This is a question I get a lot, and it makes sense. Depression and anxiety are the two most common mental health conditions. An estimated 31.1% of US adults experience an anxiety disorder at some point in their lives (National Institutes of Mental Health) and an estimated 20.6% of US adults experience a major depressive episode (Journal of the American Medical Association). The two most common ways for treating both are medication and therapy.
When I get this question of medication or no medication, I usually advise that it's worth a discussion with a prescriber to learn about options without making a commitment. Most primary care providers (PCPs) are comfortable prescribing medication for uncomplicated depression and anxiety and are often a great resource for discussing what might work for you.
Some points to consider when thinking about medication vs therapy:
Pros to medications:
- It's minimal effort to take a pill each day or each episode
- If symptoms are severe, medication can get you functioning better to then work on skills in therapy
- Depending on your insurance benefits, it may be cheaper in the short term and maybe even the long term
- You may start to feel better in as little as two weeks with full effectiveness taking up to 2-3 months. Or immediately as is the case with Benzodiazepines
Cons to medications:
- There are side effects to every medication that you may or may not experience
- You often need to try several before finding a good fit
- Benzodiazepines (for anxiety) are addictive
- Benzodiazepines are sedative
- Alcohol tends to worsen side effects of SSRIs, so it is advisable to not drink
- There will be ongoing medication management (do not discontinue on your own!)
- Depending on your medical insurance, it may be costlier in the long run
Pros to therapy alone, such as cognitive-behavioral therapy:
- You often start to feel better immediately
- No side effects
- You learn skills to manage anxiety on your own, so treatment is usually discontinued after a few months
- Risk of relapse after discontinuation of treatment is lower with therapy
- There is some evidence that therapy is more effective than medication in treating anxiety disorders
Cons to therapy alone:
- Effort to learn and practice self-management skills is much greater than just taking a pill
- You need to make time to attend appointments
- Depending on your insurance benefits, it may be costlier in the short term
- It takes courage to be emotionally vulnerable with a therapist
- The first therapist you see may not be a good fit, and then you have to tell your story all over again to someone new
And one final point to consider is that no matter what you choose, if it's not working, you can change your mind later!
When I get this question of medication or no medication, I usually advise that it's worth a discussion with a prescriber to learn about options without making a commitment. Most primary care providers (PCPs) are comfortable prescribing medication for uncomplicated depression and anxiety and are often a great resource for discussing what might work for you.
Some points to consider when thinking about medication vs therapy:
Pros to medications:
- It's minimal effort to take a pill each day or each episode
- If symptoms are severe, medication can get you functioning better to then work on skills in therapy
- Depending on your insurance benefits, it may be cheaper in the short term and maybe even the long term
- You may start to feel better in as little as two weeks with full effectiveness taking up to 2-3 months. Or immediately as is the case with Benzodiazepines
Cons to medications:
- There are side effects to every medication that you may or may not experience
- You often need to try several before finding a good fit
- Benzodiazepines (for anxiety) are addictive
- Benzodiazepines are sedative
- Alcohol tends to worsen side effects of SSRIs, so it is advisable to not drink
- There will be ongoing medication management (do not discontinue on your own!)
- Depending on your medical insurance, it may be costlier in the long run
Pros to therapy alone, such as cognitive-behavioral therapy:
- You often start to feel better immediately
- No side effects
- You learn skills to manage anxiety on your own, so treatment is usually discontinued after a few months
- Risk of relapse after discontinuation of treatment is lower with therapy
- There is some evidence that therapy is more effective than medication in treating anxiety disorders
Cons to therapy alone:
- Effort to learn and practice self-management skills is much greater than just taking a pill
- You need to make time to attend appointments
- Depending on your insurance benefits, it may be costlier in the short term
- It takes courage to be emotionally vulnerable with a therapist
- The first therapist you see may not be a good fit, and then you have to tell your story all over again to someone new
And one final point to consider is that no matter what you choose, if it's not working, you can change your mind later!
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