Therapy and medication
Most people arrive at this with the same question: therapy, medication, or both? Only a doctor can prescribe medication, and only you and your doctor can decide what’s right for you. This page is about what the research says, not about what you should take.
What the research says
For moderate depression, therapy and medication together worked better in the short term than either one alone (Cuijpers and colleagues, 2020). Therapy on its own and medication on its own came out about the same.
When people already on antidepressants added therapy, they did better than people who stayed on medication alone (Cuijpers and colleagues, 2014). That held for major depression, panic disorder and obsessive compulsive disorder (OCD), and the benefit was still there up to two years later.
The two seem to work in different ways, rather than one boosting the other, and each contributed about as much.
Most of this research is about antidepressants. They’re the medications you’ll see called SSRIs or SNRIs, short for selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors.
Where guidelines put each one
Where each one sits depends on the condition. For post-traumatic stress disorder (PTSD), Australia’s trauma guidelines put Trauma-focused therapy Therapies that work directly on the memory of what happened, rather than only on how you're coping now. Trauma-focused CBT is the family name for several of them. More in the jargon decoder first. They treat medication as an option where therapy isn’t available or isn’t right yet. That includes times when someone’s circumstances aren’t stable enough to start. Where the trauma was repeated or went on for years, complex PTSD covers what’s known about treating it.
For borderline personality disorder, recent guidelines say structured therapy is the main treatment and medication isn’t.
For attention deficit hyperactivity disorder (ADHD), Australia’s guideline recommends using medication and non-medication approaches together (Australian ADHD Professionals Association, 2022). Where ADHD is causing major difficulties in someone’s life, stimulant medications are the first to discuss with a doctor. For adults, the guideline also recommends therapy based on Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder (CBT). ADHD in adults covers what the research shows for each.
For many other conditions, therapy and medication are both reasonable starting points, and it depends on what’s going on and what you want.
Who can prescribe medication
Only doctors prescribe medication, which means a GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder or a Psychiatrist A medical doctor who has specialised in mental health. Psychiatrists can diagnose, prescribe and do therapy, though many spend most of their time on medication and diagnosis rather than weekly sessions. More in the jargon decoder . Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder , Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder , social workers and occupational therapists don’t. Who does what sets out the differences between these professions.
A Mental Health Treatment Plan A document your GP writes with you. It makes you eligible for a Medicare rebate on up to ten individual sessions a calendar year: six, then a review with your GP, then the remaining four. The plan itself isn't therapy. More in the jargon decoder is about Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder for therapy, not about medication, though the same GP appointment often covers both. How to get a Mental Health Treatment Plan covers how that works.
If you’re already on medication and wondering about therapy
Adding therapy when you’re already on medication is the situation the research above speaks to most directly. If you start seeing a therapist, it helps to tell them what you take, who prescribed it, and how long it’s been.
Therapists don’t prescribe medication, and they can’t tell you whether to change what you take. What they can do is work with you while the medication does whatever it’s doing.
Getting a diagnosis covers how an assessment and a prescription usually fit together.
If you’d rather not take medication, or you’re thinking about stopping
A medication is prescribed for a reason, based on your symptoms and anything else your GP or psychiatrist might take into account. Sometimes the difficulty itself can make you less willing to take it.
If you haven’t started and would rather not, it’s fair to tell your GP that, and to ask what the options are without a prescription.
If you’re taking something and would like to stop, talk to the person who prescribed it about why. If you both agree that’s the right course, ask how to stop safely. Please don’t change anything before that conversation. The usual advice is to make a plan to come down slowly (Royal Australian College of General Practitioners).
Stopping suddenly can bring on effects that feel physical as well as emotional. It’s hard to predict who will get them, which is why going slowly is the default advice. Some people stop easily. Others don’t.
If therapy is part of the picture, it’s worth telling your therapist you’re making a change, so someone else is watching how it goes.
If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.
Where next
Would I benefit from therapy? helps you work out whether it’s worth a try.