How do I choose between medication and psychotherapy? According to the American Psychological Association (APA), Division 12 (Society of Clinical Psychology), medications, psychotherapy, and their combination have been shown to help people with emotional or behavioral problems. Different kinds of issues, however, will respond differently to various treatments; therefore, choosing the proper treatment can be complicated.

According to the National Institute of Health and Care Research (NIHR), the most effective treatment for adults with moderate depression is likely to be a combination of antidepressant drugs and psychological interventions. A new summary provides the strongest evidence to date that the combination of treatments works better than either alone. The most recent advice from National Institute for Health and Care Excellence (NICE) comes in a clinical knowledge summary (March 2020). It suggests low-intensity psychosocial interventions such as self-help, computerized cognitive-behavioral therapy (CBT), or group exercise programs for mild to moderate depression. Routine use of antidepressants is not suggested for this group. The combination of drug and high-intensity psychological therapy is reserved for those with severe depression. Routine use of combination treatment will require increased access to psychological therapies, including computerized and group CBT as well as individual treatment.

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:

Psychotherapy or Medication, 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. As stated above, 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 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.

This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.