable for you. The most important thing is to get treatment at all. As the World Health Organization says, “Treatment of depressive [or any other mental health] disorder is cost-effective compared to no treatment.”

Personal factors determine whether medication or therapy is effective for any given individual. Some of these factors have been identified specifically in the research. People with a significant history of childhood trauma seem to respond better to therapy than to medication, for example.

But there’s no more powerful evidence to consider than your own life experience. Research can tell you what’s generally true for people, but if you’ve tried therapy or medication before, you already know a lot about how it affected you—and whether it was effective.

Some people need a treatment “tune-up” after a successful first round of treatment with therapy, medication, or both. Which route you go will depend on what worked for you last time.

For example, it might not make as much sense to go back to therapy if your most recent experience wasn’t helpful or if you already know from past experience that a medication tune-up should address your current symptoms.

Conversely, if you had a negative experience with a medication that didn’t work well, that took a long time to work, or that caused severe side effects, you might want to opt for trying a round of therapy instead of trying medication again.

Reading research and knowing what’s generally effective is important, but nothing is as important as trusting yourself and your own lived experience.

Our culture has a love-hate relationship with psychiatric medication. Though doctors prescribe it extensively, it’s also frequently dismissed with condescending terms like “happy pills” or “the quick fix.”

The popular narrative is that medications are the “lazy” or easy route, while therapy is the heroic choice, reflecting a person’s capacity for hard work and emotional “bravery.”

These are myths.

If you take psychiatric medication, you may continue to struggle with residual symptoms or other issues medication can’t address—but that the medication makes it possible for you to address. You may have to put in a lot of work to help your prescribing physician make the right adjustments to get your medication to work.

For many people, taking medication, going to therapy, or doing both is just the first step in a long-term personal recovery program that also includes significant lifestyle changes. Regardless of which type of treatment you receive, the biggest changes, greatest growth, and most significant impacts come from the choices you make in your day-to-day life.

It’s true that simply showing up for a therapy session takes work, because it means facing instead of avoiding the issues you’re seeking treatment to address. But it’s not true that if you’re in therapy, you’re necessarily doing more work than people who are treating their mental health issues with medication.

Therapy requires homework—applying what you’re learning in the therapy room to your life outside of it—to be effective, and not everyone who goes to therapy does their homework.

If someone is criticizing you for choosing to take medication or see a therapist, it’s probably because they’re projecting their own unresolved issues onto you. Their lack of understanding is their problem, not yours; your mental health is what matters most, and only you can know the way to take care of it.

Both medication and therapy are effective ways to treat a wide range of mental health conditions. Whether you should choose one over the other, combine both, or use each at a different point in your recovery depends on a number of things.

Most people choose what is most appealing to them personally and what best fits their current circumstances. This is as good a reason as any for choosing one option over the other.

You’re more likely to stick to what works for you and what you like best. Motivation and long-term commitment will increase your chances of staying in treatment long enough to recover and will reduce the risk of symptom relapse.

The most important thing to consider is your own personal experience. Trust yourself! Even if the first thing you try doesn’t work, or doesn’t work as well as you’d hoped, it puts you a step closer to finding what does. Everything you try will improve your self-knowledge and take you further along your path of recovery.