Meds are scary to me too. I posted a while back that I am contemplating the same issue right now. I have noticed that my nephew has inherited my perfectionistic thinking. I have also noticed that my brother is probably a perfectionist and my sister has a high level of self-doubt. So, I am pretty sure there is a biological component.
I have read that a person can try therapy for a while and see how it goes before trying a med. However, my T would probably not be happy with me on that because I have been talking to her regularly with only limited improvement. She wants me on anti-depressants. I found a good book on the subject called When Words are not Enough by Valerie Davis Raskin, MD. She has a clear understanding of the dilemma that we go through in making a decision like this. She also has a good section on side effects. For those on anti-depressants, she also talks about dealing with the side effects. I really liked a few of her comments in the section on the biology of depression because I have a degree in biology. So, I have trouble believing that a disorder that has no biological diagnostic test has a biological component. My advise would be to try therapy for a few months and re-consider the drug option if you don't see much improvement. I will probably talk to my T soon about the subject since I know that she will bring it up again if I don't.