Mental Health Treatment Approaches: Talk Therapy vs. Medication Management

Treatment Approaches: Talk Therapy vs. Medication Management

If you’re seeking treatment for a possible mental health condition, you’re probably asking yourself the same question many people struggle with: Do I need therapy, medication, or both?

The choice depends on many factors, including the type and severity of your condition. Mental health professionals say an important first step is talking  with your doctor about what you’re experiencing.

“Your choice of treatment should be based on the best available scientific evidence, as well as your own willingness to try these treatments and to stick with them,” the American Psychological Association says on its website. “Whatever the choice, these discussions should be reviewed with your physician, psychologist or mental health professional.”

The two primary treatment methods for mental health conditions are pharmacotherapy, or medication management.

Talk therapy is often used in cases of mild to moderate depression, some anxiety disorders, and situational stress. Medication management is frequently needed when there’s a diagnosis of a condition such as major depressive disorder or anxiety disorder, or when therapy alone hasn’t provided enough help.

Here are additional details on each type of treatment, when they’re likely to be recommended, and factors to consider when you’re seeking help for a possible mental health condition:

Understanding Talk Therapy

When patients undergo talk therapy, they’re meeting with a mental health professional to discuss their symptoms, emotions, challenges, and behaviors. Sessions can take place in person or remotely through a telehealth platform.

According to the Mayo Clinic, talk therapy can be useful for most types of mental health disorders, including:

• “Anxiety disorders, such as social anxiety, obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD).
• Mood disorders, such as depression or bipolar disorder.
• Addictions, such as alcohol use disorder, drug dependence or compulsive gambling.
• Eating disorders, such as anorexia or bulimia.
• Personality disorders, such as borderline personality disorder or dependent personality disorder.
• Schizophrenia or other disorders that cause detachment from reality.”

Talk therapy can be useful even if you haven’t been diagnosed with a mental health condition. The Mayo Clinic notes many situations that are commonly approached with the help of psychotherapy, including resolving conflicts, relieving stress, coping with major life changes, and learning to manage unhealthy responses.

The mental health profession classifies talk therapy into several different forms. According to the Cleveland Clinic, the most common types of therapy are:

• Cognitive behavioral therapy (CBT): Structured and goal-oriented, CBT helps patients examine their thoughts and emotions. “Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits,” the Cleveland Clinic says.
• Dialectical behavior therapy: This is a form of therapy based on CBT but specifically designed for people who experience emotions intensely. It comes from the term “dialectical,” which means combining opposing ideas, and it helps patients accept the reality of their lives while helping them learn to change, especially their unhelpful behaviors.
• Interpersonal therapy: As a short-term form of therapy, interpersonal therapy works on mental health symptoms by helping patients improve their relationships with others. The Cleveland Clinic says research shows this approach to be most effective with patients experiencing major depressive disorder.
• Psychodynamic therapy: This treatment method explores past experiences or unconscious thoughts and feelings and attempts to help patients understand how lived experience affects them. Therapists help patients improve their self-awareness and change thought patterns.

Understanding Medication Management

A physician, psychiatrist or nurse practitioner may prescribe one or more medications to help treat mental health conditions. When medication management – often called either pharmacotherapy or psychopharmacology – is used, it can be in conjunction with talk therapy or a standalone treatment under a doctor’s supervision.

According to the Irving Medical Center at Columbia University, medication management is often the recommended approach with moderate to severe symptoms or when talk therapy alone hasn’t been sufficient.

Many types of medications are approved for treating mental health conditions. Irving Medical Center’s website lists these classes of drugs as the most common:

• Antidepressants: The most commonly prescribed mental health medications, antidepressants affect neurotransmitters, like serotonin, in the body. Antidepressants are considered first-line treatments for depression and anxiety disorders. According to the Cleveland Clinic, a course of treatment typically lasts six months or longer, and side effects can include upset stomach, diarrhea, headache, drowsiness and sexual dysfunction.
• Benzodiazepines: These are most commonly prescribed for severe anxiety and panic attacks, and in some cases, seizures or insomnia. They work by slowing down brain and nervous system activity. Benzodiazepines, classified as controlled substances, can have dangerous effects when not used properly.
• Mood stabilizers: Physicians and psychiatrists often prescribe mood stabilizers for bipolar disorder as well as depression that doesn’t respond to other treatment options. Examples include lithium and valproic acid.
• Antipsychotics: These drugs are used for schizophrenia and other severe mental illnesses. They may also be used for bipolar disorder, depression and conditions that are difficult to treat with other medications. They might have a variety of side effects.

While medications play an important role in treating many mental health conditions, it might take time to either see improvement or find different medications or drug combinations that will work.

This is where the GeneSight® test can be particularly helpful by providing your clinician with insights on how you metabolize drugs commonly used in the treatment of these disorders.

“A few psychiatric medications work quickly, and you will see improvements within days, but most work more slowly,” the National Alliance on Mental Illness (NAMI) says on its website. “You may need to take a medication for several weeks or months before you see improvement.”

Combining Talk Therapy and Medication Management

In many cases, talk therapy combined with medication leads to improved outcomes better than either alone.

For example, a study published in 2016 in the journal Psychol  Med found that the combination of therapy and medication performed better in patients with depression, as measured by ability to function and quality of life.

Another study, published in 2014 in JAMA Psychiatry, noted similar findings from a clinical trial that included 452 adults diagnosed with major depressive disorder. The combination of antidepressants and cognitive therapy enhanced the rate of recovery when compared with antidepressants alone.

“Given variable responses to treatments, combining a medication with psychotherapy increases the likelihood of response to at least one of them,” says an article on major depressive disorder published in Psychiatric Times. The article says that while many people can benefit from the combination approach, patients most likely to see success are those with depression and anxiety disorders. This is especially true for people with severe symptoms or complex conditions.

Factors to Consider When Choosing a Treatment Approach

The sheer variety of mental health conditions, treatment options and types of providers (psychiatrists, psychologists, counselors, family physicians and others) can seem overwhelming to anyone seeking mental health treatment.

Mental health professionals say there’s no perfect “one size fits all” approach. The best approach is one that fits with your goals, experiences and individual preferences.

That option might include talk therapy, medication management or a combination of the two. And what’s right for you might not be right for a friend or family member going through similar circumstances.

“Treatment choices for mental health conditions will vary from person to person,” NAMI says. “When people are directly involved in designing their own treatment plan, including defining recovery and wellness goals, choosing services that support them and evaluating treatment decisions and progress, the experience of care and outcomes are improved.”

Regardless of the path taken, the best place to start is by talking with your physician or therapist. A licensed professional can diagnose the type and severity of your mental health condition, and discuss your preferences and values, your history and experiences, the cost, and the potential benefits and risks of each treatment option.

The Mayo Clinic lists these tips for finding a mental health professional:

• Ask your health insurer for a list of covered providers.
• Seek a referral or recommendation from your primary care provider.
• Ask trusted friends, family or someone in your faith community.
• Use your employer’s employee assistance program (EAP).
• Contact a local or national mental health organization.
• Search for directories from the American Medical Association, American Psychiatric Association, American Psychological Association, or Association for Behavioral and Cognitive Therapists.
• Check the internet or phone book for community service numbers, counselors, psychologists, psychiatrists or social service organizations.

For more information about this topic and other topics, please visit:

• Depression Diagnosis, Treatment and Beyond
• Roadblocks to Seeking Depression Treatment
• What are the Treatment Options After a Mental Health Emergency?