What are over-the-counter antidepressants?


Photo credit: Courtesy of Tyler Schoeber

America has a mental health problem. According to the National Institute for Mental Health (NAMI), more than one in five adults in the United States suffer from mental illness each year, and rates of anxiety and depression have increased by 25% during the pandemic. For men, the situation is especially dire, made worse by the fact that they are less likely to seek help or opt for prescribed treatment.

While women are twice as likely to suffer from depression, men are less likely to be treated for it. Between 2015 and 2018, antidepressant use over the course of 30 days was higher for women than men (17.7% vs 8.4%), with men aged 18 to 39 which have the lowest rate, according to a 2020 report from the Centers for Disease Control. Antidepressant use soared for women between 2009 and 2018, but rates among men remained flat during the same time period.

Male aversion to antidepressants is not all that surprising. In addition to the multitude of reasons anyone avoids the stigma, fear, and shame of clinical intervention, many men may avoid antidepressants because of one potential side effect: erectile dysfunction. This is exactly what makes over-the-counter alternatives attractive, particularly for those suffering from less severe forms of depression, including seasonal affective disorder (SAD) and brief mood dips that may not require an increase in clinical strength. They\’re also an attractive prospect for people hesitant to add another drug with unpleasant side effects to their routine.

Over-the-counter (OTC) medications aren\’t backed by the same research, but they can help relieve mild to moderate symptoms of depression, according to Dr. Mikhail Kogan, medical director of George Washington University\’s Center for Integrative Medicine.

For a psychiatrist who [didnt] have training in evidence-based integrative practice, for anxiety or depression they would likely start medication or therapy right away and then [up the dosage] at a later time depending on the severity of symptoms, said Dr. Noshene Ranjbar, an associate professor of psychiatry at the University of Arizona College of Medicine in Tucson.

According to the National Institutes of Health (NIH), the most commonly prescribed antidepressants, selective serotonin reuptake inhibitors (SSRIs) such as Zoloft and Prozac, prevent neurons from reabsorbing neurotransmitters and can help regulate mood. Anti-anxiety medications, such as benzodiazepines, restrict the central nervous system, which helps reduce symptoms such as extreme worry and panic attacks according to the Center for Addiction and Mental Health (CAMH).

According to a mountain of clinical research, these types of medications work really well for those with severe depression symptoms. Data regarding their long-term effectiveness, however, is more conflicting according to a 2022 study published in the journal PLoS.

While no one is suggesting you ditch your Zoloft prescription in favor of a range of supplements, Kogan said St. John\’s Wort has been used for centuries to regulate mood, and St. John\’s Wort and Valerian , as well as supplements such as omega-3 fatty acids and 5-hydroxytryptophan (or 5-HTP), can treat some symptoms of mild depression. That said, more research is needed to understand the risks of taking them in place of SSRIs or other chemical interventions, and they\’re not recommended for anyone with severe depression. They may be a route to avoiding doctors and potential sexual performance problems, but there are obvious drawbacks, including the risk of serotonin syndrome or reduced efficacy of other drugs.

Ranjbar said other supplements that work reasonably well for anxiety and depression include lavender oil and L-theanine, an amino acid and active ingredient in green tea. According to a 2021 review and meta-analysis conducted by Tehran University of Medical Sciences of over 342 selected studies, lavender significantly helped in symptoms of depression compared to a control group.

[For] L-theanine, the best research is for children with ADHD who also have trouble sleeping, Ranjbar said, referring to research done at the University of British Columbia on eight- to 12-year-old boys. We use it to help improve sleep because it allows for some calming effect without making people sedated. Some people with anxiety may also benefit from L-theanine because it\’s a mild sedative drug and not super intense, Ranjbar said, referring to mild cases of both anxiety and depression.

For some people, symptoms of anxiety and depression can stem from nutritional deficiencies, particularly low levels of the B vitamins, folate and omega-3 fatty acids, according to the Indian Journal of Psychiatry. Kogan said broad-spectrum micronutrients are needed for building neurotransmitters like dopamine and serotonin, so supplements like B-complex and folate can help. Researchers at the California Institute of Behavioral Neurosciences & Psychology also concluded that vitamin B-12 may help delay the onset of symptoms of depression and enhance the effects of antidepressants when taken together.

The body is also unable to produce omega-3 fatty acids on its own, a nutrient needed to reduce inflammation and blood clotting. A 2019 study published in Translational psychiatry found that omega-3 fatty acids helped mitigate symptoms of depression, especially in test groups given pure EPA (one of several omega-3 fatty acids) versus DHA (another). Rich in omega-3s, foods like salmon and walnuts are some of the best sources, but adding a supplement can help fill in the gaps in your diet.

Before any of this starts to sound too woo-woo, it\’s worth noting that the effectiveness of OTC remedies varies, and they aren\’t subject to the same kinds of regulations as prescription drugs. Ranjar said websites like ConsumerLabs.com are helpful resources for checking which supplements have been third-party tested and follow good manufacturing practices.

While it seems tempting to replace prescription drugs that come with all sorts of unpleasant side effects with a more natural option, are these OTC mood boosters as effective as regular Zoloft or Ativan? Not exactly. A 2018 meta-analysis conducted by psychiatrists and researchers in Germany, Switzerland and Texas and published by Cambridge University Press found that 5-HTP, depending on the study, was not substantially effective or on par with a standard antidepressant. Ultimately, experts say it depends on a number of personal and clinical factors.

Kogan said, for example, if an individual is trying to come off antidepressants, including an herbal or dietary supplement can help someone deal with associated withdrawal symptoms.

But for some individuals, Ranjbar said, over-the-counter herbal and dietary supplements can help supercharge traditional prescription antidepressants, especially if their symptoms aren\’t improving or they need something stronger to be adequately managed.

The supplements can be used alongside prescription medications or therapies such as cognitive behavioral therapy (or CBT), said Dr. Debra Kissen, a cognitive behavioral therapist specializing in anxiety and author of Break Free From Intrusive Thoughts: An Evidence-Based Guide to Managing Fear and Finding Peace.

Avoiding the nagging aspects of the healthcare system may be a benefit of OTC options, but every expert interviewed for this story stressed that people shouldn\’t explore alternative therapies totally unsupervised.

Sometimes when people look for over-the-counter solutions, it\’s because they\’re trying to figure it out on their own instead of actually getting help, Kissen said. As long as you do it this way [of recognizing] you deserve help and support, e [supplements] they\’re just a tool, that\’s fine, but it shouldn\’t be a lonely process.

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