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Is medication or therapy more effective for depression?

Anthony's comment:

Therapy is the first tool in treatment. Without self-awareness, any further attempts at treatment are going to be difficult if not futile. If a medical professional deems it necessary, medication can help one to cope better with depression. Neither medication nor therapy is particularly more effective than the other; for me personally it had to be both and I wouldn't have accepted any medicine unless there was the opportunity for discussion on my life circumstances.

Studies have shown that the combination of medication with therapy can be the most effective.

Both medication and therapy are effective treatments for depression. The treatment choice depends on the severity of the episode. Mild depression is often effectively treated with cognitive-behavioral therapy or interpersonal therapy alone, for example. More severe forms of depression typically require the adjunctive use of medication. Some individuals only take medication, but studies have shown that the combination of medication with therapy can be the most effective. When taking medication it is usually best to have some form of therapy at some point during the treatment to address the precipitating stressors. This helps to develop coping mechanisms and problem-solving abilities and reduces the risk of recurrence under stressful circumstances in the future.

The most important factor in determining a positive outcome from either modality is that both forms of treatment require commitment to the treatment for it to work. Therapy requires regular attendance to appointments, communication with the therapist during the session, and, for some forms of therapy, work on assignments between sessions. The process of therapy is not easy. It can be anxiety provoking, and one does not necessarily feel relief after each individual session. Relief comes over time with hard work on the issues. It may feel easier to cancel sessions or to terminate treatment prematurely, but then the therapy is not given a chance to be effective.

As for medication, its use requires daily adherence and regular communication with your doctor. It is often difficult for many people to remember to take a medication daily, twice a day, or more. Doses may be skipped. Missing doses regularly results in reduced efficacy of the medication. Sometimes a medication does not work right away. It becomes frustrating, and the medication treatment is abandoned prematurely. Often, when a person has a list of "ineffective" medication, many of them did not get adequate trials.

You may wish to try therapy alone first, and, depending on progress, consider use of medication later. This route may be appropriate for milder cases of depression. Again, the more severe the depression, the more likely medication will also be necessary, because improvement in symptoms usually occurs more quickly with medication. Persistent, unremitting depression can be harmful because of its adverse physical and emotional effects as well as its associated risk for suicide. Therefore the decision to initiate or hold off on medication needs to be made very carefully. Again, it is optimal to be in therapy while on medication, because therapy provides the skills needed to manage stressful situations in the future and will hopefully deter future depressive episodes.

Are there any natural remedies for depression?

"Natural" or alternative treatments[1] describe any treatment that has not been scientifically documented or identified as safe or effective for a certain medical condition. Examples of alternative treatments include acupuncture, yoga, herbal remedies, aromatherapy, biofeedback, and many others. In considering an alternative treatment, as with any scientifically documented treatment, one should consider the risks versus the benefits of such a treatment. If a particular procedure has no specific, direct risks associated with it, an important risk is potentially delayed treatment of the depression. For a mild depression, this risk may not be too great, but for a more severe depression with suicidal thoughts it could be a fatal risk.

A common assumption about these natural treatment choices is that they are safe because they are natural.

Other risks include loss of money on an ineffective treatment, the use of a treatment that is not standardized nor required to conform to specific regulations, and frustration when hopes of a unique treatment are not realized.

Herbal remedies are a popular natural choice for treatment of many conditions. A common assumption about these natural treatment choices is that they are safe because they are natural. Although herbs are found in nature, as with synthetic chemicals, herbs have a specific chemical structure that also alters the body chemistry. As such, there can be significant side effects from such compounds as well. Some of these side effects can be life threatening. For example, there have been many cases of liver failure from use of kava supplements around the world. In many cases the problem per se is not that there are side effects, it is that the herbal treatments are not regulated as to either their safety or efficacy. If a specific treatment is known to be effective, one may be willing to take certain risks for relief. Without known efficacy, however, it is not possible to make an informed decision about the risks from exposure. A lack of regulation also means that supplements available in the store are not rigorously tested for purity or quantity of the active compound in question. Individuals who sell these treatments may act as experts but have not necessarily obtained any specialized training or certification either. It is important to keep these issues in mind when undertaking an alternative treatment so that fully informed decisions about treatment can be made. If it is decided an alternative treatment should be tried, it is important to communicate this information with a doctor. Herbal treatments in particular may interact with other medications, making it especially important to do so.

  • [1] a treatment for a medical condition that has not undergone scientific studies to demonstrate its efficacy.
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