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Therapy or Medication?

Created on August 5, 2017. Last updated on June 4th, 2026 at 10:50 am

Therapy and medication for children and adolescents

When your child is struggling, it can be hard to know what kind of help is best. Many parents wonder whether their child should start with therapy, medication, or a combination of both.

The good news is that there are effective options. Research shows that evidence-based therapies can help children and teenagers with many mental health concerns, as well as common life challenges. Certain medications can also be very helpful, especially when symptoms are more severe or are getting in the way of daily life.

This guide is designed to help parents and caregivers better understand these treatment options, ask informed questions, and work with professionals to decide what may be most helpful for their child or teen.

Therapy and Medication for Common Mental Health Concerns

Many child and teen mental health concerns require a different approach. These common concerns for young people include anxiety, depression, OCD, ADHD, stress-related problems, or anger.

For these concerns, both CBT and medication can help. CBT teaches children and teens practical skills for managing thoughts, feelings, and behaviors. These skills may reduce symptoms during treatment and continue to help after treatment ends.

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 Note on Psychotic Disorders

Psychotic disorders involve a loss of contact with reality, such as schizophrenia or mania. For these conditions, medication has the strongest research support and is considered the standard treatment.

Parents of children or teens with psychotic symptoms should seek care from a qualified psychiatrist and follow the medication plan prescribed. CBT and family-focused therapy may be helpful supports, but they should not be used in place of medication.

Everyday Problems and Life Concerns

Many young people have difficulties that don’t meet diagnostic criteria but still respond well to CBT, including anger and aggression, assertiveness difficulties, and relationship problems with family, peers, or school. For these concerns, CBT is generally as effective as medication and produces longer-lasting results.

A note on current trends: more children are being medicated than ever before for conditions like anxiety and depression, often because primary care providers have limited alternatives to offer. For many young people with non-psychotic conditions, CBT represents an equally effective option that addresses the underlying tendency toward anxiety or depression rather than managing symptoms on an ongoing basis.

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.

Important Information on CBT:

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.
Some therapists may 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.

Citations

Source(s):

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. https://doi.org/10.1007/s10608-012-9476-1

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. https://doi.org/10.1001/archpsyc.64.10.1132

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. https://doi.org/10.1016/j.jaac.2014.12.016

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. https://doi.org/10.1111/j.1468-2850.2011.01247.x