One of the most common questions I’m asked is:
“Is therapy or medication better?”
Often, there’s a strong preference for one over the other.
Sometimes I hear:
- “I don’t want big pharma in my body.” (Trust me — we don’t either.)
- “Therapy doesn’t work.”
So let’s slow down for a moment.
A Simple Analogy
Imagine you’re holding a large bowl of soft clay.
Now picture placing a heavy marble on top and rocking it back and forth in the same direction… over and over and over again.
Eventually, the marble creates a rut.
And once that rut forms, it becomes much easier for the marble to fall back into it — even if another direction would be more efficient.
Now imagine:
- The clay is your brain.
- The marble is your thought process.
When someone experiences anxiety or depression, certain neural pathways become well-worn. Rumination, catastrophic thinking, hopelessness, self-criticism — these patterns start to feel automatic. Familiar. Almost inevitable.
Those are the ruts.
And once they’re established, it can be very difficult to shift the marble on your own.
Where Therapy Comes In
A skilled therapist helps you notice the rut.
They help you gently redirect the marble — sometimes awkwardly at first — into new, healthier pathways. With repetition and practice, those new routes begin to feel more natural. More instinctive.
This is neuroplasticity in action.
Therapy builds new patterns.
Where Medication Comes In
Medication doesn’t “erase” your personality or do the work for you.
What it can do — when appropriately prescribed — is soften the clay.
When the clay is softer, it’s easier to move the marble. It’s easier to step out of deeply entrenched pathways. It can reduce the intensity of symptoms enough that therapy becomes more effective.
Medication can lower the volume.
Therapy can help you change the song.
So Which Is Better?
For many people, the strongest evidence supports a combination of both — particularly for moderate to severe depression and anxiety.
Not because one replaces the other.
But because they work differently.
Therapy rewires.
Medication stabilizes the biological terrain.
Together, they often create more durable change.
Of course, treatment is always individualized. Some people do beautifully with therapy alone. Others benefit from medication. Many benefit from both.
The goal isn’t to “pick a side.”
The goal is helping you move the marble.
Katy Alderman, MSN, APRN, PMHNP-BC
Founder, Elessar Psychiatry
Hybrid Telehealth & In-Person Psychiatry | Utah & Colorado