Do You Need Talk Therapy If You Are Taking Antidepressants?

To Treat Depression: Therapy or Antidepressants?

Do You Need Talk Therapy If You Are Taking Antidepressants?

Every year, nearly 16 million Americans experience depression and seek medical treatment. This decision marks the beginning of an often stressful process of trying various medications to find the best treatment plan.

Patients may have to fill out forms that include screening questions and/or may be asked to share intimate details. The diagnosis of depression often leaves patients with the choice between psychotherapy, medication or both.

For many patients, the way forward is uncertain. Deciding between different types of medical treatments can pose unique challenges to each person, and patients may rely on their doctor to steer them in a certain direction.

To understand the process of finding each individual a treatment plan that works for them, it’s important to understand the different types of depression treatments offered.

Psychotherapy or Antidepressants?

Psychotherapy, or talk therapy, is a treatment method used to help people living with a mental health condition such as depression.

Psychotherapy evidence-based treatments such as cognitive behavioral therapy (CBT) have become popular in the field.

CBT provides patients with tools to address harmful thoughts, emotions and behaviors. By giving patients social support and teaching them coping skills, this form of psychotherapy help people living with depression find relief.

On the other hand, antidepressant medications work by changing chemical signaling in the brain. Antidepressants may be effective for treating depression in some patients, but researchers are still not clear on how effective these drugs are in alleviating depressive symptoms.

The understanding of the effectiveness of both types of treatments is still evolving and researchers have dedicated studies to learning more about these treatments.

A 2012 study that reviewed data from more than 100 prior trials and included 10,000 patients uncovered that both psychotherapy and antidepressants were equally effective.

Even more interestingly, the study found that these forms of treatment were no more effective than alternative therapies, exercise.

Since then, similar research has been conducted with many studies coming to the conclusion that both psychotherapies and medications are comparably effective in improving the quality of life for people living with depression.

Using Both Therapy and Medication

Knowing that both psychotherapy and medication are used to treat depression and often have the same level of effectiveness begs the question of whether the methods, if used together, would yield even greater results.

Since studies determining the effectiveness of each treatment have come to different conclusions, most patients receive either psychotherapy or medication.

In 2016, the American College of Physicians developed guidelines about using antidepressants instead of psychotherapy for depression treatment.

A committee concluded that CBT and newer generation antidepressants have similar effectiveness in adults living with depression.

The guidelines recommend clinicians offer patients the option of CBT or antidepressants when it comes to treating depression.

Doctors often prescribe antidepressants first to treat patients with depression. These medications can have side effects such as nausea and vomiting. Surveys show that more than 250 million antidepressant prescriptions are filled annually in the United States. According to a 2015 JAMA study, 13% of U.S. adults took antidepressants in 2012, which is almost double the amount since 1999.

Understanding that psychotherapy and antidepressants have the same level of effectiveness may help change this trend in depression treatment.

Are Antidepressants Overprescribed?

Patients may prefer to take medication for their depression rather than work through psychotherapies CBT. Some patients may not have a way to access a mental health specialist or have the time to talk to a therapist. There are also patients who may prefer to take a pill in their home rather than having a personal discussion with a clinician.

Another reason why antidepressants are commonly prescribed may be related to the structure of the U.S. healthcare system. Clinicians may lean towards medication treatment due to higher insurance reimbursements and the efficiency of quick check-ins rather than a series of in-depth discussions and therapy sessions.

Alternative Treatment Options

In addition to psychotherapy and medication, there are additional treatment options for depression. Exercise may help manage mild or moderate depression. Transcranial magnetic stimulation or electroconvulsive therapy can help patients with more severe depression.

In today’s hurried medical environment, it can be challenging for clinicians to discuss treatment options, adverse effect profiles, cost and accessibility with a patient. However, it is critical to have a thorough and comprehensive conversation to help patients understand the scope of treatment for depression.

One option that can help guide clinicians in deciding on a treatment plan is genetic testing.

The Genecept Assay® is a genetic test performed via a cheek swab that looks that looks at key genes in an individual's DNA that can affect how they respond to medication for depression. It identifies patient-specific genetic markers that can indicate for clinicians which treatments are ly to work as intended, have no effect or cause adverse effects.

Learn more about depression treatments here.


Alternatives — Antidepressants

Do You Need Talk Therapy If You Are Taking Antidepressants?

