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Self-Medicating with Over-The-Counter Medicines for Mental Illness
Self-diagnosis, -treatment, and -monitoring is widespread due to the expansion of healthcare and the surplus of medical information available via television, radio, magazines, and the internet. While relying on introspection to develop awareness of your body and emotions is an important skill, self-treatment with over-the-counter (OTC) remedies without the expertise or guidance of a trained health care provider can lead to dangerous outcomes.
An accurate diagnosis is crucial to accurate treatment and management of any illness or medical condition, and mental health is no exception. Many people may be skeptical of mental health care providers or feel uncomfortable talking about their anxieties, worries, or fears with a professional counselor or therapist, but treating mental illness incorrectly is just as dangerous as not treating it at all. A mental health care provider will diagnose patients based on their physical and psychological symptoms, using years of professional training, manuals and references, and research from colleagues and other health care providers. Relying on family and friends, television advertisements, or online self-assessments may not accurately explain the causes of your mental health concerns. An accurate diagnosis is the first step in determining which treatment options will have the best outcomes.
Self-treatment is prevalent for conditions from acne to zinc deficiency and everything in between. Choosing a medication for any condition is not a responsibility to be taken lightly. Physicians and pharmacists have extensive training to be able to choose the right drug, at the right dose, for the right patient. Not all medicines are appropriate for every patient, due to medical and family history, drug interactions, and potential side effects. Further, some conditions may not require a medication at all. A trained professional may be able to teach coping techniques, plan exercise programs, or recommend cognitive therapy that will effectively treat mental health conditions.
By sidestepping health care providers in choosing medications and treatment options, patients may inadvertently place themselves at risk for serious drug-related consequences.
Self-monitoring of medication therapy involves assessing ones own symptoms and adjusting the dose or medication to alleviate the symptoms. In such instances, patients may choose an entirely inappropriate drug or dose for their medical condition. Some patients have attempted to manage anxiety symptoms with antihistamines or depression with OTC pain relievers. This leads to ineffective therapy for the underlying medical condition, overuse of unnecessary medication, and the potential for unwanted side effects and drug interactions.
Being a pro-active patient is extremely important in today’s health care environment, and investigating health information is key, but always seek appropriate guidance from a health care provider before diagnosing or treating your condition. Physicians and psychologists have experience to accurately diagnose mental health conditions and to suggest therapies that will work best for each individual; Pharmacists have the training to understand the drugs you are taking and can predict and prevent drug interactions and side effects. Be an active part of your health care team, but do not do it alone.
References
CHARLTON, B. (2005). Self-management of psychiatric symptoms using over-the-counter (OTC) psychopharmacology: The S-DTM therapeutic model – Self-diagnosis, self-treatment, self-monitoring. Medical Hypotheses, 65(5), 823-828. DOI: 10.1016/j.mehy.2005.07.013
Dipiro JT, et al. (2002), Pharmacotherapy: A pathophysiologic approach (5th ed.). New York: McGraw-Hill.
Jennifer Gibson, PharmD
Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.7 Responses
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While of course I agree that getting professional advice is helpful, it’s simplistic and unrealistic to advocate that nobody should ever self-medicate. The truth is, most people actively use at least some psychoactive substances – caffeine and alcohol being the most common – to modulate their mood, improve concentration, deal with stress, reduce anxiety or enhance experiences. Extending this behavior to other substances is not intrinsically problematic.
Many people can’t afford professional help, or are leery of a medical system that may later stigmatize them for any diagnosis they are given. Moreover, medications are often prescribed with brutal disregard for their psychoactive properties – the common contraceptive pill being a classic example. Lastly, the range of medications likely to be suggested by professionals is highly restricted due to legal and commercial factors: many highly effective psychoactive substances are illegal, while others are not promoted due to lack of financial incentives.
Demystifying the functions of psychoactives through public education is far more helpful than simply saying, do nothing unless advised by a professional. Professionals are not necessarily accessible, knowledgeable or trustworthy, and a self-aware individual can often obtain more effective treatment via personal research.
