If you or someone you love has been diagnosed with depression, chances are the question has come up: do I need medication, therapy, or both? It’s one of the most common questions therapists and doctors receive — and the honest answer is that it depends on the person, the severity of symptoms, and what the research actually says.
In Ontario and across Canada, more people than ever are being prescribed antidepressants. According to the Canadian Institute for Health Information, antidepressant use has steadily risen over the past decade. At the same time, psychotherapy — including cognitive behavioural therapy (CBT) — has strong evidence for treating depression without medication. So what gives? Do you really need both?
This article walks through what the evidence shows, when each approach makes sense, and how combining the two can sometimes produce better outcomes than either alone.
What Antidepressants Actually Do
Antidepressants are medications that work on the brain’s chemistry — primarily neurotransmitters like serotonin, norepinephrine, and dopamine. The most commonly prescribed class in Canada is SSRIs (selective serotonin reuptake inhibitors), which include medications like fluoxetine, sertraline, and escitalopram.
These medications can reduce the intensity of depressive symptoms — low mood, fatigue, difficulty concentrating, disrupted sleep — often within two to six weeks. They do not, however, “fix” the underlying patterns of thought, behaviour, or unresolved life experiences that contribute to depression. That’s where therapy comes in.
Antidepressants also do not work for everyone. Research suggests that roughly 40–60% of people respond to the first antidepressant they try. Many need to try different medications or dosages before finding what works. Side effects — including weight changes, sleep disruption, or sexual difficulties — can also affect whether someone continues taking them.
What Therapy Does That Medication Cannot
Psychotherapy — particularly CBT, acceptance and commitment therapy (ACT), and interpersonal therapy (IPT) — addresses the root patterns that sustain depression: negative thinking cycles, avoidance behaviours, relationship difficulties, and unresolved emotional pain.
While medication may lift the floor of how low you feel, therapy helps you build new skills, challenge unhelpful beliefs, and develop a different relationship with your emotions. It also offers relapse prevention — skills that stay with you long after sessions end.
In Mississauga and across Ontario, many people choose therapy as their first line of treatment for mild to moderate depression. For many, it’s enough. For others — especially those with moderate to severe depression — the combination of therapy and medication can be more effective than either alone.
What the Research Says About Combining Both
The evidence for combined treatment is actually quite compelling. A landmark meta-analysis published in JAMA Psychiatry (Henssler et al., 2022) found that combination therapy — antidepressants plus psychotherapy — was significantly more effective than medication alone for treating major depressive disorder. Patients who received both were also less likely to relapse.
Similarly, a meta-analysis by Cuijpers et al. (2014), published in PLOS Medicine, found clear evidence that combined treatment with psychotherapy and antidepressant medication is more effective than treatment with either modality alone — particularly for moderate to severe depression.
The thinking is this: medication can make it easier to engage with therapy by reducing the intensity of symptoms enough for cognitive work to stick. Therapy, in turn, addresses the maintaining factors that medication alone cannot touch.
When Medication Alone May Be Considered
There are situations where antidepressants may be the primary focus, at least initially:
- Severe depression where symptoms make it difficult to engage in therapy at all
- Biological depression with a strong hereditary component or linked to medical conditions
- Postpartum depression where hormonal factors play a significant role
- Situations where therapy is not yet accessible or affordable
That said, most Canadian psychiatrists and family physicians now recommend that therapy be incorporated alongside medication — not as an afterthought, but as an equal treatment.
When Therapy Alone Is the Right Choice
For mild to moderate depression, psychotherapy alone has robust evidence. CBT in particular has been extensively studied and shown to produce outcomes comparable to antidepressants for many people — with lower relapse rates over the long term.
Therapy may be the preferred choice if:
- You prefer not to take medication, and your depression is mild to moderate
- Your depression is clearly linked to life circumstances, grief, or trauma
- You’ve had difficult experiences with antidepressants in the past
- You want to address the roots of depression, not just symptoms
In Mississauga and Ontario more broadly, accessing a registered psychotherapist can be done without a physician referral. At True Therapy, Sonia works with clients experiencing depression using evidence-based approaches tailored to what each person actually needs — not a one-size-fits-all protocol.
The Decision Is Yours — With Support
It’s important to say clearly: there is no single right answer. Some people do beautifully with therapy alone. Others find that a period on medication gives them the stability to do the deeper work in therapy. Others prefer both from the start.
What the evidence does tell us is that combining therapy with medication, when medication is involved, tends to produce better outcomes — more complete remission, fewer relapses, and more durable change. A psychiatrist or physician can help assess whether medication is appropriate; a therapist can help you do the work that medication cannot.
In Ontario, you can access both through your family doctor, a psychiatrist referral, or by booking directly with a registered psychotherapist. OHIP does not cover psychotherapy in most cases, but many extended health benefits plans in Canada cover a portion of therapy costs.
Frequently Asked Questions
Can therapy replace antidepressants?
For mild to moderate depression, yes — therapy alone (especially CBT) has strong evidence. For moderate to severe depression, the combination of both is often more effective. This is a decision best made with your doctor or psychiatrist.
Do antidepressants change your personality?
Modern antidepressants, particularly SSRIs, are not designed to change personality. Some people describe feeling “more like themselves” when symptoms lift. Side effects vary by person and medication; discuss concerns with your prescribing physician.
How long do you need to take antidepressants?
Most guidelines in Canada recommend continuing antidepressants for at least 6–12 months after symptoms resolve to reduce relapse risk. Your doctor will advise on the appropriate duration for your situation.
Is therapy or medication better for anxiety?
Both are effective for anxiety disorders. CBT has the strongest evidence base for anxiety. Some people use medication short-term to reduce acute symptoms while building coping skills in therapy.
Where can I access therapy for depression in Mississauga?
True Therapy offers individual therapy for depression in Mississauga and online across Ontario. Sessions are tailored to each client’s needs and may incorporate CBT, trauma-informed approaches, or other evidence-based methods.
Taking the Next Step
If you’re living with depression — whether you’re currently on medication, considering it, or looking for an alternative — therapy can make a meaningful difference. The goal isn’t to choose between medication and therapy as if they’re competitors. The goal is to get better.
At True Therapy in Mississauga, Sonia offers a warm, evidence-informed space to work through depression at its roots — alongside whatever medical support you’re receiving.
Book a free consultation today and take the first step toward feeling like yourself again.