Created on August 5, 2017. Last updated on September 9th, 2020 at 10:52 pm
Therapy or medication? In both children and adults, evidence-based psychosocial therapies have been shown to work for a broad range of mental health disorders, as well as for many life problems. The same can be said for the effectiveness of some medications. The information below is intended to help parents/caregivers choose between treatment options for their child or adolescent, and to decide whether therapy and medication should be combined for the most effective treatment.
Therapy or Medication for Non-psychotic and Psychotic Disorders
Non-psychotic Disorders (i.e., disorders NOT involving a loss of contact with reality, such as schizophrenic or manic disorders)
- In general, findings suggest that cognitive behavioral therapy for children and adolescents can do anything that medications can do in the treatment of nonpsychotic disorders, and it can do so without causing problematic side-effects.
- Research suggests that medications for child and adolescent mental health problems often work, but only IF your child continues to take them. The reason for this is that psychiatric medications typically treat the symptoms, but do not resolve the underlying causes of the disorders.
- Cognitive behavioral therapy (CBT), on the other hand, can improve symptoms in a more enduring fashion by teaching youth valuable skills that may reduce symptoms and also the risk for recurring problems after treatment has ended.
- Young people with more severe symptoms may benefit from taking psychoactive medications–either alone or in conjunction with CBT treatment–particularly for disorders such as depression, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. For the less severe instances of these disorders, however, the evidence supporting CBT is at least as strong as that for medications, and for some disorders it is even stronger.
- Medications tend to work a little faster than CBT (by a matter of weeks) and there are sometimes benefits from using the two in combination or in sequence. Currently, the best research evidence indicates that, for most children and adolescents, some combination of medication and CBT is the “gold standard” treatment for clinical symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder.
- Findings regarding the effectiveness of child/adolescent psychotherapy as an alternative to medication are mostly available for CBT. While there are many other approaches to psychotherapy, data indicating whether these other approaches are effective are still emerging.
A different rule applies for the psychotic disorders (i.e., those involving a loss of contact with reality, such as schizophrenia or mania). For these disorders, medication treatment has the best empirical support and represents the current standard of treatment.
- The parents of young people with psychotic disorders are advised to seek good psychiatric treatment for their children and to keep them on their prescribed medication.
- CBT and certain family-focused interventions often can play a useful supportive role in these disorders, but they should not be used instead of medications.
What If My Child Has Just A Minor Or Specific Problem?
Many children and adolescents have certain life problems not typically classified as psychiatric disorders which may benefit from CBT.
- Young people who have trouble standing up for themselves or who are prone to anger or aggression often benefit from CBT.
- Children/adolescents who are experiencing difficulties in their relationships with family members, peers, romantic partners, or people at school often benefit from CBT.
- For everyday problems of childhood and adolescents, skillful application of CBT and related principles are generally as effective as medications for everyday problems. Often, results from CBT treatment for these situations are better and longer-lasting.
- When considering how to deal with long-standing child or adolescent difficulties such as temperament or everyday problems in life, it is important to keep in mind that some of the most widely prescribed medications can be addictive and have a number of unwanted or harmful side-effects.
Most children see a pediatrician regularly whereas few will ever see a psychologist. With the advent of newer and safer medications, more children and adolescents are getting medicated than ever before for problems such as depression and anxiety. On the one hand, this may be beneficial given that these problems might be causing significant distress, especially if untreated. On the other hand, this could represent a lost opportunity as medications typically do not resolve the underlying tendency for these young people to get anxious or depressed.
Given current trends in medical practice, many children grow up to face a lifetime of more or less continuous reliance on medications, without taking advantage of equally effective and longer-lasting alternatives. It is not that pediatricians or primary care physicians do not want to help – they do – but often the only way that they know is by prescribing medications. Your child’s pediatrician will likely refer you to a psychiatrist if the child has a more severe disorder. But many young people with nonpsychotic disorders or problems (e.g., depression, anxiety, everyday stress, etc.) would benefit as much or more from receiving CBT.
