The Truth About Over the Counter Antidepressants

Antidepressants are used to reduce symptoms of depression and allow an affected person to return to his or her previous functioning. Most of these medications are prescription drugs but some can be considered over the counter antidepressants.

over the counter antidepressantsAntidepressants can be classified according to their mechanisms of action. For instance, selective serotonin reuptake inhibitors or SSRIs like Fluoxetine (Prozac), Paroxetine (Paxil), Escitalopram (Lexapro) and Sertraline (Zoloft) work by inhibiting the reuptake of serotonin, thereby maintaining high levels of serotonin between neurons. SSRIs are effective because they address the lack of serotonin, which is a major pathophysiologic mechanism in depression. In fact, SSRIs are considered to be the first line drugs for depression and are the most prescribed antidepressants.

Unfortunately, SSRIs are not considered over the counter antidepressants. A consult with a psychiatrist is needed in order to assess risk for suicide and violent behavior since these are associated with SSRI intake. A person also has to undergo several laboratory studies, including blood glucose determination and cholesterol determination, before any of these drugs can be given. These laboratory studies are necessary to avoid side effects such as long-term weight gain and metabolic problems.

Another set of antidepressants are called serotonin-norepinephrine reuptake inhibitors or SNRIs. These drugs work on both serotonin and norepinephrine neurotransmitters. These drugs include Duloxetine (Cymbalta) and Venlafaxine (Effexor). These drugs have side effects similar to those of SSRIs and are also not considered over the counter antidepressants.

The only so-called over the counter antidepressant that has met FDA approval as a dietary supplement is St John’s Wort (Hypericum perforatum) plant extract. This herbal drug is the most-widely used and studied herbal antidepressant. In Germany, it is commonly used for mild depression in children and adolescents. Several studies show that it is equally effective to standard antidepressants, with the advantage of having fewer side effects. Standardized preparations are available as over the counter medications. A dosing of 300 mg three times a day, with standardized 0.3% hypericin content, is recommended for therapeutic uses.

Like other medications, St John’s Wort also has side effects including gastrointestinal upset, tiredness, dizziness, and confusion. Some people taking this drug can suffer from photosensivity. Due to the risk of significant drug-drug interactions, it should be avoided by people who are taking antiretrovirals like Ribavirin, benzodiazepines like Diazepam, immunosuppresants like Cyclosporine and anti-arrhythmics like Amiodarone. It should also be avoided by people who are being treated with beta-blockers like Metoprolol, calcium-channel blockers like Verapamil, statins like Simvastatin, and other drugs like Warfarin, Levodopa, and Omeprazole.

Other herbal over the counter antidepressants include Ginkgo Biloba, which is also a memory enhancer, and Saffron, which works by increasing serotonin levels in the nervous system. Lavender, due to its relaxing effects, is also being used for mild depression. If used simultaneously, lavender is believed to lessen the needed dosage of other antidepressants. Valerian is also considered an over the counter antidepressant and is particularly effective when there are coexisting phobias or anxiety.

Even though herbal remedies may be an effective method for depression treatment most of these traditional herbal antidepressants are not yet well-studied. Since they lack FDA approval, a person with depression should take them with proper caution.