Gestalt, psychoanalysis, psychodynamic, CBT, EMDR—when it comes to types of therapy, I’ve tried them all. I’ve laid on couches, talked to pillows (yes, really), and re-lived painful childhood memories ad nauseum, all in an attempt to manage the depression I’ve had for as long as I can remember.
I added selective serotonin reuptake inhibitors (SSRIs) to my treatment more than 25 years ago, while continuing with therapy. It never occurred to me to stop seeing a therapist, even though the medications made me feel better than I ever had. It seemed like common knowledge that if you’re depressed, you see a therapist—period.
A few years ago, however, I came to the conclusion that I often dreaded going to therapy and didn’t necessarily find it helpful. I quit therapy altogether and have never felt better.
This is not a fact I share frequently or comfortably. People (especially therapists) do not like to hear I have decided medication is the only depression treatment I need, at least for now. I get it. Most of the studies out there, including a meta-analysis in World Psychiatry, conclude that the most effective treatment for depression is therapy plus medication. I have no doubt that’s true for a lot of people, but it hasn’t been my experience.
Don’t get me wrong, I wasn’t always so pro-medication.
I’m in my 50s, and before Prozac revolutionized antidepressants in the early ’90s, medications were never mentioned as an option for me. And it’s just as well because the very word terrified me. In those days, classes of medications used to treat depression and other mental illnesses included tricyclics (e.g., imipramine, amitriptyline, others) and monoamine oxidase inhibitors (MAOIs, e.g. Nardil, Parnate). Psychiatrists mostly prescribed them for serious conditions, like severe depression, says Dr. Jin Hee Yoon-Hudman, a psychiatrist and medical advisor at Minded. “As we did not have many effective antidepressants, a large part of treatment was psychotherapy,” she explains. “With the ‘Prozac boom’ in the early ’90s, antidepressants became safer and had fewer side effects, resulting in their increased use, including by primary care doctors.”
Due to a series of unfortunate events in my life, I hit my low point right around the time Prozac went on the market. Despite being almost unable to get out of bed or stop crying, I was still resistant to taking Prozac because I thought needing medication meant I had crossed the line into seriously ill, and that there would be no turning back. But after talking to friends who were concerned about me, I got a reference to a psychiatrist who prescribed Prozac. Over the course of a few weeks, I slowly worked up to a standard dose. The effect was subtle. As many people describe, it starts to dawn on you after a few weeks that you’re not in bed all day and are starting to enjoy the things you used to. While some call antidepressants “happy pills,” I find that an infuriating and patronizing misconception. To me, they were more like “no-longer-miserable pills.”
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Since I took that first Prozac pill, my medication journey has had its ups and downs. I’ve tried other medications from time to time. Some worked well for a while and then stopped. Others had no effect or unpleasant side effects. At one point, I even tried to go off the drugs entirely, which was a bad idea because I started to sink into depression again. I should’ve known better: A 2021 study in the New England Journal of Medicine found that among patients who stopped taking their antidepressants because they felt well, 56% relapsed within a year compared with 39% of patients who stayed on medication. I learned my lesson and went back on my meds, eventually finding a winning combination in lamotrigine (Lamictal, a type of mood stabilizer) and desvenlafaxine (Pristiq, an antidepressant that targets serotonin and norepinephrine, so-called SNRIs).
All the while, though, I continued with some form of therapy. Then, a couple of years ago, the cognitive behavioral therapy (CBT) therapist I had been seeing announced she was closing her private practice. I liked her, and of all the modalities I have tried, I liked CBT the best. Without even thinking about it, I started the familiar process of finding a new therapist. It never occurred to me not to.
If you’ve been through it, you probably know that just starting this process is exhausting and discouraging, with obstacles at every turn. For one thing, finding a therapist is not like finding a podiatrist or a dentist, where an emotional connection is not required. Finding a therapist is more like dating in that respect. There has to be chemistry.
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And then there’s the fact that very few therapists take insurance, which is, well, insane. Therapy can be ungodly expensive. Last time I looked, there were all of two therapists in my health insurance network accepting insurance payment, both miles away from me.
It’s not just me, either. A 2018 study by the National Council for Mental Wellbeing and Cohen Veterans Network attributed lack of access to mental health services as a factor in the mental health crisis in America. Among the reasons cited are high cost, insufficient insurance coverage, limited options, and long waits. Isn’t it ironic that it’s depressing and anxiety-producing to shell out hundreds of dollars per month so that you can become less depressed and anxious?
A few of the therapists I contacted weren’t accepting new patients. I had a couple of initial “consultations” in my neighborhood, but neither of them felt like a good fit. As I was writing the check for the second one, I thought, Why am I doing this?
Then it dawned on me that I didn’t actually have to find another therapist if I didn’t want to. To be honest, at this point I did not actually find it helpful to talk about my problems to a paid professional. I got just as much help and insight from a few close friends—for free. When I expressed my frustrations with therapy to my therapists in the past, some have told me I wasn’t “making progress” because I wasn’t trying hard enough or doing it right. That felt like a lot of pressure and made me feel like a failure. If I couldn’t do it right, why do it at all?
Honestly, going without therapy has actually made me feel lighter. No schlepping to after-work appointments, no anxiety about depleting my bank account on a weekly basis, no wondering why I don’t leave the office feeling better. Stopping the SSRIs sent me into a downward spiral; stopping therapy made no difference one way or the other.
I rarely share my revelation with others because when I have, it clearly makes people uncomfortable. One reason people are squeamish about antidepressants is that, despite progress in demystifying mental illness, stigma around medication still remains, so it makes sense that taking it without therapy might seem reckless. Best not to go there, I’ve found. But if my story can make a difference to someone else, I’m all for helping, so here we are.
I do check in with a psychiatrist every three months for around 30 minutes to discuss my medication and fill her in on my life. I still get depressed sometimes, but it doesn’t hobble me. And I am not anti-therapy in general. If it works for you, that’s great. If you want to combine it with medication, that’s great, too. What works for me right now is my two little pills—whether or not that’s hard for anyone else to swallow.
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