A Therapist’s Guide to Deciding Between Therapy & Medication


What If I Need Medication?

I started taking anti-anxiety medication two years ago, but I wish I’d started taking them 10 years ago. You never know what life can be like on the other side of healing until you’re finally there. Having been trained as a therapist, I knew the criteria for a formal diagnosis of Anxiety with Panic Attacks. However, when this presented within myself, I couldn’t process what was happening in my body or understand where it was all coming from.

Honestly, I felt controlled by it. The ongoing fear I felt was a part of my everyday life, underneath everything I did, always running in the background. And when that fear would break through to the surface it would explode as panic. I would cry and feel confused and rushed, like life was spinning 3x as fast.

It was so difficult to make decisions, and at times felt difficult to do literally anything. I wasn’t afraid like being afraid of spiders or the dark or public speaking, I just had this ongoing uncertainty. Should I do this? Should I take this job? What will this person think? How am I going to make it? What if I can’t pay my bills? What if I’ve done all this work for nothing? What if my boss doesn’t like my work? And on and on the what-ifs went.

This wasn’t the first time I’d felt something in my body that I didn’t understand. When I was in 4th grade, I joined a basketball team at the YMCA. For some reason when we would all run during practice, I could never catch my breath. I couldn’t keep up with the other kids, and I would have to stop and go sit with my mom instead of running with my teammates. I didn’t understand why I couldn’t keep up with everyone, all I knew is that after only a minute or two I would lose my breath and have to stop, even though I was practicing every week and otherwise in really good health. I was a very active kid, and generally in good health, so I didn’t think it was a matter of simply building up entrance.


Yet, at times I would push so hard to keep up and just feel like crying because it was so hard to breathe. It was 10 years before a physician would prescribe me an inhaler. They didn’t test me for asthma, I just explained how I can never keep my breath during physical activity and they prescribed me an albuterol inhaler. I asked my sister, who is a doctor, if I should get tested just to make sure. She said, “Does the inhaler work?” and I said, “Yeah! I didn’t know lungs could work like that!!!”

With asthma, there was something in my physical body that wasn’t working properly. I didn’t understand it; my family didn’t understand it; my coaches didn’t notice somehow, or I pushed hard enough trying to make up the difference. I was an athlete for 8 years, so I had some stamina built up, but when I finally used an inhaler it was like someone gave me a new set of lungs. I had a completely new capacity for breathing that I didn’t have when I was just pushing through and trying as hard as I could. Without an inhaler, my body simply couldn’t make up the difference.

The same was true for me when I finally decided to try anxiety medication. I had experienced another panic attack that derailed my entire day and meant I wasn’t able to make it work that day. Somehow it finally clicked in my brain what was happening, and I realized I’d been having ongoing panic attacks for three years.

Looking back, I actually first experienced anxiety around the same age as my asthma flare ups. In third grade, my mother began packing a roll of TUMS in my lunch box. I don’t know about you, but I don’t know any TUMS commercials marketing to third graders, who are afraid of their stern teacher and feel panicked when presented with a paper sheet of 100 multiplication problems at 8am and told to complete them all within 3 minutes.

But here I was, 8 years old, and feeling this pain in my chest. We thought maybe it was acid reflux (hence the TUMS) because I would drink an acidic Sunny D for breakfast and then another one at snack time, but I don’t know many other 8 year olds who have acid reflux.


After being trained as a therapist, I know understand those third grade symptoms to be the first tinges of anxiety in my life. I was afraid of my teacher, my mother had gone back to work so my support system had changed, I fell off my scooter on my birthday and was on crutches for weeks with a sprained ankle, I was being presented with timed multiplication tables first thing in the morning, and I had my first surgery- a tonsillectomy, which put me out of school for two weeks, after a series of blood draws, going under anesthetic, the whole 9 yards.

But when this pain started happening in my body, we didn’t understand the cause. Similar to having asthma- I kept pushing, I built up stamina, I took my TUMS like a champ, I put forth more effort, and I tried everything I could.

Even with these unknown mental health issues, I managed to play two sports in high school, graduated in the top 10 of my class, held a 3.8 GPA, was homecoming queen as a sophomore, held major roles in the school play, was a leader in my community, and had wonderful friendships. But just like my lungs, all the effort in the world wasn’t making my situation all that much better. My body kept running on empty, and everything I was doing to try to succeed still felt like I was starting from behind.

I remember the first prescription I took for anxiety so vividly. I was on my way to work, being late once again, and instead of feeling panic the whole way there, my brain thought, “that’s ok.” Immediately the other part of my brain incredulously said, “What do you mean, ‘THAT’S OK’?!?!. Nothing has ever been ok!” My brain was so used to feeling fear and panic it couldn’t comprehend this new and foreign, “it’s going to be ok,” mentality. I didn’t know brains could work that way!

Medication alone didn’t make everything better, solve all my problems, or make any of my stressors go away. For asthma- when I have my inhaler, I know I can run faster and longer, but I am still the one that has to motivate myself to get to the gym.When I take anxiety medication, I still need coping skills, support from my community, and I still need to be kind and compassionate with myself.

It would be eighteen years before I would finally take anxiety medication, and by that time I’d already been to a couple of years of therapy. In therapy, I learned coping skills, made some pretty significant life changes, and had been working hard on myself towards growth. But even with all that emotional growth, my body was still having a hard time keeping up.


That’s why having both therapy and medication was the best answer for me. I still have anxious moments, but I no longer feel like I’m starting from behind trying desperately to catch up.

For me, medication helped my body calm down and get out of hyperdrive, which allowed me to have more brain space to work on myself in therapy and more freedom, health, and happiness in my daily life. I’m still taking medication today even though I’m not in therapy.

Now I use what I learned in therapy, benefit from the healing that took place in my therapeutic process, and I still allow the medication to help my brain the way my inhaler helps my lungs. I may not take medication for the rest of my life, but I’ve never felt more “normal” in my entire life, so if I need it, I’ll hold my anxiety meds in one hand and my inhaler in the other.

Medication for mental health is not one size fits all. You may decide to take medication for a season to get through a tough time but not need medication assistance long-term, or you may need medication long-term to help your body stop working overtime. Therapy can help you process what you’re experiencing, and medication can help your body make up the difference when it needs medical and biological assistance.

Either can be helpful on its own and can help you move forward, but both together can at times provide the added leverage needed to heal. Each person is different, and each person should make their own decisions about what treatment is best for them, so be sure to talk with your physician, medication prescriber, and therapist to customize the path that is right for you.

Ryan Cain



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