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Are there any anti-depressants and sleeping pills which can be purchased off the counter in Singapore?

Mental Health Medication & Prescriptions

Hello doctors, I just wanted to ask if I can purchase any form of anti-depressants and sleeping pills off the shelves of the pharmacy?

DOCTOR’S ANSWER (6)

Thank you for asking this question. Many of my friends and relatives have also asked me a similar question.

First, there is St John's wort that can be bought over the counter at the pharmacy. It is meant for mild cases of depression. In some countries where access to doctors is not readily available, people do use St John's wort to relieve depression. It may not be effective in moderate or severe cases of depression.

Second, there is melatonin that can be bought over the counter, to relieve sleep symptoms. Some of my patients report that melatonin helps them to overcome jet lag, for example, when they fly back to Singapore from America or Europe. It is safe for short term use but it is not advisable to use it for many months as studies have indicated that even when a small dose of melatonin is taken, the blood level may be very high. We are not sure what the long term consequences are, when the body is exposed to such high levels of melatonin over a prolonged period of time.

Third, some patients told me that they use an antihistamine for their sleep. You can check with the pharmacist near your place which antihistamine can be bought over the counter. An antihistamine may work for a few days but many patients report after the first few days, the medicine starts to lose its effects of enabling them to fall asleep. Elderly people may become confused the next day after taking an antihistamine for sleep aid.

For the treatment of mood problems and insomnia, oftentimes we need to figure out the underlying causes of the condition (in medicine, we call this the etiology). It may be better to seek help from a mental health professional. Your records with the doctors will be kept confidential. If you are reluctant to seek medical attention, you can also consider talking to a counsellor at the Family Service Centre near your place or at a counselling centre.

I hope that you will soon get the help that you need.

3020 views 3 Nov 2018
Dr Paul Ang
Dr Paul Ang
"Family Physician with special interest in Mental Health"
(1 Reviews)

Thank you for sharing your question and taking a big first step to seek help. I am a family physician with a special interest in mental health.

In my opinion, using medications to treat mental health problems is not exactly the best solution. 

Do consider seeing a family physician with mental health interest, a psychiatrist, or a psychologist.

Self-medicating is NOT the way to go for this. Take care.

11907 views 8 Feb 2018

Thanks for the question!  

As explained by my colleagues who have replied earlier – nope, we can’t get anti-depressants and sleeping pills (benzodiazepines and z-drugs) such as diazepam (Valium), lorazepam (Activan) or zopiclone (Imovane) off the shelves in Singapore.

But, don’t lose hope. I’ll elaborate a little more in a bit.

However, before we go into the treatment of depression/ anxiety/ sleep disorders, I think it is important to emphasize that you should always get assessed by an experienced psychiatrist to get the right diagnosis.

There are medical conditions which can present with what appears to be psychiatric symptoms, e.g. low mood, lethargy, poor sleep etc. These conditions can only be ruled out after a thorough examination of your condition.  

That said, should anti-depressants be indicated, there are many different types of anti-depressants in the market, each with their different mechanism of action and side effect profile. Therefore, it is best to get an experienced psychiatrist to recommend the most appropriate agent for you.

Same goes for the sleeping aid, if needed.  

Perhaps I should also take this opportunity to allay some anxieties regarding starting treatment for the above mentioned conditions. Anti-depressants are not only prescribed in severe cases.

In fact, we do prescribe anti-depressants in mild-moderate conditions as well, on a case-to-case basis. Some of these agents can help with sleep, which negates the need for sleeping pills. Some can even help with chronic pain!

Furthermore, anti-depressants have a faster therapeutic effect compared to therapy/counseling, which helps patients bounce back faster.

Contrary to popular belief, anti-depressants are actually very tolerable in the long term, with side effects most prominent in the first 1-2 weeks of initiating treatment.  

Sleeping pills, examples of which I have listed above, are definitely helpful in the short term treatment of insomnia. These medications, if taken in the short term, at prescribed doses, are generally safe and not addictive.

However, the prescription of these medications should be closely monitored by a psychiatrist due to its abuse potential.  

Even though benzodiazepines and z-drugs are not available off the counter, there are other commonly available agents we can use to help with sleep:

1. Melatonin is a hormone found naturally in the body, which plays an important role in our natural sleep-wake cycle. Melatonin supplements can be helpful in treating certain sleep disorders. 

2. Anti-histamines e.g. chlorpheniramine (piriton), hydroxyzine (atarax) Due to their sedative effects, these agents can help with enhancing sleep in the short term.

However, do consult with your doctor about the use of these agents if you have other medical problems.  

There are also commercially available supplements (e.g. 5-HTP, St John’s Wort, magnesium) that have been promoted to help with depression, anxiety and sleep. Unfortunately, we do not have sufficient evidence on the efficacy of these agents.

However, should you take such supplements, do remember to highlight this to your psychiatrist/ doctor as they may interact with certain medications.     

Hope this helps!

12082 views 8 Feb 2018
As my colleagues mentioned, anti-depressants are usually prescription-only medications.
 
Perhaps, depending on your symptoms, you could look into seeing a counselor, psychotherapist or psychiatrist.
 

In the UK, people can buy St John's Wort - apparently this has mild anti-depressive properties, but I am not sure if it's available on these shores.

BW

11743 views 8 Feb 2018

Thank you for your question. Anti-depressants and sleeping pills are prescription medications as opposed to over the counter medication.

These medications, as pointed out by Dr Israr Wong, have potential long term side effects and may be addictive. It is more important to find out the reason for the depression or your inability to sleep (medically known as insomnia).

Treating the underlying cause of a condition often leads to a more sustainable outcome and even to a potential cure. 

Depression is an increasingly common symptom in a fast-paced and high pressure society like in Singapore. You should talk to your General Practitioner  or a Psychiatrist if you are constantly feeling down.

Many times, counselling, good advice and a change of habit/lifestyle helps tremendously. Sharing your problems with and getting support from your family and close friends may also help you feel better.

Medications are only indicated in severe cases, and they do take time to work and have potential side effects. Hence, it is important for these medications to be prescribed by a doctor trained in treatment of depression (often a GP or Psychiatrist). 

Like depression, the prevalence of insomnia is also on the rise in Singapore. There are many reasons for insomnia, ranging from poor sleeping habit or lifestyle (e.g. stress, anxiety, depression, frequent daytime napping, high caffeine intake etc) to medical conditions (e.g. nasal or sinus allergies, obstructive sleep apnoea, arthritis, gastrointestinal problems, medications etc).

Treating the underlying condition or correcting the poor sleeping habit/lifestyle is key to overcoming insomnia. You should consult your GP who will be able to help you determine the cause of your insomnia.

If you can't sleep because you have a stuffy nose or you snore a lot, your GP may refer your to an ENT Specialist to exclude nasal allergies or obstructive sleep apnoea respectively. If you can't sleep because you are stressed or depressed, then your GP may refer you to a Psychiatrist. 

Hope this helps and all the best!

11799 views 7 Feb 2018

Anti depressants have possible side effects and needs special medical expertise to be prescribed, especially when it comes to the dosage and type.

2 patients with the same condition may need different types that suits their condition best.

It also requires careful monitoring by the GP or psychiatrist.

Sleeping pills can be addictive, and should also be prescribed by psychiatrists only, to prevent unchecked prescription and addiction without treating the cause of the insomnia.

Regular prescription of these pills are to be done by PSYCHIATRISTS ONLY as regulated by the Ministry of Health. Hope that helps!

11810 views 7 Feb 2018
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