REPORTING ON THE PREVALENCE OF DRUG AND ALTERNATIVE HEALTH PRODUCT USE FOR MENTAL HEALTH REASONS: RESULTS FROM A NATIONAL POPULATION SURVEY
Main Article Content
Keywords
Psychotropic drug use, health product use for mental health problems, concomitant use
Abstract
Background
Concomitant use of alternative health products with commonly prescribed medications has been associated with elevated risks of adverse effects.
Objective
The aim of this study was to determine the prevalence and determinants of the use of alternative health products and psychotropic drugs in the same year for mental health reasons and to examine this for specific psychiatric and physical conditions.
Methods
This study used data from the Canadian Community Health Survey: Mental Health and Well-Being cycle 1.2 carried out by Statistics Canada in 2002 on 36,984 Canadians. Multivariate analyses were carried out to identify determinants of health product use.
Results
Overall, 13% of Canadians reported the use of alternative health products. Among respondents with a psychiatric diagnosis, heart disease, high blood pressure and diabetes the rate was 20.0%, 12.0%, 12.6% and 9.4% respectively. Use of alternative health products and psychotropic drugs within the same year was reported by 21.3%. Determinants of alternative health product use included older age, female sex, higher education, and mental disorder, the use of cardiovascular drugs, consulting a health care provider for mental health reasons and reporting an unmet mental health need. People with diabetes were less likely to be users.
Conclusions
Concomitant use of alternative health products and psychotropic drugs for mental health reasons are prevalent. This increases the risk for potential drug-herb interactions. Health professionals need to be aware of patient alternative health product use, especially in the presence of co-morbid mental and physical conditions. Public health campaigns aimed towards increasing awareness and education may incite discussions between health professionals and patients on the risks and benefits of these products.
References
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3. Kessler RC, Soukup J, Davis RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry 2001;158:289-94.
4. Crone CC, Gabriel G. Herbal and nonherbal supplements in medical-psychiatric patient populations. Psychiatr Clin North Am 2002;25:211-30.
5. Izzo AA, DiCarlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardio 2005;98:1-14.
6. Hoblyn JC, Brooks JO. Herbal supplements in older adults: consider interactions and adverse events that may result from supplement use.Geriatrics 2005;60:18-23.
7. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009;69:1777-98.
8. Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J Am Coll Cardiol 2010;55:515-25.
9. Singh SR, Levine M. Natural health product use in Canada: analysis of the National Population Health Survey. Can J Clin Pharmacol 2006;13:e240-e250.
10. Cohen RJ, Ek K, Pan CX. Complementary and alternative medicine (CAM) use by older adults: a comparison of self-report and physician chart documentation. J Gerontol A Biol Sci Med Sci 2002; 57:M223-M227.
11. Goldstein LH, Elias M, Ron-Avraham G, et al. Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards. Br J Clin Pharmacol 2007;64:373-80.
12. Wold RS, Lopez ST, Yau CL, et al. Increasing trends in elderly persons’ use of nonvitamin, nonmineral dietary supplements and concurrent use of medications. J Am Diet Assoc 2005;105:54-63.
13. Kennedy J, Wang CC, Wu CH. Patient disclosure about herb and supplement use among adults in the US. Evid Based Complement Alternat Med 2008;5:451-6.
14. Eisenberg DM, Kessler RC, Van Rompay ML, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001;135:344-51.
15. Giveon SM, Liberman N, Klang S, Kahan E. A survey of primary care physicians’ perceptions of their patients’ use of complementary medicine. Complement Ther Med 2003;11:254-60.
16. Clemente YN, Williams AF, Khan K, et al. A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention. BMC Complement Altern Med 2005; 5:20.
17. Mikail CN, Hearney E, Nemesure B. Increasing physician awareness of the common uses and contraindications of herbal medicines: utility of a case-based tutorial for residents. J Altern Complement Med 2003;9:571-6.
18. Kwan D, Hirschkorn K, Boon H. U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review. BMC Complement AlternMed 2006;6:31-41.
19. Sim SN, Levine MAH. An evaluation of pharmacist and health food store retailer's knowledge regarding potential drug interactions associated with St. John's Wort. Can J Clin Pharmacol 2010;e57-e63.
