Chapter 19: Over-the-Counter Drugs & Mental Health

Over-the-Counter Drugs & Mental Health establishes the distinction between alternative therapies, which replace conventional Western medicine, and complementary therapies, which are used alongside it, while noting the high prevalence of their use among mental health consumers. A significant portion of the text is dedicated to the regulatory environment in the United States, specifically the Dietary Supplement and Health Education Act (DSHEA), which classifies herbal products as dietary supplements rather than drugs, resulting in a lack of standardized guarantees regarding purity, potency, or safety. The chapter analyzes specific biologically based therapies used for psychiatric symptoms, including St. John's wort for mild-to-moderate depression, highlighting its complex mechanism of action and high risk for dangerous drug-drug interactions, such as serotonin syndrome or reduced efficacy of antiretrovirals and oral contraceptives via cytochrome P450 induction. It evaluates the use of kava and valerian for anxiety and insomnia, addressing safety concerns related to hepatotoxicity and potential additive effects with central nervous system depressants. Furthermore, the text explores the utility of ginkgo biloba for cognitive decline and its associated bleeding risks, as well as the role of nutritional supplements like S-Adenosyl-L-methionine (SAM-e), melatonin for circadian rhythm regulation, and omega-3 fatty acids for mood stabilization in bipolar disorder and schizophrenia. The discussion emphasizes the critical role of the nurse in facilitating open communication to uncover undisclosed supplement use, assessing for contraindications with prescribed psychotropics, and providing culturally competent education to prevent adverse events and delays in seeking professional care.