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When Medication May Fit Alongside Therapy, for Adults and Children

When Medication May Fit Alongside Therapy, for Adults and Children

Is therapy enough, or is it time to ask about medication? Many adults ask that question about themselves, and many parents ask it quietly about a child or teen who has been struggling for months. The honest answer is that medication can help some people with anxiety, depression or ADHD, most often as one part of a plan that also includes therapy, and the way to know whether it fits your situation is a careful evaluation with a prescriber who can see the whole picture. No article can make that decision for you, and this one will not try. What it can do is explain when medication is usually considered, who can prescribe it, what an evaluation is actually like, and how a prescriber and a therapist can work from one plan instead of two.

When medication is usually considered

Medication is rarely the whole answer, and it is rarely the first thing anyone reaches for without a reason. The National Institute of Mental Health notes that mental health medications are often used in combination with other treatments, such as psychotherapy, and its depression overview names medications, talk therapy (including telehealth and online options) and brain stimulation therapy as the established treatments.

For depression in adults, the research does not ask you to choose sides. A 2021 network meta-analysis of 58 studies including 9,301 people treated in primary care, published in the Annals of Family Medicine, found no significant differences between psychotherapy and medication, and the authors concluded that combined treatment might be better than either one alone. That is a careful conclusion rather than a promise, and it is a useful one: therapy and medication are not competitors, and for some people they work best side by side.

For ADHD, the NIMH notes that health care providers may prescribe stimulant medications to treat ADHD, and that these medications are considered safe when taken under supervision and as directed. Therapy still has a place, because medication does not teach the routines, the organizing habits or the family patterns that make daily life easier, and our article on how therapists tell whether it is really ADHD explains why a careful assessment matters before any treatment begins.

Rather than a list of drug names, it may help to bring a few questions to an evaluation, because these are the kinds of things a prescriber and a therapist will want to understand with you:

  • How much are the symptoms getting in the way? Sleep, work, school, friendships and family life are all part of the picture, not only how you or your child feel on a given day.
  • How long has this been going on, and has it changed? A hard season after a loss or a move is different from a pattern that has deepened over many months.
  • What has already been tried? If therapy has been steady and helpful but some symptoms still make it hard to use the skills you are learning, that is worth saying out loud.
  • What else is happening in the body? Physical health, other medications and family history all matter, which is one reason a prescriber asks about them.

None of these questions has a score that decides the matter. They are a way to walk into the conversation prepared, so that the decision is made with you rather than for you.

For parents of children and teens

If you are a parent or guardian, the question carries extra weight, and that is understandable. The American Academy of Child and Adolescent Psychiatry states that medication can be an effective part of the treatment for several psychiatric conditions of childhood and adolescence, and it is just as clear about the limits. The same guidance says that psychiatric medication for young people should not be used alone, that its use should rest on a comprehensive psychiatric evaluation, and that it belongs inside a broader plan that includes ongoing medical assessment and, in most cases, individual or family psychotherapy.

AACAP also describes what parents can reasonably expect from the person recommending medication: a full explanation of why it is being recommended, the benefits hoped for, how long it may be used, possible side effects and the other treatment options. It recommends close contact with the prescriber and asks families not to stop or change a medication without speaking to the child's prescriber first. In practical terms, that means you are allowed to ask every question that is on your mind, to take time to think, and to bring what you see at home back to the people treating your child. If you are still sorting out whether your teen is struggling at all, our guide to telling teen depression from ordinary moodiness is a gentler place to begin.

Who can prescribe medication for anxiety, depression or ADHD

Not everyone on a care team prescribes. A psychiatric mental health nurse practitioner (PMHNP) is an advanced practice nurse who specializes in assessing, diagnosing and treating mental health conditions across the lifespan, as our psychiatric nurse practitioner page explains, and that care may include medication management alongside holistic treatment planning.

Therapists and counselors often see the day-to-day shape of a person's struggles more closely than anyone else on the team. That is why the most useful question is often not "who can write the prescription?" but "who will be talking to each other about my care?"

