The Professional Counselor | Volume 12, Issue 2 111 Over-the-Counter Medications Globally, in 2017 the OTC market reached $80.2 billion in consumer spending (PR Newswire, n.d.) and research indicates that 81% of American adults reach for OTCs, or medicine that can be purchased without a prescription, as an initial treatment for minor medical conditions. The average American makes 26 trips to OTC outlets compared to three doctor’s visits annually, and there are around 54,000 pharmacies in the United States compared to over 750,000 retailers that sell OTCs (Consumer Healthcare Products Association, n.d.). Despite the popularity of OTCs, many clients lack the required health knowledge to safely self-medicate. Acetaminophen Many consumers do not know that an overly high dose of acetaminophen could be lethal, or that varying OTCs contain acetaminophen and taking more than one of these products simultaneously might lead to an unintentional overdose (Boudjemai et al., 2013; Wolf et al., 2012). There are a number of OTCs that have psychotropic properties. For example, Durso et al. (2015) found that acetaminophen blunts more than just pain—it seems that the OTC pain medication also diminishes emotional responses to both negative and positive events. Researchers went so far as to label acetaminophen as an “all-purpose emotional reliever” (Durso et al., 2015, p. 756). In addition, it is of interest to note that acetaminophen decreases a person’s ability to empathize with pain experienced by others (Durso et al., 2015). Roughly one-quarter of American adults are taking this drug on a weekly basis. It begs the question as to the societal implications or social cost of its frequent use (Mischkowski et al., 2016, 2019). Sleep Aids It is common for people to experience trouble with falling asleep or staying asleep. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) indicates that one-third of adults in the United States experience insomnia symptoms. This issue is evident in consumer spending: In 2018 Americans spent $410 million on OTC sleep aids (Consumer Healthcare Products Association, n.d.). Diphenhydramine and doxylamine are OTC antihistamines with considerable sedative properties and are marketed as treatment options for sleep disturbances (Perry et al., 2006). It was found that doxylamine seems to be as effective as the barbiturate secobarbital; also, doxylamine is comparable to zolpidem, a frequently prescribed sleep aid. Diphenhydramine and doxylamine are considered to be non-selective histamine H1 receptor antagonists (antihistamines for the prevention of allergies) and they are also anticholinergic (causing dry mouth, constipation, urinary retention, blurred vision, and sedation; Perry et al., 2006). Abraham et al. (2017) found that 58.6% of the elderly sample surveyed used at least one sleep aid containing diphenhydramine or doxylamine. Chlorpheniramine is also an OTC antihistamine, and it can be found as the sole active compound in remedies such as Chlor-TrimetonTM and similar generic formulations (Hellbom, 2006), or in combination with other substances to treat cold and allergy symptoms. Popular cold remedy combinations of chlorpheniramine and dextromethorphan (a cough suppressant also available over the counter) can be problematic. Dextromethorphan is a moderate SSRI (Boyer & Shannon, 2005; Foong et al., 2018), which means it acts like an SSRI antidepressant. Furthermore, diphenhydramine and chlorpheniramine have also been found to block serotonin reuptake, making them some of the oldest SSRIs (Foong et al., 2018; Hellbom, 2006; Ravina, 2011). It is not commonly known that fluoxetine (Prozac®) was derived from diphenhydramine as a result of attempts to make this drug less sedating (Ravina, 2011).
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