Patients are unlikely to read the inserts that come with medications, but perhaps OTC antidepressants could come with a video that would give instructions as to dosing, duration, risks, and when to seek help from a physician or in an emergency facility. The presentation could emphasize that while SSRIs can be very effective in treating depression and anxiety, other strategies are available, and people should see a psychiatrist for a complete evaluation. Perhaps patients who had a partial response would be more willing to seek out a mental health professional if they saw some benefit, much the way people go to their doctor when drugstore remedies don’t work for headaches or acid reflux. Furthermore, the availability of drugstore antidepressants might decrease the overall stigma of taking psychopharmacologic agents.
There are risks, but many people tolerate SSRIs. Perhaps over-the-counter antidepressants would save and improve lives; we just don’t know.
As I said above, I’m playing devil’s advocate. My last article asked the question of whether psychiatric treatment actually prevents suicide, and I concluded that it probably does. Yet SSRIs have not conclusively been shown to decrease suicide rates – the only medications known to do so are lithium and clozapine. Still, if patients are unable or unwilling to avail themselves of traditional psychiatric settings, perhaps it’s worth at least asking if some form of access is better than none at all. Society is wrestling with how to address the shortage of psychiatrists. Proposed solutions include telepsychiatry or having psychiatrists serve as consultants in settings where they don’t even meet the patients for whom they make medication recommendations. I haven’t heard anyone suggest that we let the patients try by themselves.
As a psychiatrist who treats patients with medications in combination with psychotherapy, it does seem like a strange question to ask; our patients deserve more than a bottle off a shelf. But before you get too concerned, let me assure you that I have no special connections at the Food and Drug Administration, and I’m just tossing the idea out as food for thought.
Dr. Miller is coauthor of “Shrink Rap: Three Psychiatrists Explain Their Work” (Baltimore: Johns Hopkins University, 2011).