Mental health has much in common with physical health. There are times when both falter and treatment is needed. There are no set criteria for when to seek treatment for mental health issues, but it’s important to get help when needed. The Mental Health America organization reports that 27 million U.S. adults don’t receive the treatment they need.

“The need to start therapy can involve different triggers,” Priyanka Shokeen, Ph.D., clinical director, psychotherapy and psychologic testing at Seattle Anxiety Specialists, says.

“For some people, it will be when they are faced with a new — or a different — stressful event in their lives. For others, it may be something they’ve experienced or dealt with for a long time that’s now something they are ready to talk about or seek help for.”

She adds there are some indicators that can point to the need for professional help and include:

  • You, or the people that care about you, may notice a shift in your emotions. This could range from intense emotional reactions to overly subdued responses.
  • Your behavior is changing — and not in a positive way. You may be abusing substances to address how you’re feeling, for example.
  • Your sleeping and eating patterns could become disrupted, whether it’s the inability to sleep or sleeping too much and/or experiencing the same with your eating habits. These can be hard to initially pinpoint.
  • Your thoughts are becoming consumed with what is bothering you. 
  • Your relationships start to suffer.

Shokeen says that despite the presence of these signs, it can still take people a long time to seek therapy because of the stigma attached to mental health issues and assumptions society makes about how it should be addressed. “There is often an ‘it’s all in your head’ mentality that people have toward mental health issues, as if the symptoms people are experiencing aren’t real,” she says.

Once a decision has been made to seek therapy, it’s important to find a provider — a physician or psychological professional — who can help direct you to the best treatment path. Part of this process will include determining if you need talk therapy or if you need a treatment plan that includes a combination of medication and therapy.


“The idea is to pick a place to start,” Shokeen says. Either talk therapy or medication — or a combination of the two might be the best approach. Once you’ve recognized you need treatment, the easiest place to start is to get a referral from your primary care physician. You can also check with your insurance company to find providers in your network, look for community mental health centers in your area, and for people enrolled in Medicare you can find a list of providers at

Different types of talk therapy

The primary purpose of talk therapy is to create a safe, trusting space with a therapist to discuss what’s troubling you, Shokeen says. “In this nonjudgmental space, clients can become aware of their thinking patterns, emotional reactions, coping strategies or past traumas.”

The first thing to know is that you have options. There is no singular, clearly defined remedy when it comes to mental wellness and your doctor may make a recommendation as to what path may work best for you.

Dr. Katharine Liang, M.D., Ph.D., consulting psychiatrist at Seattle Anxiety Specialists says, “therapy is about addressing thought processes and behaviors and there are a lot of types of therapy that work in different ways and fall under the therapy umbrella.”

The American Psychological Association identifies five categories.

  • Psychoanalysis and psychodynamic therapies focus on “changing problematic behaviors, feelings, and thoughts” by understanding any “unconscious meanings and motivations.”
  • Behavior therapy seeks to understand the underlying factors of a person’s behavior.
  • Cognitive therapy focuses on what people think rather than what they do.
  • Humanistic therapy “emphasizes people’s capacity to make rational choices and develop to their maximum potential.”
  • Integrated or holistic therapy is a blend of approaches that a therapist will tailor to each person’s unique needs.

Combining talk therapy and medication

Liang points out that it’s not unusual for therapists who don’t prescribe medications to only advocate for talk therapy, or for providers who only prescribe medications not to emphasize a talk therapy treatment component.

The decision as to what will work best for you is nuanced. If you’re at a loss as to where to start, Liang suggests meeting with a “provider like a psychiatrist who does both medication and therapy, or a practice that has therapists and psychiatrists on staff, to get the most objective discussion of pros and cons of each approach.

“Therapy and medications work hand in hand because sometimes patients have symptoms that are so severe that they are unable to engage in therapy. Medications can help get patients to a place where they are more physically and mentally able to engage meaningfully in therapy,” she says.

For depression specifically, Liang points out that a number of studies suggest that while in some respects antidepressants and therapy are equally as effective when you look at the percentage of patients who respond to each treatment, there is some nuance to these results.In general, patients tend to respond more quickly to antidepressant medication, but therapy is more effective at preventing the depression from returning in the long run, so the two together work synergistically, she says. In fact, numerous studies support this conclusion — that the combination of medications and therapy together is more effective for the treatment of depression than medications or therapy alone.

“Other considerations I often see in my patients are more practical. Medications can be easier to start with because many people have a primary care physician who is able to prescribe basic psychiatric medications. Some patients want to try medications first because they feel they simply do not have the time in their busy lives to commit to therapy. On the other hand, some patients may be reluctant to try medications because they are worried about side effects, or they’re afraid of becoming dependent on medication. For patients with mild to moderate mental health issues, I think it’s often reasonable to choose either one based on what seems to fit with the patient’s lifestyle and priorities.”

Shokeen points out that research reveals that medication and therapy are similarly effective for a host of problems. “Which one should you start with is based on what is the first line of defense for what you are experiencing, and your own willingness to try it.

“It’s possible that the first thing you try may not feel helpful or effective,” she adds. “That doesn’t mean the option you picked doesn’t work for you, so don’t hesitate to ask for a different therapist or different medication if the first one isn’t working out.”

Seattle Anxiety Specialists, PLLC is a private psychiatry and psychotherapy practice in downtown Seattle, providing evidence-based treatments and in-depth self-exploration for anxiety and conditions that create anxiety including phobias, depression, GAD, OCD, PTSD, ADHD, OCPD and bipolar.