Why Medication and Therapy Together?

Therapy and medication work on different parts of the same problem. In research on moderate depression, the combination works better than either one alone, and for major depression, panic disorder and obsessive-compulsive disorder, adding therapy to medication works better than medication alone (1, 2). A suggestion to consider medication is not a sign that therapy has failed, and an evaluation does not always end with a prescription.

What does the research show?

Large analyses that pool many clinical trials point the same way. A 2020 analysis in World Psychiatry found the combination more effective than either treatment alone for moderate depression, with therapy alone and medication alone performing about equally (1). An earlier analysis of 52 trials found that adding psychotherapy to medication improved results in major depression, panic disorder and OCD, with benefits lasting up to two years. The two treatments appeared to add to each other rather than overlap (2).

There is a nuance. A 2023 analysis of more than 400 trials of cognitive behavioral therapy found combined treatment better than medication alone, but not clearly better than CBT alone, and CBT held its benefits longer than medication did (3). The evidence does not say that everyone in therapy needs medication.

What does medication do that therapy does not?

Medication does not resolve conflicts, rewrite a history or teach new ways of relating to people. That is the work of therapy. What medication can do is lower the intensity of symptoms such as severe insomnia, exhaustion, poor concentration, panic or obsessive thoughts, which can otherwise make it hard to use what happens in session.

Are some conditions different?

Yes. Bipolar disorder usually requires medication, and it changes which medications are safe to use. Adult ADHD can make the structure of therapy itself, such as attending regularly and completing exercises between sessions, harder to sustain.

Does medication blunt emotions and get in the way of therapy?

Emotional blunting is a real side effect for some people on some antidepressants. It can often be addressed by adjusting the dose or changing the medication.

How do a psychiatrist and a therapist work together?

The therapist usually sees the patient more often and notices changes early. The psychiatrist brings medical training, diagnostic review and prescribing. With the patient's permission, the two coordinate so that medication and therapy pull in the same direction.

As a psychiatrist who also practices psychotherapy, I see this question from both sides. The aim is never medication for its own sake. The aim is to get well and stay well, with the least treatment that does the job.

This post is general information, not medical advice. If you are in crisis, the 988 Suicide and Crisis Lifeline is available by call or text.

Sylvia Cartwright MD is a board-certified psychiatrist in independent practice in San Diego since 2013. She sees adults across California by telehealth. To learn more, visit https://www.sylviacartwrightmd.com/general-evaluation-medications

Sources

1. Cuijpers P, Noma H, Karyotaki E, Vinkers CH, Cipriani A, Furukawa TA. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 2020;19(1):92-107.

2. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67.

3. Cuijpers P, Miguel C, Harrer M, et al. Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry. 2023;22(1):105-115.