Why I don't always reach for medication first

Specialist CBT therapy for anxiety, OCD, depression and more in West London

Medication can be an important part of care for some people. CBT can also be an important part of care for some people. There is no universal rule that medication should always come first, that therapy should always come first, or that one option is inherently better for every person. Decisions depend on symptoms, health, previous treatment, current medication, side effects, risk, preference, availability and what matters most to the individual. As a CBT therapist, I do not prescribe, start, stop or alter medication. Those decisions belong with an appropriate prescriber, who can discuss potential benefits, risks, interactions, withdrawal considerations and monitoring. It is important not to stop or change prescribed medication because of a blog post or because a course of therapy has begun. If someone experiences a concerning reaction, worsening symptoms or feels unsafe, they should seek appropriate urgent medical advice. An assessment can help clarify the difficulties that have brought someone to therapy, including OCD, anxiety, low mood, panic, trauma, sleep problems, physical health and life circumstances. It can also help distinguish a discussion about medication from a decision about whether CBT, another kind of support, medical review or more than one input may be appropriate. A website cannot replace that assessment. When CBT with exposure and response prevention is considered for OCD, the work is planned collaboratively with a therapist. It is not a self directed instruction to confront feared situations, discontinue reassurance or delay medical care. Suitability, pacing, consent, health factors and the person’s broader safety all matter. A clinician can help create a plan that reflects the specific difficulty rather than a generic formula. The aim is informed choice, not a competition between treatments. For some people, talking through medication with a prescriber may be an important next step. For others, assessment led CBT may be appropriate. Some people may use both at different points. A plan can be reviewed as new information, priorities or circumstances emerge. For related information, read about <a href="/therapy/ocd/">CBT for OCD</a>, <a href="/therapy/anxiety/">CBT for anxiety</a> and the <a href="/guides/cbt for ocd intrusive thoughts/">OCD and intrusive thoughts clinical guide</a>. The Lyceum Clinic offers assessment led CBT online and in West London, and a first conversation can help clarify which questions to take forward.