The Professional Counselor | Volume 12, Issue 2 113 from 400mg–1600mg per day; however, some individuals may have to take a higher dose to achieve improvement of depressive symptoms (Mischoulon & Fava, 2002; Olsufka & Abraham, 2017; Sakurai et al., 2020). Overall, use of SAMe results in little to no side effects, although at higher doses SAMe may cause gastrointestinal discomfort (Sakurai et al., 2020). In clients diagnosed with bipolar disorder it may cause anxiety and mania (Mischoulon & Fava, 2002; Olsufka & Abraham, 2017). Tryptophan Tryptophan is an amino acid that the body requires to synthesize proteins (Modoux et al., 2020). Tryptophan is also needed to synthesize serotonin and melatonin (Modoux et al., 2020). Tryptophan was available in the United States in the 1990s. At that time, there was some evidence that it might be effective in treating depression (Perry et al., 2006). Tryptophan was taken off the market after there were concerns that it caused several deaths because of eosinophilia-myalgia syndrome (EMS), an inflammatory disorder that affects multiple body parts and causes high white blood cell counts. There was some speculation that in these cases the ingested tryptophan may have been contaminated (Perry et al., 2006). Tryptophan can now be purchased over the counter again; however, Perry et al. (2006) suggested that because of EMS risks, clients should be encouraged to consult with their physician before taking this product. The Role of the Counselor Concerns regarding psychotropic medication can find their way into counseling settings. Clients may take any number of drugs, ranging from prescribed psychotropic medications to herbal remedies, OTCs, and dietary supplements. In order to be able to provide effective counseling services, counselors must attempt to understand the role these drugs play in clients’ lives. Areas to consider include education, assessment, diagnosis, case conceptualization, treatment planning, and client advocacy, such as referral and consultation with medical and psychiatric treatment providers. Education Clinicians should be knowledgeable about the intended use of prescribed psychoactive medications as well as herbal remedies, OTCs, and dietary supplements. It is also important to be familiar with route of administration, pharmacokinetics/pharmacodynamics, therapeutic effects, side effects, and contraindications. CAMs frequently fall in and out of favor because of marketing efforts and fads (Crawford & Leventis, 2005; Smith et al., 2017). Consequently, in order to stay abreast of current trends, it is prudent to pursue continuing education in this area. Counselors should be skilled in nonjudgmentally addressing CAMs and OTCs in a variety of areas, including assessment, education, and referrals. CACREP’s 2016 standards require that counseling students receive education in the “classifications, indications, and contraindications of commonly prescribed psychopharmacological medications for appropriate medical referrals and consultation” (CACREP, 2015, Section 5.2.h., p. 18). Many states, including Texas (Professional Counselors, 2021), require psychopharmacology training for counselor licensure. It could be argued that this education should also extend to herbal remedies, OTCs, and dietary supplements. Assessment Counselors also have the option to be proactive and include questions inquiring about CAMs, OTCs, and prescription medication during the intake process, as well as intermittently throughout the counseling relationship with clients. Assessment may include questions about dosage, frequency, and reason for use. Because clients may not think to share CAM and OTC use with counselors, direct
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