Research studies using antidepressant medications (that increase the level of serotonin activity in the brain) show that some people with compulsive hoarding respond well to these medications. However, many do not. People with compulsive hoarding do not appear to respond as well to medications as do people with other kinds of obsessive-compulsive symptoms.
Cognitive-behavioral therapy is a form of counseling that goes beyond "just talking." In this form of treatment, the therapist often visits the person's home and helps him learn how to make decisions and think clearly about his possessions. There haven't been as many studies of this kind of treatment, so it's hard to say with certainty how effective it is for hoarding. However, the available evidence suggests that cognitive-behavioral therapy is effective for many people with compulsive hoarding, perhaps more so than medications.