Over the Counter and Psychiatric Medications: Helpful or Dangerous Combination?

By October 16, 2018Medication

Over the counter medications (OTC’s): many of us have relied on them for day-to-day ailments. Be it for coughs, colds, headaches, fever, minor sprains, allergies, or aches and pains, we’ve all found ourselves meandering into our local pharmacy seeking relief from these minor but pesky symptoms. In fact, studies have revealed that around $116 Billion dollars was spent on OTC remedies in the United States in 2016.

The true question here though is: Is there anything wrong with managing our symptoms this way? The proper answer to this question is: Well, it depends. To give an oversimplified answer, there are two essential ways to address an illness: treat the symptoms or the underlying illness itself.

In reality, symptoms are what drive us to seek help. Symptoms like fever, nagging cough, sore throat or runny nose can be very troublesome and we simply want relief. That’s understandable and human. We just want the headache to go away, nose to stop running, or irritating cough to cease That’s where a pain reliever, cold syrup, or cough drops can help. We take it, feel better, get on with our day, or simply fall asleep easier. However, that doesn’t mean that we have treated the viral illness that gave rise to flu symptoms in the first place. This is where a prescription medicine may prove more effective by both shortening the duration of the flu symptoms and by making them less intense—because it is targeting the root cause.

Such an analogy would also apply to psychiatric symptoms. For example, the inability to fall asleep might be a sign of depression or anxiety. While an over the counter sedative might help you fall asleep, it won’t address the other symptoms of those disorders. If you are regularly resorting to a sleep aid for insomnia you may be treating the problem superficially, never really addressing the underlying causes. This is where it would probably be more helpful to seek professional advice and help.

Most physicians understand patients’ need for symptom relief and would likely prescribe something for this. In addition, what I do as a physician is educate my patient about what medication does, how it works, and the underlying nature of the problem/disorder. That way we can go about tackling the problem comprehensively, rather than just skimming the surface with use of OTC medications.

The other important issue I inform patients about is that OTCs are not totally harmless just because they can be obtained without a prescription. This is especially important to know if I plan to prescribe psychiatric medications that might interact dangerously with sedative medications such as Benadryl.  This interaction could either mean intensifying the effects of the existing prescription medication (including side effects) or undermining it by affecting the prescription medication’s metabolism by the liver.

Given the above, I get especially concerned as a physician when my patient tells me after that fact that they have resorted to an OTC medication. That usually tells me they are still trying to self-medicate a troubling symptom even with their existing prescribed medication. In such cases, I work with my patient to establish the full range of medications they should or shouldnot be taking. It also tells me whether I need to add or change their existing medication to address their ongoing symptoms.  I then ask them to inform me as soon as possible of any changes or additions to any of their othermedications or to inform me before they intend to take any other medications, supplements or herbs.

If chosen well, prescribed psychiatric medications should ideally address all ofthe symptoms of a patient’s psychiatric disorder so that a patient should not feel the need to reach for OTC symptom relief. If not, I always encourage my patient to tell me if a medication or dosage has not worked in the way that it was expected to. That way I can adjust or change their prescribed medications accordingly. I also then advise them of the time frames expected, so that they do not lose hope and again resort to OTC medication use.

Teaching patients about how brain receptors work helps people have a realistic understanding of medications’ effectiveness and what symptoms they can treat. Patients who are used to being on several medications or who have had histories of alcohol or drug use may require higher doses of their psychiatric medications. However, such increases should always be supervised by a physician who is familiarwith their medical and psychiatric history and never done by the patient of their own accord.

The most common cause of poor outcomes that has been repeatedly proven in healthcare studies is inadequate communication among healthcare professionals and patients. This is why I want to emphasize the importance of always telling your treating psychiatrist about allof your symptoms, what remedies—including OTC medications—and what doses you have tried thus far. That way he/she can make their best judgment as to the most appropriate and safest next step to help you achieve relief of your symptoms faster.

 

 

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