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Therapy vs Medication: Your Decision Making Guide

Therapy vs Medication: Your Decision Making Guide

At OpenCounseling, we believe in the power of therapy to help people overcome depression, anxiety, trauma, and a host of other mental and emotional challenges. Based on our personal experiences giving and receiving therapy, as well as our review of the research, we know that therapy is effective and that it helps people grow, heal, and recover.

 

While we love and believe in therapy, we don't share the view of other therapy-focused sites that medication is morally or medically inferior to therapy. In fact, research suggests that medication and therapy are similarly effective and that who responds to what depends on a range of highly personal variables. Whether medication, therapy, or a mix of both works for you depends on your unique circumstances and preferences. 

 

We want you to heal and recover using what works best for you. Our goal with this article is to present you with a clear and succinct overview of expert opinions and research results to help you make an informed decision about the treatment path you want to pursue. Naturally, your will also want to consult with your therapist and psychiatrist. 

 


Therapy vs. Medication for Depression

 

Most research on therapy versus medication focuses on treatment for depression, and the vast and complex body of research shows that both medication and therapy are effective treatments for depression. Which approach appeals to you the most and best fits your current circumstances is as important as any other consideration.

 

One of the most prevalent psychiatric disorders, depression can range in form from mild seasonal changes in mood to severely disabling symptoms that can limit your ability to work, maintain relationships, or engage in everyday self-care tasks. Each year, 7 percent of American adults, or about 17 million people, experience a major depressive episode. Of those, 64 percent experience severe impairment as a result of their depression.

 

This may be why antidepressants are among the most commonly prescribed drugs in America. In fact, 5 out of the 25 most frequently prescribed drugs in 2018 were antidepressant medications (ADMs):

 

  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Trazodone (Oleptro)
  • Bupropion (Wellbutrin)

 

The only classes of drugs prescribed more often than antidepressants in 2018 were medications for high blood pressure and high cholesterol.

 

The upside of the increasing popularity of ADMs is that more people are receiving effective treatment for depression than ever before. The downside is that ADMs have become the default treatment for depression, even for people who would prefer, or be better served by, therapy.

 

The results of research on medication versus therapy for depression 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. Based on these findings, it would be false to say either therapy or medication was the "winner" or the best choice for everyone. The World Health Organization (WHO) advises that both are considered to be effective evidence-based treatments for depression and that personal preference and circumstantial factors should play a role in which you choose.

 

If any consistent result has come from the research, it's that the best treatment for depression depends on your unique circumstances. For people who can only participate in treatment for a short period of time, therapy may be a better choice because its effects persist after therapy has ended, while antidepressants generally only continue to work as long as you take them. (This may be enough if you're able to address life issues contributing to your depression while you're taking ADMs.) Other factors that determine which is the better choice include:

 

 

It's also important to consider which option excites or inspires you most. Your motivation to maintain your treatment regimen will play a significant role in how well it works for you.

 


Therapy vs. Medication for Anxiety Disorders

 

As with depression, research shows that therapy and medication are both effective treatments for anxiety. Which is the best for you depends on your preferences, circumstances, and what type of anxiety disorder or symptoms you have.

 

Anxiety is the most common mental health condition in the United States, with 18 percent of the United States population, or about 40 million adults, experiencing an anxiety disorder each year. The most prevalent anxiety disorders are specific phobias, which affect 8.7 percent of American adults; social anxiety disorder, which affects 6.8 percent of adults in the U.S. each year; and generalized anxiety disorder, which affects about 3 percent of the adult population.

 

Anxiety can be treated with different kinds of medications, usually sedatives or antidepressants. The most popular sedative medications for anxiety are benzodiazepines. Drugs in this class include:

 

  • Alprazolam (Xanax)
  • Diazepam (Valium)
  • Lorazepam (Ativan) 
  • Clonazepam (Klonopin)

 

Benzodiazepines are powerful drugs that are popular for their rapid calming effects. Many people can take them as prescribed and benefit from them without significant complications or side effects, especially people with acute anxiety. 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)

 

Selective serotonin reuptake inhibitors (SSRIs) and other medications that were originally formulated as antidepressants are also effective in treating anxiety. Antidepressant medications that are used to treat both depression and anxiety include:

 

  • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor XR)

 

These medications 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, or a review of multiple studies that included over 13,000 participants, found that 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 for people whose OCD symptoms have not responded to medication. 

 


Therapy vs. Medication for Psychotic and Bipolar Disorders

 

Psychotic and bipolar disorders usually require medication to successfully treat. Therapy is not as effective as antipsychotic medications in controlling psychotic symptoms like hallucinations and delusions. Some of the most commonly prescribed antipsychotic medications are:

 

  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Clozapine (Clozaril)

 

Most people who have schizophrenia or another psychotic disorder must take one of these medications to be able to live and function independently in the community. 

