One of the most common questions I hear from patients and from people considering reaching out for the first time is some version of this: “Do I actually need medication, or should I just try therapy first?” Sometimes it’s the reverse: “I’ve been on medication for years, but I still don’t feel like myself. Is something missing?”
These are exactly the right questions to be asking. And the honest answer is that it will vary based who you are, what you’re struggling with, and what kind of change you’re actually looking for.
What Medication Can and Can’t Do
For patients experiencing severe depression, debilitating anxiety, or significant ADHD symptoms that are interfering with daily functioning, medication can reduce the intensity of symptoms enough to make other work possible. I take that seriously, and I’m glad these tools exist.
That said, in my experience, medication rarely gets to the root cause of the difficulties that bring people into treatment. Antidepressants can lift the floor of how bad things feel. Stimulants can improve focus and follow-through. Anti-anxiety medications can take the edge off. But they don’t, on their own, help a person understand why they keep ending up in the same painful relationships, why self-doubt follows them from job to job, or why the sadness comes back every time the medication is adjusted or stopped.
Medications treat symptoms. While helpful and sometimes critical, I have found that for many patients, they aren’t enough.
What Therapy Can Do That Medication Cannot
Psychotherapy, particularly the kind of open-ended, depth-oriented therapy I practice, offers something different: the possibility of lasting change. Not just symptom reduction, but a genuine shift in how a person understands themselves, relates to others, and moves through the world.
This kind of work takes time. It involves looking carefully at patterns: in relationships, in how you respond to stress, in the thoughts and feelings you may not even be fully aware of having. It means exploring how your personal history, the dynamics of your family, and your earliest experiences of being cared for (or not) have shaped the person you are today.
That may sound abstract, but in practice it often clarifies things that have felt confusing for years. Why do I always pull away when someone gets close? Why do I work so hard and still feel like I’m failing? Why does criticism land so hard, even when I know it’s minor? These aren’t questions medication can answer. But they’re often exactly the questions worth answering.
When Both Make Sense
There are situations where I recommend both therapy and medication, and I want to be clear that I see that as a legitimate and sometimes optimal approach. For patients with significant depression or anxiety that is making it difficult to engage meaningfully in therapy, medication can create enough stability to make the therapeutic work possible. In those cases, the two work together.
I also work with patients who come to me already on medication prescribed elsewhere and who are looking to add a therapy component to their treatment. When I take on that kind of case, I generally prefer to manage both the therapy and the medication myself, rather than coordinating across providers. In my experience, having one clinician who knows the whole picture — the symptoms, the history, the relational dynamics, the medication response — leads to better, more coherent care.
How I Think About This Decision
When I meet with a new patient, I’m not arriving with a predetermined answer about whether they need therapy, medication, or both. I’m trying to understand them. What are they struggling with, and for how long? What have they tried before? What are their goals? Are they looking to feel better quickly, or are they interested in something deeper and more lasting?
I take a conservative approach to medication. I prefer to use the lowest effective dose, the fewest medications possible, and to revisit those decisions regularly. And I’m genuinely interested in what brings a patient to treatment in the first place — not just the diagnosis, but the life behind it.
For most of the patients I work with, psychotherapy is the foundation of treatment. Not because medication doesn’t have a place, but because the kind of change that actually sticks tends to come from the slower, more demanding work of truly understanding your own mind.
If you’re trying to figure out where to start, the most important first step is a thorough evaluation with a psychiatrist who has the time and training to think carefully with you about your options. If you’d like to explore what treatment might look like for you, I’d encourage you to reach out at (720) 288-0882 or visit the For New Patients page to learn more about getting started.
Dr. David J. Williams, M.D. is a board-certified psychiatrist in private practice in Denver, CO, treating children, adolescents, and adults, specializing in psychodynamic psychotherapy and psychoanalysis.
