Cognitive Behavioral Therapy and Antidepressants: What’s the Difference?

Cognitive Behavioral Therapy, also called CBT, is an evidenced-based form of therapy that focuses on changing harmful thoughts that become ingrained beliefs. The idea behind CBT is that deeply-held beliefs affect people’s behaviors, which impacts nearly every aspect of their lives. 

According to many experts in the field of mental health, CBT is now considered the current gold standard for psychotherapy, which may sound a bit scary but really just means “ talk therapy.”

 

What’s the Main Difference Between CBT and Antidepressants? 

CBT is a type of therapy while antidepressants are a class of medications. 

Examples of popular antidepressants include SSRIs (selective serotonin reuptake inhibitors) such Prozac, Paxil, Zoloft, Celexa and Lexapro. These medications are used to treat major depressive disorder, some anxiety disorders, some chronic pain conditions, and to help manage some addictions.

Both CBT and antidepressants may be prescribed to the same patients, as they are often used simultaneously. Together, or when used separately, they can help treat some of the same conditions, including depression.

Does one work better than the other? 

Different kinds of mental health problems respond differently to various treatments. This means that which one is “better” seems to depend on the individual. That being said, a 2019 meta‐analysis found evidence suggesting that antidepressant medication is slightly more efficacious than CBT in reducing overall depression severity in patients with a DSM‐defined depressive disorder. 

 

However, other studies and even meta‐analyses have indicated that their efficacy is overall comparable. And some even suggest that for anxiety and addictions, psychotherapy is more effective than medications.

 

How Does Cognitive Behavioral Therapy Work?

CBT is all about building awareness of your own thoughts and feelings. Unlike the idea of merely practicing “positive thinking,” CBT is about acknowledging and accepting your feelings rather than trying to push them away. 

If you’re familiar with mindfulness practices, this may sound familiar. And you’d be right, because mindfulness and CBT have many things in common; both are about non-judgemental awareness of your own thoughts.

A good deal of research suggests that CBT can help treat a wide range of mental health concerns, including: anxiety, depression, obsessive compulsive disorders, and many others.

With help from a CBT therapist, you can explore and uncover thoughts that are destructive that you may not even realize you have, and then reframe how you think about things. By reframing your thoughts, such as by replacing negative thoughts with more positive or realistic ones, you can positively impact how you feel, act and behave. 

According to CBT-trained therapists, when you have the same thoughts over and over again (these are referred to as “thought patterns”) then they eventually become ingrained beliefs. Your thoughts may have originated during childhood and been formed by your early experiences, including your relationship with your parents, so it’s often necessary to discuss your past during CBT sessions to gain a better understanding of the root causes of your unwanted, ingrained beliefs.

 

Can Cognitive Behavioral Therapy and Antidepressants Be Used Together?

When people are dealing with problems such as anxiety or depression, it’s very common for therapy and use of psychiatric medications to be combined. Each has its own benefits, and in many cases the two can offer the most help when used together. For instance, antidepressants work by balancing chemicals in your brain called neurotransmitters that affect mood and emotions, while CBT works by changing destructive thought patterns.

When patients are dealing with severe depression, some studies suggest that symptoms are likely to improve significantly more from antidepressants plus CBT than from CBT alone. Recent findings have demonstrated that, in general, antidepressant medications may be better at managing “depressed mood”, “feelings of guilt”, “suicidal thoughts”, “psychic anxiety”, and “general somatic symptoms” compared to CBT alone.

Antidepressants are one of the most widely used medications in many industrialized countries, including the U.S. As of 2018, more than 13% of Americans over 18 and over reported taking antidepressant medications, and among those over 60 (especially women) nearly one-quarter (25%) took antidepressants.

There’s no shame in choosing to take antidepressants if they help relieve your symptoms, especially if they give you the motivation you need to be successful with ongoing therapy.

Antidepressants can help to kickstart the process of CBT and potentially make sessions more productive and helpful. You’ll recall that the first step in practicing CBT is to become aware of your thoughts so that you can replace and hopefully change them, or at least change how you react to them. This can be difficult to do when you’re deep in the throes of depression, however antidepressants may be able to help.

Antidepressants can take time to start working, usually about 6 weeks or so, plus a patient may need to try several types before finding one that’s a good fit. So while a patient is waiting to find relief from depression or anxiety symptoms after starting on antidepressants, CBT can be used in the meantime to help begin the healing process.

Here are other benefits of combining antidepressants and CBT:

• Antidepressants typically work as long as you keep taking them, whereas CBT may reduce risk for symptoms returning over time.
• Medications can help treat symptoms but do not cure the disorders, whereas CBT may better target underlying causes of depression and anxiety.
• People with more severe symptoms may benefit from adding medications to therapy, particularly among disorders like severe depression, obsessive-compulsive disorder, and attention deficit hyperactivity disorder.
• For some people, CBT can take a long time to start making a difference, so medications may actually work a little faster. It really depends on the individual.
• CBT represents a viable alternative to medications for people with nonpsychotic disorders or for those who can’t tolerate antidepressants, such as because of side effects (which are fairly common and can sometimes include weight gain, drowsiness, insomnia and lack of libidi).

 

Which One Is Right For Me?

Which one is a better fit for you really comes down to the specific type of symptoms you’re experiencing, and how well you respond to therapy vs. medication. 

If you haven’t experienced great results with therapy alone, adding medication may make all the difference. On the other hand, for children with depression symptoms or adults who don’t respond well to antidepressants, CBT may be a better option.

According to the Association for Behavioral and Cognitive Therapies, “As a general rule, findings suggest that CBT can do anything that medications can do in the treatment of the nonpsychotic disorders and it can do so without causing problematic side effects. CBT also can address symptoms on a more enduring basis.” This of course is only one opinion, but it’s something to consider.

If you’re interested in starting CBT, the good news is that it’s become a very pretty popular approach to therapy and therefore it should be easy to find a therapist near you that is a CBT-trained, or at least incorporates CBT into their offerings.

You can discuss with your therapist whether the use of antidepressants makes sense for you, for example depending on your current symptoms and if you’ve tried them in the past. 

Many therapists believe that among people with psychiatric disorders that cause a loss of contact with reality, CBT and certain family focused interventions often can play a useful adjunctive role in these disorders but they should not be used instead of medications.

Keep in mind that while trained mental health professionals usually utilize CBT techniques while working one-on-one with their patients, it’s also possible to practice the same CBT-based techniques on your own at home, such as by journaling and writing out your thoughts. 

These techniques can be considered valuable “coping skills,” and can be continued even after therapy and use of medications has ended. In fact, they are recommended for just about everybody, even those with no history of depression of mental health problems. 

For someone who has recovered from depression or who simply wishes to prevent it from developing, relaxing activities like writing out worries, keeping a gratitude journal, and exercising regularly can all help support mental wellbeing. While it is not an FDA approved treatment for any mental health disorder, and the scientific community is still out on the question of whether it has significant benefits for mental health, there is emerging evidence that the use of CBD flower to be helpful with symptoms of depression.

While for some people there’s no substitute for professional therapy or medications, many can find relief from depression and anxiety symptoms with help from a healthy lifestyle and these natural remedies.