Is therapy or medication better for depression?
Neither is better for everyone. The National Institute of Mental Health (NIMH) says depression treatment typically involves psychotherapy, medication or both, and that the right plan is based on a person's needs, preferences and medical situation, worked out with a mental health professional or health care provider. It adds that finding the best treatment may take some trial and error.
Severity is a big part of the decision. NIMH notes that for milder forms of depression, psychotherapy is often tried first, with medication added later if therapy alone does not produce a good response, while people with moderate or severe depression are usually prescribed medication as part of the initial treatment plan.
This page is general information, not advice about your treatment. Laura Bass is a psychotherapist and does not prescribe medication. Questions about whether to start, change or stop a medication belong with your primary care doctor, a psychiatrist or a psychiatric nurse practitioner.
What does the research say?
Head-to-head, the two approaches look broadly similar on average. A 2013 meta-analysis of cognitive behavioral therapy for adult depression by Pim Cuijpers and colleagues found no indication that CBT was more or less effective than medication, and a 2016 meta-analysis of interpersonal therapy found no significant difference between IPT and medication either.
Combining them tends to do better than medication alone. A 2014 meta-analysis by Cuijpers and colleagues, published in World Psychiatry, pooled 52 trials comparing antidepressants alone with antidepressants plus psychotherapy in depression and anxiety disorders. Combined treatment came out ahead, with a moderately large difference, and the authors found sufficient evidence of an advantage in major depression. They concluded that medication on its own may not be optimal care for common mental disorders. The NHS puts it simply: a combination of an antidepressant and CBT usually works better than having just one of them.
Averages are not individuals. Some people do well with therapy alone, some need medication to get to a place where therapy is even possible, and some find one helps more than the other. If anxiety is the bigger part of the picture for you, our Tryon page on therapy or medication for anxiety looks at that question.
What each one offers
Medication
Antidepressants work by changing how the brain produces or uses certain chemicals involved in mood or stress, according to NIMH. They take time, usually four to eight weeks, and problems with sleep, appetite and concentration often improve before mood lifts. People may need to try more than one before finding the right fit. All medications can have side effects, and the FDA advises that people starting an antidepressant, especially young people, be watched closely in the first weeks for any increase in suicidal thoughts.
Therapy
Therapy works on the patterns around depression: the thoughts that keep you stuck, the withdrawal that shrinks your days, the relationships, losses and transitions that may be feeding it. NIMH describes it as teaching new ways of thinking and behaving and changing habits that contribute to depression. It asks more of your time and effort, and in return it builds skills you keep. Therapy for depression and anxiety explains the main approaches.
Questions to take to your doctor
A primary care visit is a reasonable place to start, partly because NIMH notes that some medications and medical conditions, such as thyroid problems, can cause the same symptoms as depression. These questions can help the conversation.
- How severe does my depression look to you, and does that change what you would recommend?
- Could anything physical, or any medication I take, be contributing?
- If I start an antidepressant, how long before we judge whether it is working, and what side effects should I watch for?
- Would you recommend therapy alongside it, and can you refer me?
- If I prefer to try therapy first, what would make you suggest adding medication?
If you already take medication
Keep taking it as prescribed while you think about counseling. NIMH is clear that people should not stop a prescribed medication, even when they feel better, without the help of a health care provider, who can reduce the dose slowly and safely. If you are unhappy with a medication, tell your prescriber.
Starting therapy does not mean changing your medication, and many people do both. If you would like your therapist and your prescriber to be able to talk, you can give written permission, and you can limit what is shared.
Where Laura Bass fits
Laura Bass is a psychotherapist in Charlotte, North Carolina, who works with adults, and depression and anxiety are among the concerns she sees. She does not prescribe, and she has no stake in whether you take medication. Her part is the therapy: a place to understand what is happening and work on it. You can bring a list of your current medications and the names of your doctors to the first session. Read about individual counseling, or contact Laura with questions.
If you are unsure whether you need help yet, when to get help may be useful. And if depression comes with thoughts of suicide, call or text 988 at any hour; in an emergency, call 911.
Common questions
Can therapy alone treat depression?
For many people, especially with milder depression, yes. NIMH notes that psychotherapy is often tried first for milder depression, with medication added if therapy alone does not produce a good response. For moderate or severe depression, medication is usually part of the plan from the start. A doctor or mental health professional can help you judge where you are.
Does Laura Bass prescribe antidepressants?
No. Laura Bass is a psychotherapist and does not prescribe or manage medication. If you want to consider medication, talk with your primary care doctor, a psychiatrist or a psychiatric nurse practitioner. Many people see a prescriber for medication and a therapist for counseling at the same time, and the two can coordinate with your written permission.
Is it better to take antidepressants and do therapy together?
On average, research suggests combined treatment works better than medication alone. A 2014 meta-analysis of 52 trials found a meaningful advantage for adding psychotherapy to antidepressants in major depression. That does not mean everyone needs both. The choice depends on severity, history and preference, and is worth discussing with your doctor.
Can I stop my antidepressant once I start therapy?
Not on your own. NIMH says people should not stop a prescribed medication, even if they feel better, without the help of a health care provider, because stopping too quickly can cause unpleasant or harmful effects and symptoms can return. If you would like to come off a medication at some point, plan it with your prescriber, who can lower the dose gradually.