These are excellent points regarding the necessity of using appropriate doses of both medications as well as a sufficiently aggressive trial of cognitive-behavioral therapy. Often, patients will say, "Oh, I've tried that medication" or "Oh, I've tried cognitive-behavior therapy" when neither have been tried in a manner which is likely to be effective. Doing a half-hearted approach to either meds or therapy is a disservice to the patient, since it makes them rule out an entire avenue of treatment when it has not actually been given a fair trial.