By William Schroeder, LPC, NCC and medically reviewed by Kate Van Norman, PMHNP-BC
Clients often ask me whether they should take medication for depression, and what therapy does that medication doesn’t. My answer usually starts here: medication can be very helpful, and it doesn’t have to be lifelong. For a lot of people, the best results come from using both, with a plan for what happens next.
This post is not medical advice. Decisions about starting, changing or stopping a medication belong with your prescriber.
What Medication Does and What Therapy Does
The way I explain it, medication often lifts the fog. It can ease the symptoms that are getting in the way, like low energy, poor sleep or a mood so heavy that nothing else feels possible.
Therapy is where you learn coping skills and do the work on what is underneath. When that work takes hold, some people find they may not need medication in the future. Others stay on it and do well. Either way, the skills stay with you.
What the Research Says About Lasting Results
A number of studies suggest that what people gain in therapy tends to last after treatment ends. A 2013 meta-analysis in BMJ Open pooled nine trials of cognitive behavioral therapy (CBT). People who finished CBT were less likely to relapse than people whose antidepressant was stopped, and did about as well as people who stayed on their medication.
A 2024 review in Frontiers in Psychiatry looked at 19 trials that followed people for at least a year after treatment ended. Therapy alone, and therapy plus medication, both had lower relapse rates than medication alone. The authors note that few studies follow people that long, so the picture is still filling in.
The two together are often the most helpful. I also see the benefit of medication plateau for some people over time, which is one more reason to build skills alongside it.
There is another piece I think about a lot. It makes a big difference whether someone believes they made themselves better or believes a pill did it. In my experience, people who credit the medication alone tend to struggle more over the long run. People who see their own effort in the change have something to fall back on.
Should You Start With Therapy or See a Prescriber First?
It depends on what is going on. There isn’t a wrong door. A good therapist will assess where you are and help you figure out what level of care you need. A prescriber can be a psychiatrist, a psychiatric nurse practitioner or your primary care doctor.
One question I always ask is whether once-a-week therapy is going to be enough. If someone is already in weekly therapy, are they making progress, or do they need something more?
It is time to look at a bigger intervention when someone is struggling to do basic things, like:
- Getting out of bed.
- Showering or eating.
- Getting through a normal day at work or school.
In those situations, an intensive outpatient program (IOP) plus medication can help, followed by individual therapy. Some medications can also help more quickly than others. That is something to talk through with a prescriber, case by case.
If you are thinking about suicide, call or text 988, the Suicide & Crisis Lifeline, any time. If you are in immediate danger, call 911.
The Two Myths I Hear Most
The first myth is that antidepressants don’t work. They help a lot of people, especially when depression is getting in the way of daily life.
The second is that once you start, you will be on them forever. That doesn’t have to be true. The problem is that coming off is often not discussed. A 2023 survey in the Journal of Psychiatric Research of people trying to stop antidepressants found that most felt their prescriber could not help them stop safely. The people surveyed came from online withdrawal support groups, so they likely had harder experiences than most. Still, it matches what I hear in my office.
Some people feel low, decide not to refill and stop all at once. That can come with its own consequences, from withdrawal symptoms to a relapse that is hard to tell apart from them. It helps to talk about how you would come off a medication before you ever need to. We go into that more in our post on how therapy can help you get off antidepressants.
Medication Support at Just Mind
Just Mind plans to add a prescriber in January 2027. Until then, you can let our client care team know you are interested and join the waiting list. You can also see one of the prescribers we know and trust in the community. Our referral partners page lists several, and our guide to ADHD specialists in Austin includes prescribers too. We collaborate with them closely, with your permission, so your therapist and prescriber are working from the same plan.
If you are ready to start therapy, read more about our depression counseling, or tell us what is going on and a real person on our client care team will match you with a therapist who fits.