 

Therapy also isn't as effective as mood stabilizing medications for bipolar disorder, which include:

 

  • Lithium
  • Lamotrigine (Lamictal)
  • Valproic acid (Depakote)
  • Carbamazepine (Tegretol)
  • Topiramate (Topamax)

 

In some cases, antipsychotic medications, especially aripiprazole, olanzapine, and quetiapine, are used as mood stabilizers for people with bipolar disorder even when they don't have psychotic symptoms.

 

While medications are usually necessary, therapy also plays a role in treating bipolar and psychotic disorders. Some people don't respond to medications for these conditions or find that medications don't fully control their symptoms. Even people who do respond well to medications can benefit from the addition of therapy to support and enhance the effects of their medications. 

 

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 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 in people with psychotic disorders. Overall, therapy promotes better long-term recovery for people with psychotic disorders.

 

Therapy benefits people with bipolar disorder in a similar way by addressing symptoms that aren't well controlled by mood stabilizers. Interpersonal therapy, CBT, and psychoeducation can help people with bipolar disorder track and manage moods and identify warning signs and triggers for new mood episodes. Therapy facilitates faster recovery from depressive episodes and can help reduce rates of symptom relapse for people with bipolar disorder.

 


Therapy vs. Medication for Other Mental Health Conditions

 

Some mental health conditions don't respond well, if at all, to medications. For example, while medications can sometimes help people manage specific symptoms of personality disorders, therapy is best, as it is the only treatment that addresses the core traits 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. Advances in research on PTSD and other trauma-related conditions have led to the development of effective trauma-oriented therapies including cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR).

 

Insomnia has historically been treated with medication, but it doesn't have to be. A newer form of CBT, cognitive behavioral therapy for insomnia (CBT-I), has proven so successful that the Substance Abuse and Mental Health Services Administration (SAMHSA) now recommends it as the first-line treatment for insomnia.

 


Therapy vs. Medication for Children with Mental Health Conditions

 

Similar principles apply to choosing between therapy or medication for children. Some conditions require medication to successfully treat, while others respond better to therapy. 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.

 


ADHD Medication vs. Behavioral Therapy

 

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 when children are not in crisis, but are 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 ADHD, including methylphenidate (Ritalin) and amphetamines (Adderall and Vyvanse), have continued to rise 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 also an effective treatment for ADHD. 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, research suggests that behavior therapy may be more effective over the long term than medication treatment for ADHD, and that combining both can be especially effective. Research shows that specialized CBT for ADHD symptoms can improve outcomes for adults with the disorder.

 


Fast Results vs. Long-Term Recovery

 

Both medication and therapy have clear benefits, and research shows that neither is better in all cases or under all circumstances. One factor that is important to consider is timing. In general, medications take effect faster and have stronger effects in the early stages of treatment, while therapy takes longer to have an effect but yields lasting effects that grow stronger over time.

 

This may be the reason that many people choose to combine both forms of treatment, especially when their symptoms are severe. Medications can help you stabilize more quickly after a mental health crisis, while engaging in 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. The best way to find the right option for you is to speak with an experienced mental health practitioner who can assess your unique circumstances and make a recommendation based on your specific case. 

 


Cognitive Behavioral Therapy vs. Medication: Weighing the Evidence

 

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. 

 

Researchers have also found that publication bias has exaggerated the apparent efficacy of evidence-based therapy methods like CBT and antidepressant medications. This doesn’t mean they aren't effective; it just means they may not be as effective as they are said to be in both academic and popular publications. 

 

That said, CBT has been studied more intensively than any other form of therapy and is the therapeutic method with the strongest evidence base. This may be because 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.

 

This doesn't mean that if you feel drawn to a type of treatment that isn't as well-researched as CBT, you shouldn't choose it. Even with CBT, the evidence is not conclusive beyond the fact it's generally effective. Just how effective it is, and under what circumstances, and if it is truly superior in both the short- and long-term over other therapeutic methods, requires more study to say definitively. 

 

Ultimately, the most important research is your own. Take notes on what works for you and read research news. Research methods have improved over the last several decades and have generated many insights into how to make both medication and therapy more effective. 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.

