What the evidence shows about each
For mild to moderate depression, both therapy (particularly CBT) and antidepressants have comparable evidence bases, with response rates and remission rates in similar ranges across major clinical trials. For severe depression, antidepressants have stronger evidence and are usually recommended first. NICE explicitly recommends offering choice for mild to moderate depression and recommends therapy plus medication for severe.
Where the differences are
Therapy has longer-lasting effects after treatment ends — relapse rates are lower after successful therapy than after successful medication that is later stopped. Antidepressants often work faster, particularly for severe symptoms. Therapy requires availability, motivation, and often financial cost; medication requires prescriber access. Therapy has no medication side effects but does have emotional intensity.
Choosing between them
Personal preference matters. If you have a strong preference for one over the other, that preference is usually respected in guidelines. If both are available and you are not sure, discuss with your GP. For treatment-resistant situations, combining therapy and medication typically outperforms either alone. There is no shame in either choice.
What to flag to your prescriber
- Severe symptoms where waiting for therapy access is unsafe.
- Suicidal thoughts — these usually warrant medication consideration alongside any therapy plan.
- Difficulty accessing either option — worth discussing barriers with your GP.
- Situations where one option has been tried without success — the other or a combination may be next.
Related reading: What Is a Mental Health Treatment Plan in Australia? and When to See a Psychiatrist Rather Than a GP.
Frequently asked questions
Is therapy or medication better for depression?
For mild to moderate depression, comparable evidence for both. For severe depression, medication has stronger evidence. Personal preference and access matter.
Can therapy replace antidepressants?
For some patients, yes. Others do better with medication or with both. This is an individual decision with your prescriber.
How do I choose between them?
Discuss with your GP. Personal preference, symptom severity, access, and prior experience all inform the decision.
Evidence and sources referenced
- NICE Guideline NG222 — Depression in adults: treatment and management (United Kingdom).
- Royal Australian and New Zealand College of Psychiatrists (RANZCP) — Clinical Practice Guidelines for Mood Disorders.
- NPS MedicineWise — patient and prescriber resources on antidepressants (Australia).
- Royal College of Psychiatrists — patient information on antidepressants.
- TGA and FDA — product information for SSRI and SNRI classes.
- Maudsley Prescribing Guidelines in Psychiatry.
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