Therapy helps you change how you think, act and cope. Medication works on symptoms through the body’s chemistry. Neither is automatically better. For many adults, the right answer is one or the other. For some, it is both at once.
More therapy now happens by video, phone or online programme. That raises new questions. Does it work as well? How does a remote therapist keep in touch with the doctor who prescribes your medicine? This page walks through the evidence-based options and the practical side.
Two tools, one plan
Think of therapy and medication as tools with different strengths.
Therapy teaches skills that tend to stay with you. It asks for time and effort, often including practice between sessions. It avoids medication side effects.
Medication can ease symptoms such as low mood, constant worry or intrusive thoughts. For some people that relief is what makes therapy possible, because it is hard to do homework when you can barely get out of bed.
A good plan says which tool you are using, why, and how you will know if it is working. When two professionals are involved, it also says who is responsible for what.
Therapies you can have online
The NHS lists several talking therapies, and many can be delivered remotely. Here are the ones most often recommended for anxiety, depression and trauma.
Cognitive behavioural therapy (CBT)
In CBT, a therapist helps you change how you think and act. You practise what you learn between sessions. It is used for depression, anxiety disorders, OCD and more. For OCD, a form of CBT called exposure and response prevention (ERP) is central.
Behavioural activation
This approach looks at the links between what you do and how you feel. You gradually rebuild activities that matter to you. The NHS says it typically involves 12 to 16 individual sessions.
Interpersonal therapy (IPT)
IPT focuses on relationships and the problems in them, such as communication difficulties, conflict or loss. It is one of the therapies NHS Talking Therapies can offer for depression.
EMDR and trauma-focused CBT
For adults with PTSD, NICE recommends individual trauma-focused CBT for people who come forward more than one month after a traumatic event. It also recommends eye movement desensitisation and reprocessing (EMDR) for PTSD that has lasted more than three months after a non-combat-related trauma. Both typically involve 8 to 12 sessions.
Guided self-help and digital programmes
Guided self-help means working through a workbook or online course with some support. The NHS describes around 6 to 8 sessions for depression. NICE has also assessed digitally enabled therapies for adults with depression. Its recommendations are conditional while more evidence is collected.
Does therapy work over video?
Remote therapy is now a normal part of NHS care. NHS Talking Therapies offers treatment in person, by video or phone call, or as an online course, in groups or one to one.
National guidance has made room for remote formats for some time. NICE’s OCD guideline includes brief individual CBT by telephone as a low-intensity option. Its PTSD guideline says supported, computerised trauma-focused CBT can be considered for adults who prefer it, as long as they do not have severe dissociative symptoms and are not at risk of harm.
That does not mean remote therapy suits everyone. It can be harder if you have no private space, if your internet is unreliable, or if you are in a very unsettled state. A therapist should talk this through with you at the start.
When both are recommended
Guidance does not treat every condition the same way. These examples show where combining approaches comes up. They are general summaries, not advice for your situation.
Depression
The NHS says a GP may recommend a course of antidepressants plus talking therapy, particularly if depression is quite severe. For milder depression, guided self-help or a talking therapy is often offered first. The NICE depression guideline sets out the full range of options.
Obsessive-compulsive disorder
NICE uses the level of impairment to guide choices. Adults with moderate impairment should be offered either a course of an SSRI medicine or more intensive CBT including ERP. Adults with severe impairment should be offered both together.
PTSD
Trauma-focused therapy comes first in NICE guidance. Medication, such as venlafaxine or an SSRI like sertraline, can be considered for adults who prefer drug treatment. NICE says drugs, including benzodiazepines, should not be offered to prevent PTSD.
Generalised anxiety
The NHS says a GP will usually suggest trying talking therapy before prescribing medicine or referring to a specialist. CBT is the usual therapy, and SSRIs are the usual type of medicine if one is needed.
Keeping your professionals in step
When a therapist and a psychiatrist both support you, good communication stops the plan pulling in two directions. Usually it works like this:
- You give consent. Nothing is shared without your agreement. Say clearly who can receive letters.
- The psychiatrist writes a summary. It explains the diagnosis, any medication and what to watch for. You can pass a copy to your therapist.
- The therapist flags changes. If your mood drops, side effects affect your sessions or risk increases, they may advise you to contact your prescriber.
- Medication changes are timed with care. Starting or changing a medicine during an intense phase of therapy can make it hard to tell what helped. Your prescriber can plan around that.
- Your GP stays informed. They hold your overall medical record and often need to know about new medicines.
You are the link in the chain. Keep your own copies of letters, and bring questions from one appointment to the next.
Signs the plan needs a rethink
Combined treatment is not fixed. Tell one or both professionals if:
- you have given therapy a fair try and your symptoms have not shifted
- side effects make it hard to concentrate in sessions or finish practice tasks
- you feel emotionally flat or too drowsy to engage with therapy
- your mood or sleep suddenly gets worse after a medicine change
- life has changed a lot, such as a new job, a loss or a pregnancy
A short conversation often leads to a small adjustment, such as a different session time, a dose review or a change of therapy focus.
Making online sessions work
A few practical habits make a big difference to remote therapy:
- Find a private spot. A parked car, a bedroom with the door shut or a booked room at work can all work. Headphones help.
- Test your connection early. Join a few minutes before the start. Keep a phone nearby in case video fails.
- Agree a backup plan. Ask your therapist what happens if the call drops, and how to reach help between sessions.
- Share your location. Your therapist needs to know where you are in case of an emergency during a session.
- Leave a buffer afterwards. Try not to jump straight into a work call. Give yourself ten minutes to settle.
- Keep notes in one place. Write down homework tasks, medication questions and anything to tell your psychiatrist.
- Be honest about screens. If video feels harder than face to face, say so. There may be other options.
Where a psychiatrist adds value
A psychiatrist is a medical doctor who can diagnose, prescribe and review medication. This matters when you are not sure what the underlying problem is, when therapy alone has not been enough, or when your current medicine needs reviewing.
Happy Clinic’s GMC-registered consultant psychiatrists see adults aged 18 and over by video, anywhere in the UK. They work with conditions such as depression, generalised anxiety, panic, OCD and PTSD. After an assessment, your treatment plan may include medication, therapy referral advice and follow-up appointments. A clinical summary goes to you and, with your consent, to your GP, which you can also share with a therapist. Happy Clinic’s how it works page sets out the process.