At Life Enrichment Counseling Center, psychiatric evaluations and medication management are provided by Nadia Lassic, MSN, NP, APRN, a Board Certified Psychiatric Mental Health Nurse Practitioner licensed in Virginia, at our Gainesville office and online, within the same practice where you, your teen or your loved one may already be meeting with a therapist. You can read more about her on our psychiatric nurse practitioner page.

What a psychiatric medication evaluation is like

Many people put off an evaluation because they imagine it as a quick visit that ends with a prescription. A careful evaluation is closer to a long, structured conversation. For young people, AACAP describes the evaluation as an interview with the child or teen and a diagnostic assessment that may include a physical exam, lab tests, an EKG and information from parents or teachers. For adults the shape is similar, even though the people giving information are different.

In general, you can expect the prescriber to ask about:

  • what has brought you, or your child, to this point, in your own words;
  • how sleep, appetite, energy, concentration and mood have changed;
  • medical history, current medications and supplements, and any past experience with psychiatric medication;
  • family history of mental health conditions;
  • what therapy has looked like so far and what has or has not helped;
  • what you hope will be different, and what concerns you have about medication.

An evaluation does not have to end with a prescription. Sometimes the recommendation is to continue therapy and check in again; sometimes it is to begin a medication alongside therapy; sometimes it is to look into a medical question first. Whatever the outcome, it is reasonable to leave the visit understanding the reasons behind it.

One plan, two clinicians

When a therapist and a prescriber work in different places, the person in the middle often becomes the messenger, carrying updates from one office to the other and trying to remember what each one said. In many practices where both work under one roof, and with your written permission, it is simpler for them to share what they are each seeing, so that the plan is one plan.

In general terms, a shared therapy-and-medication plan can look like this:

  1. The therapist notices a pattern. Over several sessions, symptoms may be making it hard to use the skills being practiced in therapy, and the therapist raises the idea of an evaluation with you.
  2. The prescriber evaluates and explains. The evaluation covers the questions above, and any recommendation comes with its reasons, its expected timeline and its possible side effects.
  3. Therapy continues alongside. Medication is not a replacement for the work you are doing in therapy, and for children and teens AACAP is explicit that it should not stand alone.
  4. Both clinicians follow progress. Changes in sleep, mood, focus or side effects that come up in therapy can be shared with the prescriber, and any adjustments are discussed with you.

What to keep in mind once medication is part of the plan

A few things are worth knowing before you begin, so that the early weeks feel less uncertain.

It takes time. The NIMH notes that antidepressants usually take 4 to 8 weeks to work, and that improvements in sleep, appetite and energy often come before mood lifts. It also notes that buspirone, a medication used for anxiety, must be taken every day for 3 to 4 weeks to reach its full effect.

Do not stop on your own. The NIMH advises that people should not stop taking a prescribed medication, even if they are feeling better, without their provider's help, because stopping too soon can cause unpleasant or harmful effects.

Young people need closer watching. The NIMH notes that children, teenagers and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first weeks or after a dose change. This is one reason close follow-up matters, and it is a reason to stay in touch with the prescriber rather than a reason for alarm.

This article is general information, not advice about your own situation or your child's. Please do not start, stop or change any medication based on what you read here; those decisions belong in a conversation with a prescriber who knows your history.

If you or someone you love is in crisis or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988, or chat at 988lifeline.org. If there is immediate danger, call 911.

Taking the next step

Deciding whether to consider medication can feel like a weight to carry alone, and there is no need to carry it that way. Even the most resilient people can find themselves overwhelmed, and asking for an evaluation is not a sign that therapy has failed or that you have run out of options; it is one more way of getting to the other side of a hard season.

At Life Enrichment Counseling Center, we are committed to walking alongside you, your family and your loved ones, whether that means therapy, an evaluation for medication, or both. We offer counseling in Gainesville, Alexandria and Haymarket, VA, in Port St. Lucie, FL, and online; psychiatric evaluations and medication management are offered at our Gainesville office and online. You can learn more about our ADHD counseling or request an appointment whenever you are ready.

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