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Self-management of psychiatric symptoms using over-the-counter (OTC) psychopharmacology: The S-DTM therapeutic model - Self-diagnosis, self-treatment, self-monitoring

Lookup NU author(s): Dr Bruce Charlton

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Abstract

Pharmacological self-management is becoming more widespread in modernizing societies, as part of a general expansion of health care. This may exert a vital corrective balance to the professionalization of health by ensuring that the individual perspective of patients is not neglected. There are many 'good ideas' for new treatments being published which have a plausible scientific rationale for effectiveness and a low likelihood of harm, yet are essentially ignored by mainstream medical research. The most likely avenue for progress is probably the spread of self-management, together with increased sharing of experience via the internet. There is considerable scope for self-management of psychiatric symptoms with psychoactive medication purchased 'over-the-counter' (OTC) and without prescription. A surprisingly wide range of effective psychoactive agents are available with the potential to self-treat many of the common psychiatric problems. These include 'medical' psychopharmacological agents such as analgesics and antihistamines, a plant extract called St. John's Wort (Hypericum), and physical treatments such as early morning bright light therapy. But self-management currently lacks an explicit therapeutic model. A three stage process of S-DTM - self-diagnosis, self-treatment and self-monitoring is proposed and described in relation to psychiatric symptoms. Self-diagnosis describes the skill of introspection to develop awareness of inner bodily states and emotions. A specific sensation is identified and isolated as the 'focal symptom' for subsequent treatment and monitoring. Self-treatment involves choosing a drug (or other therapy) which is intended to alleviate the focal symptom. Self-monitoring entails a continued awareness of the focal system and of general well-being in order to evaluate effect of therapy. Self-monitoring could involve repeated cycles of dose-adjustment, and on-off ('challenge-dechallenge-rechallenge') therapeutic trials. An example of S-DTM applied to psychiatry might include the attempt to alleviate the fatigue and malaise symptoms underlying a 'depressed' mood by using OTC analgesics such as aspirin, paracetamol/acetaminophen, ibuprofen or codeine. Anxiety symptoms might be self-managed either using an 'unofficial SSRI' (selective serotonin-reuptake inhibitor) such as the antihistamines diphenhydramine or chlorpheniramine; or with St John's Wort/hypericum. © 2005 Elsevier Ltd. All rights reserved.


Publication metadata

Author(s): Charlton BG

Publication type: Review

Publication status: Published

Journal: Medical Hypotheses

Year: 2005

Volume: 65

Issue: 5

Pages: 823-828

Print publication date: 01/01/2005

ISSN (print): 0306-9877

ISSN (electronic): 1532-2777

URL: http://dx.doi.org/10.1016/j.mehy.2005.07.013

DOI: 10.1016/j.mehy.2005.07.013

PubMed id: 16111835


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