Several treatments can be used instead of antidepressants for treating depression and other mental health conditions.

Cognitive behavioural therapy (CBT) is a type of talking therapy that's increasingly being used in the treatment of depression. Most experts recommend that people with moderate to severe depression are treated with a combination of CBT and antidepressants.

However, if you're unable or unwilling to take antidepressants, you have the option of receiving CBT on its own.

CBT helps you understand your thoughts and behaviour, and how they affect you. It helps you recognise that events in your past may have affected you, but it concentrates mostly on how you can change the way you think, feel and behave in the present. It also teaches you how to overcome negative thoughts.

CBT is usually available on the NHS, although the waiting lists are usually long. You normally have a short course of sessions, usually 6 to 8 sessions, over 10 to 12 weeks, on a 1-to-1 basis with a therapist trained in CBT. In some cases, you may be offered group CBT.

Online CBT

Computerised or online CBT is a form of CBT that works through a computer screen, rather than face-to-face with a therapist.

These therapies can be prescribed by your GP or a mental health specialist and are carried out with their advice and support.

Ask your GP for more information or read more about self-help therapies.

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) focuses on your relationships with other people and on problems you may be having in your relationships, such as difficulties with communication or coping with bereavement.

A course of IPT is usually structured in the same way as a course of CBT.

There's some evidence that IPT can be as effective as antidepressants or CBT, but more research is needed.


Counselling is a form of therapy that helps you think about the problems you're experiencing in your life to find new ways of dealing with them. Counsellors support you in finding solutions to problems but do not tell you what to do.

Counselling on the NHS usually consists of 6 to 12 sessions lasting an hour each. You talk in confidence to a counsellor, who supports you and offers practical advice.

Counselling is ideal for people who are generally healthy but need help coping with a current crisis, such as anger, relationship issues, bereavement, redundancy, infertility or the onset of a serious illness.

Talking therapies on the NHS

You can get talking therapies counselling for depression and cognitive behavioural therapy (CBT) on the NHS.

You can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from a GP.

Read more about NHS talking therapies

Research suggests that regular exercise may be a more effective treatment for mild depression than antidepressants.

Exercise helps boost levels of chemicals called serotonin and dopamine in the brain, which can lift your mood.

Exercising on a regular basis can boost self-esteem and confidence, which can help to relieve symptoms of depression.

Read about starting exercise and exercise for depression.

Talking through your feelings can be helpful. You can either talk to a friend or relative, or you can ask your GP to suggest a local self-help group. There are also chat rooms on the internet that offer support.

Read more about depression support groups.

If you've tried several different antidepressants and seen no improvement, your doctor may offer you a medicine called lithium, in addition to your current treatment.

If the level of lithium in your blood becomes too high, it can become toxic. So, you'll need blood tests every few months to check your lithium levels while you're taking it.

You'll also need to avoid eating a low-salt diet because this can also cause the lithium to become toxic. Ask your GP for advice about your diet.

Side effects of lithium include:

  • dry mouth
  • a metallic taste in your mouth
  • some mild shaking of your hands
  • diarrhoea

These side effects usually pass with time once your body gets used to the medicine.

Sometimes a treatment called electroconvulsive therapy (ECT) may be recommended if you have severe depression and other treatments have not worked, as it can be highly effective.

During ECT, you'll first be given an anaesthetic and medicine to relax your muscles. Then you'll receive an electric current to your brain through electrodes placed on your head.

You may be given a series of ECT sessions. It's usually given twice a week for 3 to 6 weeks.

It's not exactly clear how ECT works, but recent studies suggest it may help reduce connections in an area of the brain linked to depression.

For most people, ECT is good for relieving severe depression, but the beneficial effect tends to wear off after several months.

Some people get unpleasant side effects, including short-term headaches, memory problems, nausea and muscle aches.

But these risks need to be balanced against the risks of other treatments and the effects of not treating depression.


Comparing Talk Therapy and Other Depression Treatments With Antidepressant Medicines

Do You Need Talk Therapy If You Are Taking Antidepressants?

  • Your health care professional* said you have depression (also called «major depressive disorder»).
  • You are age 18 or older. This information is from research on adults.

* Your health care professional may include your primary care doctor, psychiatrist, psychologist, other therapist, nurse practitioner, or physician assistant.