Types of Medications
There are several different types of psychiatric medications:
- What are Antipsychotics? Antipsychotics are used in the treatment of schizophrenia and other psychotic disorders such as mania. Common antipsychotics include chlorpromazine or haloperidol, and newer atypical antipsychotics include aripiprazole or olanzapine. These are powerful medications that are intended to treat serious disorders, and they can sometimes have serious side-effects or complications. They typically require close psychiatric management.
- What are Mood Stabilizers? Mood stabilizers like lithium and the anticonvulsants are used to reduce the risk for mania and depression in bipolar patients, and typically require psychiatric management.
- What are Antidepressants? Antidepressants are widely used in the treatment of depression and anxiety. The newer selective serotonin reuptake inhibitors (SSRIs) are relatively safe and widely prescribed in primary care settings. Older types of antidepressants like the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) work at least as well, but are more difficult to manage.
- What are Stimulants? Stimulants, like methylphenidate and dextroamphetamine, are commonly used in the treatment of attention-deficit disorder (with or without hyperactivity) in children and adolescents, and are sometimes used to supplement other medications in the treatment of depression. Stimulants can have significant side effects, including physical growth. However, stimulant medication, especially in combination with CBT, may be indicated for more severe ADHD.
- What are Anxiolytics? Anxiolytics include benzodiazepines like diazepam and chlordiazepoxide and are used to treat anxiety and stress-related disorders. Although widely prescribed and providing very rapid symptom relief, they can be addictive if used for too long (especially the high-potency benzodiazapines like alprazolam). CBT sometimes is used to help children and adolescents withdraw from these medications, and many psychiatrists now prefer to treat these disorders with the slower-acting but non-addictive antidepressants.
- What are Hypnotics? Hypnotics include medications like zolpidem that are widely used to treat insomnia, but also can be addictive if taken for too long. Once again, CBT has been shown to provide comparable and more lasting relief of pediatric insomnia without the risks associated with medication.
Each of these medication classes has its uses and drawbacks. To summarize: CBT is commonly added as a treatment to the antipsychotics and mood stabilizers in the treatment of patients with psychotic and bipolar disorders. CBT is also a viable alternative to the antidepressants and stimulants for less severe nonpsychotic disorders. CBT is best used in combination with medication for more severe non-psychotic disorders, and generally superior over time to the anxiolytics and hypnotics for anxiety and sleep disorders.
Some Limitations of CBT Include:
- It can sometimes be hard to find a good CBT practitioner. The Association for Behavioral and Cognitive Therapies (ABCT) maintains a website to help in that regard.
- It has become fashionable for therapists to describe themselves as offering CBT, even when they do something quite different; it is perfectly appropriate to ask what kind of training your potential therapist has received. Refer to our Advice for Selecting a Psychologist page on proper credentials.
- It may be difficult to find a well-trained CBT therapist in some communities. In this case, medications may represent the best available option.
- CBT will not work for everyone, and if it does not work for your child within a reasonable period of time, then it might be wise to consider adding or switching to medications.
- It also may help to add medications if CBT produces some relief but, after a time, does not fully resolve the problems that brought your child into treatment.
- Some parents, or even the children or adolescents themselves, may prefer medications to CBT, since medications typically work a little faster and may involve less time and effort. That is perfectly all right; it is good to live in an age in which there are multiple efficacious treatment options. But remember, just as adding medications can sometimes help when CBT alone is not enough, adding CBT to medications can often help when drugs alone are not enough.
- Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive therapy and research, 36(5), 427-440.
- March, J. S., Silva, S., Petrycki, S., Curry, J., Wells, K., Fairbank, J., … & Severe, J. (2007). The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Archives of general psychiatry, 64(10), 1132-1144.
- Vidal, R., Castells, J., Richarte, V., Palomar, G., García, M., Nicolau, R., … & Ramos-Quiroga, J. A. (2015). Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 54(4), 275-282.
- Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., … & Smith, R. L. (2011). Evidence‐based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. Clinical Psychology: Science and Practice, 18(2), 154-172.