I don’t like medication; can’t I just do therapy instead?

Quick answer: Yes and No. 

When my clients discuss their worries about starting medication, it often has to do with potential side effects.  “I don’t want to get fat,” some will say or “I don’t want to get addicted,” others might state.  In fact, most of my patients experience none to minimal negative effects, while the minority share negative experiences such as weight gain, increases sleepiness, dry mouth, etc. Though one can find tons of articles and discussion posts about how medication ruined their father, sister, best friend’s, or uncle’s life, psychopharmacological intervention is often life enhancing, if not lifesaving.  There is a large research base supporting the use of medication to treat a range of psychiatric disorders including depression, anxiety, OCD, bipolar disorder, and psychotic disorders. 

People who are reticent about psychiatric medication may feel more at ease participating in therapy instead.  Indeed, therapy is also a wonderful intervention, and many people find it incredibly helpful.  Therapy can be a successful tool in the treatment of anxiety, depression, interpersonal problems and various other psychiatric disorders.  Different modalities, such as cognitive behavioral therapy, acceptance and commitment therapy and psychodynamic therapy can be very useful approaches.  In fact, many therapy approaches are widely researched, such as Exposure and Response Prevention for OCD and Dialectical Behavior Therapy for symptoms of self-harm and chronic suicidal ideation.

Despite the effectiveness of therapy, medication is not an equivalent tool in our toolbox.  Medication and therapy should be considered 2 separate and not equal interventions in the fight against mental illness.  To avoid the initial use of medication, psychiatrists will at times recommend a trial of therapy and often this can be enough.  Engaging in therapy can have a hugely positive impact on someone’s life.  It can teach a new way of coping and change our relationship with our own thoughts and feelings.  Progress in therapy is dependent on so many factors and not surprisingly motivation and one’s relationship with their therapist are of utmost importance. 

Still, forward movement in therapy is not easy. Progress is dependent on so many factors and not surprisingly motivation and one’s relationship with their therapist are of utmost important. Sometimes life keeps throwing you curveballs and it’s hard not to rely on our old ways.  It can be terrifying to try out new behaviors, engaging in new communication patters, and mostly, just sit in our own uncomfortable feelings.  For those who have tried therapy with little to no progress or for those who are struggling with life threatening symptoms such as suicidal ideation or self-harm, medication can provide the initial relief of symptoms that then make patients more available for therapy.  One of the best approaches to treatment takes a multipronged approach including life changes, medication, therapy and social support.  Treatment can be an uncertain ride, but with trusted doctors, therapists and family members, an integrated approach to treatment is often the most effective.