Depression Medication vs Therapy: What Each Does and How to Decide

What medication does

The National Institute of Mental Health (NIMH) says antidepressants work by changing how the brain produces or uses certain chemicals involved in mood or stress. They take time, usually 4 to 8 weeks, and problems with sleep, appetite and concentration often improve before mood lifts.

Medication comes with things to weigh. All medicines can have side effects, and antidepressants carry a boxed warning about suicidal thoughts and behaviors in children, teens and young adults, with close watching advised at every age in the first few weeks. MedlinePlus also says a medicine should not be stopped without your provider's help, so it is a commitment to follow-up visits. Our medicine library covers individual medicines, including sertraline.

What therapy does

NIMH says psychotherapy can help people with depression by teaching them new ways of thinking and behaving and by helping them change habits that contribute to depression. NIMH describes it as a treatment that happens with a licensed, trained mental health professional, one on one or in a group, and says it can be effective in person or virtually.

Therapy can take time and effort too. It can involve talking openly, trying new things and coming back regularly. NIMH says there is no formal FDA approval process for psychotherapies the way there is for medicines, but that research has shown many are effective.

• Cognitive behavioral therapy (CBT). You learn to challenge and change unhelpful thoughts and behaviors.
• Interpersonal therapy (IPT). This focuses on relationships and life events that affect mood, and builds communication skills and support networks.
• Other forms, such as psychodynamic therapy. NIMH says these, used for a limited time, also may help some people.

How clinicians often think about it

NIMH gives a general pattern. For milder forms of depression, psychotherapy is often tried first, with medication added later if therapy alone does not bring a good response. People with moderate or severe depression are usually prescribed medication as part of the first plan.

That is a pattern and not a rule for any one person. NIMH says the plan is based on a person's needs, preferences and medical situation, and is made with a professional. Some people have strong feelings about medicine or about talking, and that counts. Telling a clinician what you are willing to try is part of a good plan.

Using both together

You do not have to pick one forever. NIMH says psychotherapy can be used as an alternative to or alongside medication. It also says that even when medication relieves symptoms, psychotherapy can help with specific issues, such as self-defeating ways of thinking, problems with other people, or trouble coping at home or at work.

MedlinePlus lists adding talk therapy as one way to get more relief if an antidepressant is not doing enough. If you see both a therapist and a prescriber, ask whether they can share information and how your permission is handled. If you already take a medicine and want to add therapy, talk with your prescriber before changing anything about the medicine.

Questions to help you decide

No checklist decides this, but these questions can make a first conversation with a clinician more useful. NIMH suggests asking a therapist about their experience and whether medication is an option, and being open about what you notice.

• How much are my symptoms affecting sleep, work, school and relationships?
• Have I had thoughts of death or suicide? Please say so, even if it is hard.
• What have I tried before, and what did it do for me?
• Do my other health conditions or medicines affect the choice?
• Am I pregnant, planning a pregnancy or breastfeeding?
• What can I realistically keep up with right now, and what would I do if it does not help?

What we offer, by state

Medication care is with a licensed psychiatrist on our team, a Doctor of Osteopathic Medicine with more than three decades of practice, by secure video. You must be physically located in Pennsylvania or New York during each visit. Our online depression treatment page explains the options. Whether a medicine is an option for you is a decision for you and your prescriber, so ask us whether our psychiatrist can help using our medication care contact form.

Therapy is with our licensed therapists, who do not prescribe. Depression therapy is online for clients in Pennsylvania, West Virginia, Arizona, Colorado or Florida during sessions. It is not available with us in New York, so a New York reader would need a therapist elsewhere. In Pennsylvania, with your permission, a therapist here and the psychiatrist can coordinate your care.