How Do I Choose Between Medication and Therapy?

In the last couple of weeks, there have been some big announcements from the medical and mental health communities about the wisdom of using drugs over behavioral methods for various disorders. The meds vs. therapy debate has been an active one for a number of years.But these days, some experts and organizations are questioning, more and more, whether popping pills should really be our go-to treatment, based on the literature. And it seems that for some that have historically used meds as the first line of treatment, the evidence for behavioral methods has mounted to the point where recommendations have shifted in their favor. At least for some things.

Therapy or medication? In both children and adults, evidence-based psychosocial therapies have been shown to work for a broad range of mental health disorders, as well as for many life problems. The same can be said for the effectiveness of some medications. The information below is intended to help parents/caregivers choose between treatment options for their child or adolescent, and to decide whether therapy and medication should be combined for the most effective treatment.Medications, psychotherapy and their combination have been shown to help people with emotional or behavioral problems. Different kinds of problems, however, will respond differently to various treatments; therefore, choosing the right treatment can be complicated. Your choice of treatment should be based on the best available scientific evidence, as well as your own willingness to try these treatments and to stick with them. Whatever the choice, these discussions should be reviewed with your physician, psychologist or mental health professional. Here are some things to consider:

Best Evidence

  • For depression, two kinds of psychotherapy called cognitive-behavioral therapy and interpersonal psychotherapy, as well as antidepressant medications, have been shown to be helpful. There is some evidence that combining psychotherapy and medications may be more effective than either treatment alone. People who are suicidal may need to be treated in a hospital.
  • For anxiety disorders, cognitive-behavioral therapy, antidepressant medications and anti-anxiety medications have all been shown to be helpful. Research generally shows that psychotherapy is more effective than medications, and that adding medications does not significantly improve outcomes from psychotherapy alone.
  • For alcohol and drug use disorders, cognitive-behavioral therapy and environment-based therapies, as well as 12-step support programs, have been shown to be helpful. People with severe substance use problems may also benefit from the addition of certain medications that reduce cravings or intoxication effects.
  • For eating disorders, medical management may be necessary to maintain physical safety. Cognitive-behavioral therapy, interpersonal psychotherapy and antidepressant medications have all been shown to be helpful, and some evidence suggests that combining psychotherapy and medications may be more effective than either treatment alone.
  • For schizophrenia or bipolar disorder, most people will require treatment with antipsychotic or mood-stabilizing medications. Research suggests that adding cognitive-behavioral or family psychotherapy to the treatment can improve functional outcomes.
  • For problems with parenting, marriage or adjustment, psychotherapy is usually the first recommendation. This treatment can help you build skills and respond more appropriately to stressors.

Personalizing Your Treatment

  • Different people respond to treatments differently. Therefore, if one treatment does not help, try adding the other. Research shows that psychotherapy can be helpful even for people who do not respond well to medications.
  • Psychotherapy and medications both require that you stick with the treatment. Results usually do not happen overnight. Therefore, only start a treatment if you are willing to continue it long enough for it to help you.
  • You will be most likely to stick with a treatment if it makes sense to you. Therefore, it’s important that you discuss the treatment thoroughly with your doctor, and that the treatment is explained in a way that you can understand.
  • When in doubt, ask your doctor. He/she can inform you of the best evidence and make a specific recommendation for your condition.