 


Medication vs. Therapy for Mental Illness: Assessing Symptom Severity

 

The severity of your symptoms is another important factor in deciding what kind of treatment to pursue. Severe symptoms, especially when they reach a crisis point, can put you at risk of harm. Taking fast-acting medications may be necessary to stabilize severe symptoms before you're safe enough or otherwise psychologically ready for therapy. In general, you're considered to have a severe or serious mental illness (SMI) if you:

 

  • Are diagnosed, or could be diagnosed with, a mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Note that while other disorders can qualify as SMI, the diagnoses most commonly associated with SMI are:
    1. Bipolar disorder
    2. Major depressive disorder, severe 
    3. Schizophrenia or other psychotic disorders
  • Experience changes in mood or thinking that persist over time, cause significant pain or distress, and interfere with your daily functioning
  • Suffer significant functional impairment in one or more of the following areas as a result of your mental health symptoms:
    1. Interpersonal relationships (you are socially isolated or experience significant chaos or instability in your relationships)
    2. Work or school (you have lost a job, failed a class, or are otherwise having difficulty fulfilling responsibilities at work or school)
    3. Society and the legal system (you have been arrested or incarcerated multiple times or are having other serious difficulties maintaining social norms in a way that affects your security or well-being)
    4. Activities of daily living (you're having difficulty caring for or keeping up with personal hygiene or the hygiene of your home; you're homeless or experiencing housing instability; you're unable to maintain good nutrition; you're not taking medications or actions you need to take to manage chronic medical conditions)

 

Even within the same general mental health episode, symptoms can shift in severity. What might start out as a vague sadness can develop into a depressive episode. A long-standing mental health condition may resolve to the point that you're ready to move beyond symptom stabilization to work on personal growth goals like being more creative or living more authentically.

 

That said, the severity of the issues you want to address can guide your treatment decisions. If you're in crisis or otherwise experiencing severe mental health symptoms, medication and intensive treatment like inpatient or day treatment programs are usually recommended to make sure you stabilize as quickly as possible. 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.

 


Talk Therapy vs. Medication: Access, Cost, and Quality

 

As we understand well at OpenCounseling, the cost of therapy is a deciding factor for many people who are thinking about trying it.

 

Research suggests that while both medication and therapy are similarly cost-effective, therapy may be more cost-effective over the long term than medication. However, 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 disorder is cost-effective compared to no treatment."

 

Some people choose medication as their preferred long-term treatment simply because it's what works best for them. Others choose it because it fits into their schedule and budget better than therapy does. If you can get medication for free or for a minimal co-pay, and 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. If it's more affordable, you're more likely to maintain it over time, which is an essential factor in long-term recovery. 

 

If your insurance doesn't cover therapy, or if your co-pay for therapy is high, financial and time burdens can make it hard to stay in therapy long enough to achieve your therapeutic goals. 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 a specific method or in working with clients similar to you can also determine whether therapy is the most effective choice for you.

 


"One Size Fits All" vs. Tailored Treatment: The Significance of Personal Factors

 

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. 

 

It's important to consider evidence from your own life. Your past experiences with therapy or medication are the most personally significant source of information about what works for you.

 

Some people need a treatment "tune-up" after a successful first round of treatment with therapy, medication, or both. 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 may not want to take medication again. 

 


"Hard Work" vs. "The Quick Fix": Moral Myths About Therapy and Medication

 

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. No form of mental health treatment is easy. It takes bravery to be vulnerable and to deal with mental health issues no matter how you choose to go about it. 

 

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 changes or adjustments to get your medication to work. For many people, medication is just the first step in a long-term personal recovery program that also includes significant lifestyle changes.

 

Therapy is less effective if you don't do your homework in between sessions or don't apply what you're learning in the therapy room to your life outside of it. It's true that simply showing up for a 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.

 

You don't need to apologize for knowing what works for you. Even your closest friends and family don't know everything you've been through or what it's taken for you to get where you are today. If someone is criticizing you for choosing to take medication or to see a therapist, it's probably because they're projecting their own unresolved issues onto you. Whatever their reasons, their lack of understanding of you or your needs isn't your concern; your mental health is. 

 


Conclusion

 

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 factors, including:

 

  • Which mental health condition or symptoms you're treating
  • The severity of your mental health condition or symptoms
  • Whether you've achieved good results with therapy or medication (or both) in the past
  • Whether you've had a bad reaction to therapy or medication (or both) in the past
  • Which type of treatment is the most accessible where you live
  • Which type of treatment has the most experienced clinicians available to you
  • Which is the most affordable for you now and which will be the most affordable for you long-term
  • Whether you're in crisis or otherwise need fast-acting treatment for your safety or stability
  • Whether your symptoms are related to past (or recent) experiences or traumas that you need to process or "talk through" to fully resolve
  • Whether cognitive factors, like negative thinking, or emotional factors, like heightened sensitivity to mood changes, are most prominent for you
  • Whether you have comorbid medical or mental health issues that would be negatively or positively affected by direct effects or side effects of therapy or medication

 

Most people choose based on 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 treatment approach 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. It's also fine to change your mind: what worked for you once may no longer work for you.

 

The most important information to consider for your individual case comes from 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.





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Stephanie Hairston
Posted on 02/23/2020 by Stephanie Hairston

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.


 

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