20. Lesage A, Vasiliadis H-M, Gagné M-A, Dudgeon S, Kasman N, Hay C. Prevalence of Mental Illnesses and Related Service Utilization in Canada: An Analysis of the Canadian Community Health Survey. Report prepared for the Canadian Collaborative Mental Health Initiative, Mississauga, Ontario, Canada; January 2006. Available at: www.ccmhi.ca.
21. Gravel R, Beland Y. The Canadian Community Health Survey: Mental health and Well-being. Can J Psychiatry 2005;50:573–9.
22. Kessler RC, Ustun TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121.
23. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc. 1994.
24. Brisebois F, Bédard M. Formation pratique_ l’utilisation de la méthode du bootstrap. [Practical Training_use of the bootstrap method]. Quebec Inter-University Centre for Social Statistics (QICSS), March, 2003.
25. Barnes PM, Powell-Griner E, McFann K, Nahin RL, editors. Complementary and Alternative Medicine Use Among Adults, United States, 2002. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004.
26. Mansoor GA. Herbs and alternative therapies in the hypertension clinic. AJH 2001;14:971-5.
27. Sood A, Sood R, Brinker FJ, et al. Potential for interactions between dietary supplements and prescription medications. Am J Med 2008;121:207-11.
28. Dergal JM, Gold JL, Laxer DA, et al. Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 2002;19:879-86.
29. Ulbricht C, Basch E, Weissner W, Hackman D. An evidence-based systematic review of herb and supplement interactions by the Natural Standard Research Collaboration. Expert Opin Drug Saf 2006;5:719-28.
30. Boullata J. Natural health product interactions with medication. Nutr Clin Pract 2005;20:33-51.
31. Geil P, Shane-McWhorter L. Dietary supplements in the management of diabetes: potential risks and benefits. J Am Diet Assoc 2008;108:S59-S65.
32. Sørensen JM. Herb-drug, food-drug, nutrientdrug, and drug-drug interactions: mechanisms involved and their medical implications. J Altern Complement Med 2002;82:293-308.
33. De Smet PA. Herbal remedies. N Engl J Med 2002;347:2046–56.
34. Gardiner P, Phillips R, Shaughnessy AF. Herbal and dietary supplement – drug interactions in patients with chronic illnesses. Am Fam Physician 2008;77:73-8.
35. Ravindran AV, Lam RW, Filteau MJ, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. V. Complementary and alternative medicine treatments. J Affect Disord 2009;117:S54-S64.
36. Ernst E. Second thoughts about safety of St. John’s wort. (erratum in Lancet 2000;355:580). Lancet 1999;354:2014–6.
37. Beckman SE, Sommi RW, Switzer J. Consumer use of St. John’s wort: a survey on effectiveness, safety, and tolerability. Pharmacotherapy 2000;20:568 –74.
38. Brown TM. Acute St. John’s wort toxicity. Am J Emerg Med 2000;18:23.
39. Lantz MS, Buchalter E, Giambanco V. St. John’s wort and antidepressant drug interactions in the elderly. J Geriatr Psychiatry Neurol 1999;12:7– 10.
40. Yue QY, Bergquist C, Gerden B. Safety of St John’s wort (Hypericum perforatum). Lancet 2000;355:576–7.
41. Johne A, Brockmoller J, Bauer S, Maurer A, Langheinrich M, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John’s wort (Hypericum erforatum). Clin Pharmacol Ther 1999;66:338–45.
42. Ernst E. St. John’s wort supplements endanger the success of organ transplantation. Arch Surg 2002;137:316–9.
43. Mai I, Stormer E, Bauer S, Kruger H, Budde K, Roots I. Impact of St John’s wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients. Nephrol Dial Transplant 2003;18:819–22.
44. Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St John’s wort. Lancet 2000;355:547–8.
45. Strum R, Sherbourne CD. Are barriers to mental health and substance abuse care still rising? J Behav Health Serv Res 2001;28:81–8.
46. Perron BE, Jarman CN, Kilbourne AM. Access to conventional mental health and medical care among users of complementary and alternative medicine with bipolar disorder. J Nerv Ment Dis 2009; 197:287–90.
47. Yoon SJL, Horne CH. Herbal products and conventional medicines used by communityresiding older women. J Adv Nurs 2001;33:51-9.
