Skills Before Pills: When Should I Be Evaluated for Psychiatric Medications?


, Skills Before Pills: When Should I Be Evaluated for Psychiatric Medications?, Box Tree Clinic | Your Key to World Class Private TherapyWhen I was in college studying psychology, one of my professors had a handy little saying he liked to share that guided his counseling practice: “skills before pills.”

What did this mean? In essence, as a psychologist, when he was working with clients, helping them manage various types of mood concerns, he always advocated for his clients to learn coping skills before pursuing taking psychiatric medications, such as antidepressants. The reason he advocated for this is because, by learning coping skills, you can use these to self-manage the stressors and symptoms impacting your mental health. Coping skills are tools you keep in your imaginary tool belt, and you can whip out whenever you need them. Those coping skills provide you the confidence to manage your own mental health symptoms whenever they pop up. 

Psychiatric medications, such as antidepressants or anti-anxiety medications, for instance, are also very valuable for treating mental health disorders. But many people wonder if and when they should consider being evaluated for a possible medication.  Here, we will outline how you may know it’s the right time to consider adding medication to your treatment plan for your mental health issues. As always, though, you need to work with your treating provider to create the best treatment plan specific to your needs.  

When speaking of moderate to severe depression and anxiety, the very best evidence-based treatment is a combination of psychotherapy (i.e., talk therapy) and psychiatric medication. When used in combination, these two treatment options help alleviate symptoms and provide relief to people who are suffering from anxiety and depression.  

But what if you’re unsure if seeking medications is the right choice for you? If you are experiencing your first ever bout of anxiety or depression and have never had treatment for it before, it can be best to start with psychotherapy. In therapy, you can explore what may be triggering your depression and begin to learn how to better cope with the symptoms and stressors leading to your mood concerns.  

On the flip side, if you are finding one of the following rings true for you, it can also be helpful to seek an evaluation for psychiatric medications:

1) “My anxiety/depression is impacting me so significantly that I can barely function in my day to day life. I struggle to even get out of bed or make it to work. I can’t care for my kids.”    

If you find that your symptoms are so severe that you just can’t make it through what you need to do in a day, psychiatric medications can help alleviate your symptoms. By using medications in this instance, you can get to the point where you can better engage in psychotherapy and practice skills to manage your day to day stressors. 

2) “I’m struggling to actually be able to implement coping skills. I just can’t seem to work up the energy or motivation to practice the skills I’m learning.”

If you’re feeling so impaired by your mental health symptoms that you can’t work up the strength and energy to use the skills you’ve learned, medication can help. Medication can help provide reduction in the severity of your symptoms so you can feel better able to use those skills you’ve learned.  

3) “I’m having suicidal thoughts and am scared that nothing will get better. I’m not sure I can stay safe.” 

Your safety and well-being are the top priority. If you’re experiencing a mental health crisis, it can be extremely helpful to be evaluated for psychiatric medications. By doing so in combination with psychotherapy, you can work on reducing the depression that is impacting those suicidal thoughts.  

4) “I’ve been in psychotherapy for quite some time and my depression/anxiety just isn’t improving.”    

If you find that, despite consistently going to psychotherapy, your symptoms haven’t gotten better, it can be a good time to consider an evaluation for psychiatric medications. What many find is, by starting medication, they can feel some increased relief of their symptoms and, as a result, find that their therapy also becomes more productive and helpful.  

5) “I have had psychotic symptoms (for instance, seeing or hearing things that aren’t really there) or manic symptoms (for instance, reduced need for sleep, increased impulsive/risk taking behaviors, fast/pressured speech).” 

If you have found, or a loved one has expressed to you concerns about possible psychotic or manic symptoms, it is important to be evaluated for psychiatric medication. These symptoms very often require a medication intervention to combat the symptoms. The fact is, if you are having psychosis or mania, it is extremely difficult to engage properly or benefit from psychotherapy until the symptoms are better under control.  

What if you’re still unsure whether psychiatric medications are right for you?  

It is extremely helpful to broach this topic with your provider. If you are currently in psychotherapy, talk to your therapist about your questions and concerns. As part of counseling, your therapist’s job is to outline all of the various treatment options for you, including whether a medication evaluation could be beneficial. Your therapist may also be able to provide you a referral to a psychiatrist or family medicine provider who could provide such an evaluation.  

With that said, though, medications alone may not be enough. This brings us back to the start of this article, where we advocated for “skills before pills.” What has been proven to be the most beneficial treatment for anxiety and depression is a combination of medication and psychotherapy. So, if you have started psychiatric medications, it is best to continue on with therapy at the same time. Medications can help alleviate your symptoms, and therapy can help fill your toolbox with skills to keep those symptoms at bay in the long-term.   

Remember, there is hope. Your anxiety or depression can be treated. You can find relief. 



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Box Tree Clinic | Your Key to World Class Private Therapy

Box Tree Clinic | Your Key to World Class Private Therapy