Over the counter antidepressants
Pro Research Analysisby 
Searched over 200M research papers
Over-the-Counter Antidepressants: Efficacy, Safety, and Usage
Introduction to Over-the-Counter Antidepressants
Over-the-counter (OTC) antidepressants have gained popularity as alternatives or adjuncts to prescription medications for treating major depressive disorder (MDD). These agents include natural health products, dietary supplements, and certain medications that do not require a prescription. This article synthesizes current research on the efficacy, safety, and usage of OTC antidepressants.
Efficacy of OTC Antidepressants
Natural Health Products and Dietary Supplements
Several natural health products and dietary supplements have shown promise in augmenting the effects of conventional antidepressants. Notable examples include S-Adenosyl-L-Methionine (SAMe), folate, omega-3 fatty acids, curcumin, N-acetylcysteine, saffron, and 5-hydroxytryptophan. These agents are believed to enhance the effectiveness of standard antidepressant treatments through various mechanisms, such as modulating neurotransmitter levels and reducing inflammation1.
Dehydroepiandrosterone (DHEA)
DHEA, an adrenal androgen and neurosteroid available OTC, has demonstrated antidepressant-like effects in clinical studies. A double-blind, randomized, placebo-controlled study found that DHEA significantly improved depressive symptoms in individuals with midlife-onset major or minor depression, suggesting its potential as a monotherapy for this population8.
Dextromethorphan (DM)
Dextromethorphan, commonly used as an antitussive, has shown rapid antidepressant effects in preclinical studies. Modified forms of DM, such as deuterated DM (d6-DM), have produced antidepressant-like effects in animal models, indicating potential for clinical use. However, further research is needed to fully understand its mechanisms and efficacy in humans3.
Safety and Adverse Effects
Potential Neuropsychiatric Reactions
While many OTC antidepressants are considered safe, there are reports of serious neuropsychiatric side effects and interactions. For instance, SAMe has been associated with adverse events, including a case of attempted suicide by self-burning, highlighting the need for caution and further research on the safety of these products4 7.
Drug-Drug and Herb-Drug Interactions
The potential for drug-drug and herb-drug interactions with OTC antidepressants is a significant concern. Many of these interactions are not well-documented, leading to underreporting of adverse events. This underscores the importance of consulting healthcare professionals before combining OTC antidepressants with other medications4.
Usage Patterns and Public Health Implications
Underutilization in the Elderly
A survey in Germany revealed low usage rates of both prescription and OTC antidepressants among the elderly, particularly in institutionalized settings. This suggests a need for increased awareness and education about depression treatment options in this demographic6.
Regulatory Considerations
Given the potential risks associated with OTC antidepressants, stricter regulatory oversight by agencies like the U.S. Food and Drug Administration (FDA) is warranted. This would ensure better safety profiles and more reliable information for consumers4.
Conclusion
OTC antidepressants offer a range of options for individuals seeking alternatives or adjuncts to prescription medications for depression. While some agents show promise in enhancing the efficacy of conventional treatments, safety concerns and the potential for adverse effects necessitate further research and regulatory oversight. Healthcare professionals should guide patients in making informed decisions about using these products.
Sources and full results
Most relevant research papers on this topic
Natural health products, dietary minerals and over-the-counter medications as add-on therapies to antidepressants in the treatment of major depressive disorder: a review
Nutraceuticals and over-the-counter drugs, such as curcumin and NSAIDs, may be effective and safe additions to standard antidepressant treatment for major depressive disorder.
Systematic ReviewMechanism of action of antidepressant medications.
New antidepressants target specific brain receptors without causing unwanted side effects, improving depression treatment.
Highly CitedDeuterated (d6)-dextromethorphan elicits antidepressant-like effects in mice
Deuterated (d6)-dextromethorphan (d6-DM) has antidepressant-like effects in mice, suggesting it may utilize different antidepressant mechanisms than regular dextromethorphan.
Non-RCT
Animal StudyAdverse neuropsychiatric reactions to herbal and over-the-counter "antidepressants".
Over-the-counter remedies for depression may be safe and effective for some subgroups, but more research is needed before they can be recommended for routine use and stricter FDA oversight is needed.
Systematic ReviewAntidepressant efficacy and side effect burden: an updated guide for clinicians
Antidepressant treatment has evolved over time, with newer medications targeting specific neurotransmitters and areas of the brain, and a variety of nonpharmaceutical treatments available for patients despite treatment efforts.
Literature ReviewThe Utilization of Antidepressants in Community-Dwelling and Institutionalized Elderly - Results from a Representative Survey in Germany
Antidepressant use is remarkably low in elderly individuals, with institutionalized individuals being particularly disadvantaged.
Observational StudySuicide Attempt by Self-Burning Associated With Ingestion of S-adenosylmethionine: A Review of the Literature and Case Report
S-adenosylmethionine (SAMe) may be a safe alternative treatment for depressive symptoms, but further research is needed on its safety and tolerability.
Dehydroepiandrosterone monotherapy in midlife-onset major and minor depression.
DHEA is an effective treatment for midlife-onset major and minor depression, providing significant improvements in depression symptoms and sexual functioning.
RCTHighly CitedShould antidepressants be used for major depressive disorder?
Antidepressants have minimal benefits for major depressive disorder and increase the risk of serious and non-serious adverse events, making their use for adults with depression questionable.
Systematic ReviewHighly Cited