This information is not right for you if:

  • You are in the hospital because of your depression.
  • You are a mother, and your depression started slightly before or after you gave birth.
  • Your health care professional said you have any of these conditions:
    • Seasonal affective disorder (depression symptoms that happen only during the winter when there is less sunlight)
    • Dysthymia (mild depression on most days for at least 2 years)
    • Psychotic depression (depression that can cause you to see, hear, or believe things that are not real)
    • Bipolar depression (depression with severe mood swings)

This summary will answer these questions:

  • What is depression?
  • What have researchers found about how antidepressants compare with talk therapy (also called counseling) and other depression treatments (exercise programs, acupuncture, and dietary supplements)?
  • What should I ask my health care professional about treating my depression?

What is the source of this information?

This information comes from a research report that was funded by the Agency for Healthcare Research and Quality, a Federal Government agency.

Researchers looked at 44 studies that compared antidepressants with other treatments for depression. The studies were published between January 1990 and January 2015. Health care professionals, researchers, experts, and the public gave feedback on the report before it was published.

What is depression?

Depression is an illness that involves the brain. Depression is different from feeling sad or down for a few days. If you are depressed, you may have symptoms almost every day. You may be sad, lack energy, or feel tired most of the time. You may not feel doing activities you used to enjoy.

You may also:

  • Have trouble thinking and paying attention
  • Have trouble sleeping or sleep too much
  • Eat too little or too much
  • Feel hopeless, helpless, worthless, or guilty
  • Avoid being with people
  • Have thoughts about your own death, harming yourself, or suicide

Medical experts are not sure what causes depression. It could be caused by changes in the chemicals in your brain, stress in your life, or other causes. Depression also runs in some families.

Depression is very common. In 2014, about 17.5 million adults (or 1 in every 14 adults) in the United States had depression that needed treatment.

Depression can be a serious health problem, but treatment can help.

How do depression treatments compare?

There are many ways to treat depression. You may have to try several treatments before you find something that works for you. Your health care professional may first suggest an antidepressant medicine or talk therapy (also called counseling).

One type of talk therapy is called cognitive behavioral therapy. When researchers compared it with antidepressants as a first treatment for depression, they found:

  • Cognitive behavioral therapy works as well as antidepressants to improve depression symptoms.

Two other types of talk therapy (interpersonal therapy and psychodynamic therapy) might also work as well as antidepressants, but more research is needed to know for sure.

Some other treatments for depression include exercise programs, acupuncture, and dietary supplements (such as St. John's wort and SAMe). These treatments may work as well as antidepressants, but more research is needed to know for sure.

This summary will cover each of the treatments discussed above, their possible side effects, and what researchers found. This summary can help you talk with your health care professional about which treatment or combination of treatments may be best for you.

What are antidepressant medicines?

Antidepressants improve the way your brain uses certain chemicals that control your mood and stress levels. Some examples of antidepressants include bupropion (Wellbutrin®), citalopram (Celexa®), fluoxetine (Prozac®), and venlafaxine (Effexor®).

Depression symptoms improve for three every five people who try antidepressants as their first treatment.

If you try an antidepressant, you should take it for at least 8 weeks to see if it will help. If the antidepressant does not help enough, you may need to try a different one. Some people need to try several antidepressants before finding one that works.

What are possible side effects of antidepressants?

The U.S. Food and Drug Administration (FDA) lists the following possible side effects of antidepressants:

  • Nausea and vomiting
  • Weight gain
  • Sleepiness
  • Diarrhea
  • Sexual problems
  • Trouble sleeping

More serious side effects are much less common. These include heart problems, too little sodium (salt) in your blood, and liver damage. Antidepressants can also cause a life-threatening reaction called «serotonin syndrome.» Serotonin syndrome can cause shivering, diarrhea, fever, seizures, and stiff muscles.

Never stop taking an antidepressant without first talking with your health care professional, even if you start feeling better.

What is talk therapy?

Talk therapy is a type of treatment in which you talk with a trained therapist. You may meet with the therapist one-on-one or in a group. Sessions are usually once a week. If you try talk therapy, you should have at least eight sessions to see if it helps.

Talking with a therapist about issues that have to do with your depression may upset you. You may feel angry, nervous, or sad. Working through these feelings may be part of getting better. It is important to tell your therapist if talk therapy upsets you or if your depression symptoms get worse.

There are many types of talk therapy. The chart below lists three types of talk therapy that researchers compared with antidepressants.

