Do You Need Talk Therapy If You Are Taking Antidepressants?

Understanding add on therapy for depression.

Talk therapy

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Almost 1 in 10 Americans is struggling with major depression. The illness has a high disease burden on society and is a re-occurring illness. Therefore, the search for effective and evidence-based treatment is fervent and ongoing.

Research demonstrates that the combination of psychotherapy and medication is the most effective approach to treat depression.

There is a myth that treatment for major depression involves either talk therapy or medication. This is misleading as combining talk therapy and antidepressants can provide many benefits to your depression-treatment journey.

If you're considering getting treatment for depression you might be wondering if you should begin talk therapy or medication treatment. The truth is you can do both.

Let's discuss add-on therapy for depression and how combining talk therapy and medication might be a good option for you.

Talk Therapy

Some people may initiate talk therapy (a kind of therapy that allows you to explore your past and current experiences) first, feeling that processing their life experience will be helpful in addressing depressive symptoms.

This may be especially true for those who feel that their depression is situational or stemming from a traumatic childhood or a conflict-ridden relationship.

It could seem that talking through this specific issue will rectify the situation and provide clarity. In this case, if the therapist notices persistent symptoms of clinical depression during treatment, he or she may recommend seeing a psychiatrist whose training as a medical doctor enables them to discuss medication options with a patient.

Medication Treatment

For some individuals, the beginning of their depression treatment journey begins with medication.

That individual may be very ready to alleviate symptoms such as insomnia, lethargy, brain fog and lack of motivation that are inhibiting their productivity and quality of life.

For most, antidepressants will effectively improve those symptoms. Without the weight of those physical manifestations of a depressive episode, underlying issues that are detracting from someone’s best life are more likely to declare themselves. The need for add on therapy may become apparent.

Therapists routinely recommend the involvement of a psychiatrist to potentially prescribe medication to their patients. It is also usual for prescribers to suggest that psychotherapy would compliment their patient’s treatment plan.

It is very common for a psychiatrist and therapist to provide collaborative care and take a team approach for the best outcomes. Of note, there are many psychiatrists who incorporate talk therapy into their treatment approach.

Benefits of Add On Talk Therapy

If a patient has benefitted from antidepressants, then adding talk therapy can move that person towards their most optimal life.

Part of the purpose of talk therapy is to reflect upon and review your life with someone who can offer clarity on a problem and help identifying how patterns from the past have continued to play out in the present and create obstacles.

Having another person in the room offers objectivity to a situation in which you are emotionally involved. This lends itself to a bird’s eye view of a life which can be incredibly illuminating and informative. This knowledge and, most importantly, self-knowledge creates a path for meaningful change.

Sounds great, right? Well, it really is. Many people will tell you that the experience of effective talk therapy is a game changer and can be a major life hack.

However, this work is not easy. That level of self-inspection and insight building is tough work. It is extremely difficult to apply the radical honesty to situations in your life that leads to true and lasting improvement.

You Will Be Less Defensive

It is not unusual for a person to feel a bit worse during therapy as painful truths come to the surface. These truths may have been hidden from you or repressed because your mind was doing you that favor, as you may not have been ready to understand or process them. This is called a defense mechanism.

Individuals who are actively depressed may be quite defensive and protective of themselves. Depression is an illness and a psychological wound. Like a wounded animal, a depressed person may be in the emotional equivalent of a defensive posture. They may be extra sensitive to slights or potential threats in their environment, as they perceive their own vulnerability.

They will be hesitant to let down their walls and let someone else in. They may be resistant to the challenge of accurate assessment of their actions and introspection and this might not be a conscious choice.

Those with depression are more likely to have had a traumatic childhood or complicated life circumstances. Therefore, a depressed person's symptoms may be improved by antidepressants but they might still have turbulent areas of their life that need unpacking.

This is how antidepressants and add on psychotherapy can compliment each other. The antidepressant can help dissipate the depression that would be a barrier to the difficult and transformative work of therapy.

You Will Have Better Insight

Often, when you are depressed you cannot connect the dots and see the parts of your life that require some attention. Antidepressants can clear the smoke a bit and make the path clear because the dense fog of depression is no longer obscuring your vision.

At that point, talk therapy can aid you in taking that path to become a better version of yourself.

Many describe that the experience of talk therapy is entirely different before antidepressants, when they were actively depressed, compared to after when they are no longer depressed.

They are able to distinguish how working with a psychotherapist when not depressed enables them to be sufficiently vulnerable to see inconvenient truths about their life story. This is the work of therapy that allows for evolution and changes in perspective that gives one the tools to cope better with life’s challenges. And that is the ultimate goal of psychotherapy.

You Are Better Able to Do the "Work" of Therapy

Add on therapy as an adjunct to pharmacological interventions for mood disorders is a logical, stepwise treatment strategy. Well executed psychotherapy often involves “homework” to do between sessions. This may be things such as journaling, affirmations, the reading of certain self-help genre books and maybe even starting a rigorous self-care program.

An acutely depressed person may not have the motivation and follow through to perform these tasks. These assignments will feel bothersome and overwhelming when someone is actively struggling. This person may become frustrated with themselves as they fail to complete this work and eventually frustrated with the process of therapy itself because they feel burdened instead of enlightened.

When not depressed, the person in therapy will be better equipped to keep commitments made to themselves and submit to the process of therapy, even when it gets uncomfortable.

A Word From Verywell

There are, of course, times when talk therapy or medication can be done separately. That perhaps meets the needs of the patient at that time. However, it should be known that you do not have to choose between medication and therapy and you may want to consider some of the advantages of add on talk therapy.

Discuss your treatment options with your health care provider to discuss what is best for you.

3 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Margaret Seide, MD
Margaret Seide, MS, MD, is a board-certified psychiatrist who specializes in the treatment of depression, addiction, and eating disorders.