CBT vs antidepressants for depression

Depression is not a single illness with a single cause. For some people life events, thinking patterns and behaviours play a large role, which is where CBT works. For others, biological factors and past episodes are prominent, and medication is useful. Many people benefit from both.

CBT focuses on the links between thoughts, feelings and behaviour in the present. A therapist and patient identify patterns such as withdrawal, rumination and self-criticism and practise alternatives. Antidepressants, most often selective serotonin reuptake inhibitors (SSRIs), alter the signalling of brain chemicals, which over several weeks can lift mood, improve sleep and appetite and restore energy.

CBT is structured, goal-oriented and time-limited, usually delivered weekly in one-to-one sessions or in groups, sometimes online. Between sessions you practise techniques, so engagement and time matter. Benefits can continue after the course because you keep the skills. It suits people who prefer not to take medication or who want to understand and change patterns.

Limitations are access and readiness. Waiting lists for NHS talking therapies vary, and very severe depression, with poor concentration and low energy, can make therapy hard to engage with at first, which is one reason medication may be started alongside.

Antidepressants are prescribed by a doctor after assessment, with the starting dose increased as needed and review after a few weeks. They are not addictive in the way some other drugs are, but stopping suddenly can cause discontinuation symptoms, so they are withdrawn gradually under guidance. Side effects such as nausea, sleep changes or sexual side effects are common early on or ongoing and can usually be managed by adjustment.

If a first antidepressant does not help, there are other options, including switching or adding another treatment. Treatment commonly continues for several months after recovery to reduce relapse.

NICE guideline NG222 on depression in adults recommends different approaches by severity. For less severe depression, options include individual or group CBT, behavioural activation and exercise-based programmes, with antidepressants considered if there is a history of moderate or severe depression or if the person prefers them. For moderate to severe depression, it recommends a combination of an antidepressant with a high-intensity psychological therapy such as CBT.

Preferences, previous responses, other health conditions, pregnancy or breastfeeding and the risk of self-harm all influence the choice. A clinician will review progress regularly and adjust.

• Mild or newly developing low mood, willing to engage in therapy: ask about CBT or guided self-help first.

• Moderate to severe symptoms affecting work, sleep or relationships: discuss therapy plus an antidepressant.

• Previous good response to a particular treatment: tell your clinician; it informs the choice.

• Pregnant, breastfeeding or planning pregnancy: discuss treatment options early with your doctor.

• Thoughts of self-harm: seek urgent help from 999, A&E or NHS 111.

Needing an antidepressant is not a sign of weakness, and having therapy does not mean the problem is "just in your head". Antidepressants do not change your personality, and they are not a quick fix; they take weeks. And CBT is not merely "positive thinking"; it is a structured treatment with evidence.

Equally, stopping medication when you feel better is a common mistake; clinicians advise a planned course and gradual reduction.