Table 1. Talk Therapy Compared With AntidepressantsType of Talk Therapy How does it help? Researchers found that as a first treatment for depression:Cognitive behavioral therapyInterpersonal therapyPsychodynamic therapy
You learn to notice your negative thoughts and actions so you can replace them with positive ones.
  • Cognitive behavioral therapy improves depression symptoms as well as antidepressants.
  • People are able to stick with cognitive behavioral therapy as well as they are able to stick with antidepressants.
You work on problems you have with people in your life and learn new ways to communicate.
  • Interpersonal therapy and psychodynamic therapy may improve depression symptoms about as well as antidepressants, but more research is needed to know for sure. Only a few studies have been done on these types of talk therapy.
You uncover deep feelings and past experiences to learn how they affect the way you feel and act now.

What are some other treatments for depression?

You may have heard of some other treatments for depression, such as those listed in the chart below. Always talk with your health care professional before starting any of these treatments.

Table 2. Other Treatments for DepressionType of Treatment About the TreatmentExercise programsAcupunctureDietary supplements
Doing exercises a few times a week that make your heart beat fast, such as brisk walking or jogging
Treatments from a trained therapist who inserts thin needles into your skin at certain points
Taking St. John's wort (an herb), SAMe (a chemical your body makes, also called s-adenosyl-l-methionine), or fish oil (healthy fats, also called omega-3 fatty acids)

Only a few studies have been done on these other treatments as a first treatment for depression. The studies suggest that:

  • Exercise programs, acupuncture, St. John's wort, and SAMe may improve depression symptoms about as well as antidepressants, but more research is needed to know for sure.
  • Fish oil does not appear to improve depression symptoms as well as antidepressants, but more research is needed to know for sure.

What are possible side effects of these other treatments?

Table 3. Possible Side Effects of Other TreatmentsType of Treatment Possible Side EffectsAcupunctureSt.

John's wort

SAMeFish oil
  • Pain
  • Fainting
  • Dizziness
  • Nausea
  • Nausea
  • Dry mouth
  • Heartburn
  • Constipation
  • Swelling of the tongue
  • Sweating
  • Tiredness
  • Anxiety
  • A fishy taste in your mouth

What if my first treatment does not help enough?

If your first treatment did not help enough, your health care professional can help you switch to a different treatment or add another treatment to the first one.

Researchers looked at second treatments after the first treatment with an antidepressant did not work. They found that:

  • For some people, switching to a different antidepressant improved depression symptoms. The type of antidepressant they switched to did not matter. Symptoms improved about the same with all second antidepressants.

Researchers also found the following about second treatments, but more research is needed to know for sure:

  • Adding cognitive behavioral therapy to the first antidepressant appears to work about as well as adding a second antidepressant to the first one.
  • Stopping antidepressants and switching to cognitive behavioral therapy appears to work about as well as switching to another antidepressant.

What should I think about?

You and your health care professional can decide what might be best to treat your depression. But first, your health care professional needs to know how you feel about your depression and your treatment options.

Here are some things to think about. Be sure to share your thoughts with your health care professional.

  • How is depression affecting your daily life?
  • Which possible side effects from treatment concern you?
  • How much time are you able to put into your treatment?
  • How might the cost of treatment affect your decision?
  • If you were treated for depression in the past, what helped?
  • Which treatment feels the best fit for you?

Ask Your Health Care Professional

  • Which treatment or combined treatments do you think may be best for me? Why?
  • How long will it take to know if a treatment is working?
  • What do I need to know about possible side effects from treatments?
  • If a treatment helps, how long would I need to continue it?
  • How does the use of alcohol and other substances affect depression and its treatment?


The information in this summary comes from Gartlehner G, Gaynes BN, Amick HR, Asher G, Morgan LC, Coker-Schwimmer E, Forneris C, Boland E, Lux LJ, Gaylord S, Bann C, Pierl CB, Lohr KN.

Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder. Comparative Effectiveness Review No. 161. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No.290-2012-00008-I.

) AHRQ Publication No. 15(16)-EHC031-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2015.

Additional information came from, a service of the National Library of Medicine and the National Institutes of Health.

Some information also came from the report Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review, December 2011.

The report was also produced by the RTI International–University of North Carolina Evidence-based Practice Center through funding by AHRQ.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Sherry Reisner, B.A., Amelia Williamson Smith, M.S., Mark Kunik, M.D., and Michael Fordis, M.D. Patients with depression gave feedback on this summary.


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