OTC options for mental health in older adults: A review

As we age, mental health concerns such as depression, anxiety, and insomnia become increasingly common. Many older adults turn to over-the-counter (OTC) products to manage these conditions, seeking alternatives to prescription medications. A recent scoping review published in BMC Complementary Medicine and Therapies sheds light on the landscape of OTC products used for depression, anxiety, and insomnia in older populations.

Understanding the Prevalence of Mental Health Issues in Older Adults

Mental health disorders are a significant concern among older adults, affecting their quality of life and overall well-being. Depression, anxiety, and insomnia are particularly prevalent in this age group:

• Depression: Affects approximately 7% of older adults worldwide
• Anxiety: Impacts about 3.8% of older individuals globally
• Insomnia: Experienced by up to 50% of older adults

These conditions often co-occur and can have serious consequences, including increased risk of cognitive decline, falls, and mortality. Despite their prevalence, mental health issues in older adults are frequently underdiagnosed and undertreated.

The Rise of OTC Products for Mental Health

Many older adults prefer OTC products for managing their mental health concerns due to several factors:

• Accessibility without prescription
• Perceived lower risk of side effects
• Desire for natural or alternative treatments
• Concerns about polypharmacy and drug interactions

The global market for OTC products targeting mental health has seen significant growth, with projections indicating continued expansion in the coming years.

Objectives and Methodology of the Scoping Review

The scoping review aimed to:

1. Identify OTC products used for depression, anxiety, and insomnia in older adults
2. Examine the evidence supporting their use
3. Explore potential safety concerns and interactions

Researchers conducted a comprehensive search of electronic databases, including PubMed, EMBASE, and CINAHL, focusing on studies published between 2000 and 2022. The review included various types of OTC products, such as herbal remedies, dietary supplements, and non-prescription medications.

Key Findings: OTC Products for Depression

The review identified several OTC products commonly used for depression in older adults:

St. John's Wort

• Efficacy: Moderate evidence for mild to moderate depression
• Mechanism: Inhibits serotonin, norepinephrine, and dopamine reuptake
• Safety concerns: Potential interactions with numerous medications, including antidepressants and blood thinners

S-Adenosyl Methionine (SAM-e)

• Efficacy: Limited evidence for depression in older adults
• Mechanism: Involved in neurotransmitter synthesis and metabolism
• Safety concerns: Generally well-tolerated, but may interact with certain medications

Omega-3 Fatty Acids

• Efficacy: Mixed evidence, with some studies showing potential benefits
• Mechanism: Anti-inflammatory effects and support for brain function
• Safety concerns: Generally safe, but may increase bleeding risk in high doses

Key Findings: OTC Products for Anxiety

Several OTC products were identified for managing anxiety in older populations:

Kava

• Efficacy: Moderate evidence for reducing anxiety symptoms
• Mechanism: Interacts with GABA receptors in the brain
• Safety concerns: Potential liver toxicity, especially with long-term use

Passionflower

• Efficacy: Limited evidence for anxiety reduction
• Mechanism: May enhance GABA activity
• Safety concerns: Generally well-tolerated, but may cause drowsiness

Lavender

• Efficacy: Moderate evidence for anxiety relief, particularly in oral form
• Mechanism: Modulates GABA and serotonin systems
• Safety concerns: Generally safe, but may interact with certain medications

Key Findings: OTC Products for Insomnia

The review highlighted several OTC options for managing insomnia in older adults:

Melatonin

• Efficacy: Moderate evidence for improving sleep quality and duration
• Mechanism: Regulates circadian rhythms
• Safety concerns: Generally safe for short-term use, but may interact with certain medications

Valerian Root

• Efficacy: Mixed evidence for improving sleep quality
• Mechanism: May enhance GABA activity
• Safety concerns: Generally well-tolerated, but may cause drowsiness and interact with sedatives

Chamomile

• Efficacy: Limited evidence for improving sleep quality
• Mechanism: Contains apigenin, which may have sedative effects
• Safety concerns: Generally safe, but may cause allergic reactions in some individuals

Safety Considerations for Older Adults

The review emphasized several important safety considerations for older adults using OTC products for mental health:

1. Polypharmacy: Older adults often take multiple medications, increasing the risk of interactions with OTC products.
2. Age-related changes: Altered metabolism and kidney function in older adults may affect how OTC products are processed in the body.
3. Comorbidities: Existing health conditions may influence the safety and efficacy of OTC products.
4. Cognitive impairment: Some OTC products may exacerbate cognitive issues in older adults with dementia or mild cognitive impairment.
5. Fall risk: Certain OTC products, particularly those with sedative effects, may increase the risk of falls in older adults.

Implications for Healthcare Providers

The findings of this scoping review have several implications for healthcare providers working with older adults:

1. Awareness: Providers should be aware of the range of OTC products used by older adults for mental health concerns.
2. Patient education: Educating patients about the potential benefits and risks of OTC products is crucial.
3. Medication reconciliation: Regular review of all medications, including OTC products, is essential to identify potential interactions and safety concerns.
4. Individualized approach: Treatment decisions should consider the unique needs, preferences, and health status of each older adult.
5. Monitoring: Close monitoring of older adults using OTC products for mental health is important to assess efficacy and detect any adverse effects.

Future Research Directions

The scoping review highlighted several areas for future research:

1. Long-term safety: More studies are needed to evaluate the long-term safety of OTC products in older populations.
2. Efficacy in specific subgroups: Research focusing on the efficacy of OTC products in specific subgroups of older adults (e.g., those with comorbidities) is warranted.
3. Combination therapies: Investigating the potential benefits and risks of combining OTC products with conventional treatments could provide valuable insights.
4. Dosing guidelines: Developing age-specific dosing guidelines for OTC products in older adults is crucial.
5. Novel products: Exploring new OTC options specifically designed for older adults' mental health needs could expand treatment options.

Conclusion

The scoping review provides valuable insights into the landscape of OTC products used for depression, anxiety, and insomnia in older adults. While some products show promise, the evidence supporting their use is often limited or mixed. Safety concerns, particularly regarding interactions with medications and age-related factors, underscore the importance of caution when using these products in older populations.

Healthcare providers play a crucial role in guiding older adults in the safe and effective use of OTC products for mental health. By staying informed about these products, engaging in open communication with patients, and taking an individualized approach to treatment, providers can help older adults make informed decisions about their mental health care.

As the population continues to age and the demand for mental health solutions grows, further research into OTC products for older adults is essential. This will help ensure that safe and effective options are available to support the mental well-being of our aging population.