OTC anti-depressants? Harvard Medical School professor says yes

Safe and effective strikes again

According to many studies and surveys, over 15 percent of people in modern America suffer periods of depression at least once a year, and many, if not most, take prescription drugs of some form to deal with their emotions. Since mental health services are often difficult to access, as well as expensive, unhealthy use of illicit drugs or alcohol is also common among the depressed.

Another approach has been proposed by Roy Perlis, a professor of psychiatry at Harvard Medical School and associate chief for research in the Department of Psychiatry at Massachusetts General Hospital in Boston. Noting that oral contraceptives are now available over-the-counter without a prescription, he suggests that the same should apply for the class of anti-depressant drugs known as SSRIs. After all, he claims, they are “safe and effective”:

These medications, which have been used in the U.S. for three decades, have repeatedly been shown to be safe and effective for treating major depression and anxiety disorders.

Downplaying suicide risk, homicide risk unmentioned

After making that categorical statement on safety and effectiveness, Perlis admits that “depression is associated with increased risk for suicide and medication overdose is among the most common methods of suicide.” He claims, however, that the increased suicide risk associated with SSRIs only applies to those under the age of 25 and then only “modestly,” and that for those above this age, there is no increased risk.

Based on a wealth of data, Professor Peter Gotzsche, one of the founders of the Cochrane Collaboration, concludes that SSRIs are far more dangerous than Prof. Perlis asserts. Aside from their links to suicide (and also homicide) which apply to those over the age of 25 as well, SSRIs are also linked to events that few people would consider as being associated, such as falls in the elderly (which often contribute to death), as anti-depressants cause orthostatic hypertension, confusion, and dizziness. Given that the link is indirect, studies that investigate the dangers of SSRIs will usually miss such risks.

SSRIs are also linked to dangers for unborn babies, and while this also applies to many OTC drugs making SSRIs so readily available may contribute to a perception that they are safe for pregnant women.

Anti-depressants linked to antibiotic resistance

An interesting study published in 2023 has also linked use of anti-depressants to antibiotic resistance, a growing and under-publicized problem across the world, providing another reason to restrict access to these drugs. The study's authors note that,

Antidepressants are consumed in large quantities, with a similar pharmaceutical market share (4.8%) to antibiotics (5%). While antibiotics are acknowledged as the major driver of increasing antibiotic resistance, little attention is paid to the contribution of antidepressants in this process.

Meanwhile, the idea of freely available ketamine sparks alarm

Not too long ago, Elon Musk sparked controversy when he spoke about his use of ketamine to treat depression.

Interestingly, many doctors were quick to condemn ketamine and claim that SSRIs are safer. According to Dr. R. McShane, associate professor at the Department of Psychiatry at the University of Oxford, 

Using ketamine as the first alternative instead of an SSRI is not something I would recommend … The risks of long term ketamine include tolerance, which depends on the dose and how frequently it is taken. The risks of long term SSRIs are better understood.

Dr. McShane added that, 

People who try to treat themselves without medical help tend to take more ketamine (ie higher doses and more frequently) than if they were being prescribed it medically.

Presumably, this argument could be extended to any OTC medication, including SSRIs if they become OTC.

Just waiting for a brave Pharma company to step up

Prof. Perlis concludes his article with the hope that, 

… an SSRI manufacturer [will emerge] with the courage to engage with the FDA and invest the necessary resources for a prescription-to-OTC switch, a well-trod path…

Clearly, he is convinced that SSRIs fulfill the FDA's criteria for OTC drugs: they can be used for self-diagnosed conditions; there is no need for a doctor's involvement to ensure safe usage; and there is only a “low” potential that the drugs will be misused or abused.

For other psychiatrists (and many laypeople), the idea remains “unthinkable.”

These medications, after all, carry a black box warning…