Good I agree.Self medicating in mental illness is dangerous as the chance for addiction is high and tendency to suicide may also be there if some of these medicines are stopped suddenly..You can question the diagnosis of your doctor and get a second or third opinion but better not to self mediciate..
I’m really glad you used the term “health care provider”. Unfortunately, most people associate this term with their physician. So, I’m not sure the answer to this dilemma. As a body psychotherapist and psychologist I’ve seen problems at both ends. And, from this perspective I own up to a bias against wholeheartedly endorsing clients to see their physicians, when a Chinese herbalist or a naturopath is, in my opinion, is often the better option.
I’ve certainly seen clients who are mixing OTC with their prescription medicines with little regard to interaction effects. So the need for guidance is certainly there. But by far I’ve seen the opposite, questionable “guidance” for clients who are prescribed medication by their physicians when available psychotherapy would have been the more long-lasting solution. In many cases, psychotherapy isn’t even mentioned by their doctor. Yet, some of these clients will be on medication for years for problems that are best treated faster and more effectively by psychotherapy.
I’ve also seen clients being directed to make dramatic changes in dosages and medications by their physicians with little regard to the level of activation present in the client and the impact on the nervous system. I can understand this. Physicians are not trained to notice the level of activation. As a body psychotherapist, that’s my job.
Maybe it’s problems like these that have lead folks to take matters into their own hands. Alternative treatments such as acupuncture, Chinese herbs, naturopathy, bodywork treatments offer a less invasive and gentler approach that complements my work. But these treatments are rarely mentioned by family physicians.
I couldn’t disagree more. My modus operandi is that of human freedom. This includes “cognitive freedom”. People should have the freedom to control their own brain function if they so desire. No one seems to object to the legality of alcohol, revealing a bit of the hypocriticality of this outmoded, lingereringly paternalistic line of thinking. Are engineers denied the right to produce their own computer code (other than copyright by the monoliths?) Are people denied the right to represent themselves in court without hiring an attorney? Are woman even denied the right to kill off their own babies (“fetuses”). What I see here is mostly defensiveness over the physician’s last remaining dominion of entitlement, with a potential economic motive creating an inherent conflict of interest that is flagrantly ignored. Don’t worry, there is plenty of money to go around. Many people have no interest in pursuing cognitive improvement of their own, and many will suffer side effects to feed the medical bureaucracy its piece of pie (like the heroin addicts with endocarditis, or the coming hepatitis C epidemic to maintain the transplant industry.
I absolutely agree with you concerning the widespread tendency to use OTC meds for self-diagnosed conditions without healthcare provider input, esp when it comes to insomnia. People use and abuse OTC antihistamines such as Benadryl and Tylenol PM (which contain diphenhydramine). This med is not recommended for use in the elderly (>65) and yet many of the cognitively impaired residents newly admitted to the nursing facilities I do consulting at are on this and probably have been taking this for years. When their family is told that this may be a cause of their cognitive impairment, they are shocked “Why didn’t her doctor take her off this??”
When the resident is taken off this, and their sleep patterns are examined, it is usually found that they don’t need it, the underlying cause of the insomnia is fixed (pain issues, sleep apnea, GERD,etc), and surprise, surprise, their cognitive function improved, sometimes to an extent that they can be discharged.
I am not blaming the physicians because chances are the patient never told the doctor they were taking this. Usually, they see it advertised on TV, or a well-meaning neighber recommends it, “It works great for me!”
It is true that self-medication is very dangerous and can only lead to more problems. And the reason is not just that they have limited funds or health insurance but rather some are in denial and won’t accept the fact that there could be something wrong with them so they choose to make their own research and diagnose themselves instead of consulting with a professional, thinking this is best for them. I think pharmacies should also be accountable for distributing these medications over the counter without prescription, most especially medications with known side-effects.
All drugs have side-effects, and most people don’t realize this. The FDA requires that side-effect info be printed along with dosage information on all OTC meds. I don’t understand why pharmacies should be accountable for distributing these meds if the FDA determines that they are safe enough to be sold over the counter.