What's Best for my Depression: Medication or Psychotherapy?
People are becoming more informed about their mental health and, quite rightly, are beginning to ask questions about the effectiveness of treatment options. In the case of depression two main treatment options exist. The first of these is antidepressant medication and the second is psychotherapy. But which should you opt for?
There are no hard and fast rules about which of the methods are best for depression. It's also true that they aren't mutually exclusive - in other words plenty of people take medication and receive some form of psychotherapy. Still, it's worth having an appreciation of the benefits and limitations of both options.
From what we know of antidepressant medication the most significant pharmacological effects seem to be with people suffering with major depression. In other words, people with a milder form of depression appear to derive little if any chemical benefit from antidepressants.
Milder forms of depression, as well as people recovering from major depression, seem to respond well to psychotherapy. These days psychotherapies tend to be clustered within the general description of ‘talking therapies'. They include counseling, cognitive behavioral therapy, interpersonal therapy and family therapy, to mention just a few. Of these, cognitive behavioral therapy (CBT) is probably the best researched. Many of the other therapies may include elements of CBT within their scope.
The main problem with medication is side effects. Not everyone suffers with side effects but most people are aware of the fact that medication is doing things to them which may not feel pleasant. Ironically, some antidepressants may cause anxiety as a side effect. There is also some evidence that SSRI medication can increase suicidal thoughts in young people. The standard statement is that side effects of antidepressant medication usually wear off within a couple of weeks. However, the person may not feel any therapeutic benefits for at least six weeks. Many people don't feel antidepressants are helping them. They are usually referred to as ‘treatment resistive' rather than the treatment being considered ineffective. However, as previously mentioned, if the depression is not major few benefits may be derived.
This does not mean that psychotherapy is without its problems. At its worst pretty much anyone with an inclination, or a two-week certificate in counseling, can set themselves up as a therapist. For this reason it is essential that your therapist can demonstrate they are properly licensed and their practice is overseen by a professional body that makes the therapist accountable for their actions.
Not everyone wants antidepressants and not everyone wants psychotherapy. Antidepressants have side effects but some of the talking therapies do too. Of course the side effects are psychological and emotional, and depending on the therapy of choice, the digging up of past events may take more or less prominence.
In summary, the treatment options are exactly that - options. For major clinical depression there is evidence that antidepressant medication is effective. For milder forms of depression the talking therapies may be better. If your form of depression is bipolar, then mood stabilizing medications will probably be necessary and could be needed for a very long time.
Lastly, it's important to remember that we can all help ourselves to a greater or lesser extent. Self help for depression includes cutting out alcohol, eating a regular balanced and nutritious diet, gentle regular exercise, good sleep and possibly tackling the cause if you feel you know what this is.