Anxiety Medication vs Therapy: What Each Does

This is often not an either/or choice

It can feel like you have to pick a side. The sources are more relaxed about it. MedlinePlus says the main treatments for anxiety disorders are psychotherapy, medicines or both. The National Institute of Mental Health (NIMH) says treatment for generalized anxiety disorder typically involves psychotherapy, medication or both, and that the choice depends on your needs, preferences and medical situation.

NIMH also says finding what works may take trial and error, and that both can take some time to work. So there is real room to try something, review it and adjust. Plenty of people find a good fit this way, and needing to adjust is not failure.

What therapy does

Psychotherapy, also called talk therapy, aims to help a person identify and change troubling emotions, thoughts and behaviors, according to NIMH. MedlinePlus adds that to be effective, it should focus on your specific anxieties and needs.

Cognitive behavioral therapy (CBT) is the approach NIMH says is commonly used for generalized anxiety disorder. It helps you notice automatic ways of thinking, question them, and change patterns that keep anxiety going. Exposure therapy, a type of CBT, involves spending brief periods in a supportive setting learning to tolerate distress linked to certain things, until the fear goes down over time.

NIMH also describes acceptance and commitment therapy, which uses strategies such as mindfulness and goal setting, as another option for generalized anxiety disorder, with a growing body of research. NIMH says there is no formal approval process for psychotherapies like the FDA process for medicines.

What medication does

NIMH says anti-anxiety medications help reduce symptoms of anxiety, such as panic attacks and extreme fear and worry. Options include antidepressants such as SSRIs and SNRIs, benzodiazepines and buspirone. Our guide to medications for anxiety explains how these groups differ.

Medicines take a prescriber and follow-up. NIMH says they affect people differently and that it may take several tries to find the one that works well with the fewest side effects. Antidepressants usually take 4 to 8 weeks. Benzodiazepines have dependence and withdrawal risks, which is why providers usually prescribe them for short periods. Antidepressants carry a warning about suicidal thoughts in children, teens and young adults. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services.

What NIMH says about combining them

NIMH says psychotherapy can be used as an alternative to or alongside medication and other treatment options, and that the plan should be based on a person's individual needs and medical situation, under the guidance of a mental health professional.

It also says that even when medication relieves symptoms, psychotherapy can help address specific issues. Examples it gives include self-defeating ways of thinking, irrational fears, problems interacting with other people, and difficulty coping with situations at home, school or work. In plain terms, feeling calmer and learning skills are different things, and for many people both are useful.

NIMH does not name one option or combination as better for everyone. That choice is made with a clinician who knows your history.

How to decide with a clinician

You do not have to work this out alone. Here is a simple way to prepare for the conversation.

1. 1Describe what is hardestSay what anxiety stops you from doing, what it feels like in your body, and how often it happens. Specific examples help more than a general label.
2. 2Share your historyNIMH says to tell your provider about all your medications, including over-the-counter drugs, herbal remedies, vitamins and supplements. Past experience with therapy or medicine also helps.
3. 3Say what you preferNIMH lists preferences as part of choosing a plan. Be honest if you are nervous about side effects or about opening up in therapy.
4. 4Ask your questionsIf a provider suggests a treatment you are unfamiliar with or uncomfortable with, NIMH suggests saying so and asking about other options.

Getting care with us

We offer both, with limits by state. A licensed psychiatrist on our team treats anxiety by secure video for people physically located in Pennsylvania or New York during each visit, and therapists do not prescribe. Whether a medicine is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help: contact us about medication care, or read about online anxiety treatment.

Our anxiety therapy is online for clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida. It is not available in New York, so a New York reader can get psychiatry here but would need to find a therapist elsewhere. Things can get better, and reaching out is a strong first step.