Guest Column: Rebuttal to Gatekeepers to Pharmaceuticals

Jane H. Feldman, MD

In This Article


The issue of access to medication and the role of the consumer are crucial to the present and future of medical treatment in general and psychopharmacology in particular. There are many problems in the current system that need to be acknowledged, approached, and solved. Making more medications, particularly psychotropics such as antidepressants, available over the counter is not the solution and would almost certainly create more problems than it would solve.

One major issue is the utilization of such treatment for the appropriate diagnosis. Generally, medications that are available over the counter for treatment of various complaints are used on an "as needed," or "prn" basis. These remedies are, for the most part, intended for specific complaints amenable to short-term treatment. It is easy to know if you have a headache. Then you can go to the store and buy a treatment intended to make it go away. Even cold remedies are intended to treat the symptoms of an upper respiratory infection, not the cause; as such, the diagnosis of what is causing the upper respiratory infection is of little to no importance. The idea of over-the-counter treatment for behavioral problems becomes enormously problematic because, in virtually all cases, we are not talking about a prn issue but a chronic condition. The fact that these medications are only available by prescription requires that patients, at least in theory, actually talk to a practitioner before they get the medication, and that the practitioner believes that they need that particular medication. You do not need a doctor to tell you if you have a headache or you are congested. You do indeed need some professional guidance before you start a multiweek trial of a medication for anxiety or depression.


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