48. Loya AM, González-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border. Drugs Aging 2009;26:423-36.
2. Unützer J, Klap R, Sturm R, et al. Mental disorders and the use of alternative medicine: results from a national survey. Am J Psychiatry 2000;157:1851-7.
3. Kessler RC, Soukup J, Davis RB, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry 2001;158:289-94.
4. Crone CC, Gabriel G. Herbal and nonherbal supplements in medical-psychiatric patient populations. Psychiatr Clin North Am 2002;25:211-30.
5. Izzo AA, DiCarlo G, Borrelli F, Ernst E. Cardiovascular pharmacotherapy and herbal medicines: the risk of drug interaction. Int J Cardio 2005;98:1-14.
6. Hoblyn JC, Brooks JO. Herbal supplements in older adults: consider interactions and adverse events that may result from supplement use.Geriatrics 2005;60:18-23.
7. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009;69:1777-98.
8. Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J Am Coll Cardiol 2010;55:515-25.
9. Singh SR, Levine M. Natural health product use in Canada: analysis of the National Population Health Survey. Can J Clin Pharmacol 2006;13:e240-e250.
10. Cohen RJ, Ek K, Pan CX. Complementary and alternative medicine (CAM) use by older adults: a comparison of self-report and physician chart documentation. J Gerontol A Biol Sci Med Sci 2002; 57:M223-M227.
11. Goldstein LH, Elias M, Ron-Avraham G, et al. Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards. Br J Clin Pharmacol 2007;64:373-80.
12. Wold RS, Lopez ST, Yau CL, et al. Increasing trends in elderly persons’ use of nonvitamin, nonmineral dietary supplements and concurrent use of medications. J Am Diet Assoc 2005;105:54-63.
13. Kennedy J, Wang CC, Wu CH. Patient disclosure about herb and supplement use among adults in the US. Evid Based Complement Alternat Med 2008;5:451-6.
14. Eisenberg DM, Kessler RC, Van Rompay ML, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001;135:344-51.
15. Giveon SM, Liberman N, Klang S, Kahan E. A survey of primary care physicians’ perceptions of their patients’ use of complementary medicine. Complement Ther Med 2003;11:254-60.
16. Clemente YN, Williams AF, Khan K, et al. A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention. BMC Complement Altern Med 2005; 5:20.
17. Mikail CN, Hearney E, Nemesure B. Increasing physician awareness of the common uses and contraindications of herbal medicines: utility of a case-based tutorial for residents. J Altern Complement Med 2003;9:571-6.
18. Kwan D, Hirschkorn K, Boon H. U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review. BMC Complement AlternMed 2006;6:31-41.
19. Sim SN, Levine MAH. An evaluation of pharmacist and health food store retailer's knowledge regarding potential drug interactions associated with St. John's Wort. Can J Clin Pharmacol 2010;e57-e63.
20. Lesage A, Vasiliadis H-M, Gagné M-A, Dudgeon S, Kasman N, Hay C. Prevalence of Mental Illnesses and Related Service Utilization in Canada: An Analysis of the Canadian Community Health Survey. Report prepared for the Canadian Collaborative Mental Health Initiative, Mississauga, Ontario, Canada; January 2006. Available at: www.ccmhi.ca.
21. Gravel R, Beland Y. The Canadian Community Health Survey: Mental health and Well-being. Can J Psychiatry 2005;50:573–9.
22. Kessler RC, Ustun TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121.
23. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Press, Inc. 1994.
24. Brisebois F, Bédard M. Formation pratique_ l’utilisation de la méthode du bootstrap. [Practical Training_use of the bootstrap method]. Quebec Inter-University Centre for Social Statistics (QICSS), March, 2003.
25. Barnes PM, Powell-Griner E, McFann K, Nahin RL, editors. Complementary and Alternative Medicine Use Among Adults, United States, 2002. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004.
26. Mansoor GA. Herbs and alternative therapies in the hypertension clinic. AJH 2001;14:971-5.
27. Sood A, Sood R, Brinker FJ, et al. Potential for interactions between dietary supplements and prescription medications. Am J Med 2008;121:207-11.
28. Dergal JM, Gold JL, Laxer DA, et al. Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 2002;19:879-86.
29. Ulbricht C, Basch E, Weissner W, Hackman D. An evidence-based systematic review of herb and supplement interactions by the Natural Standard Research Collaboration. Expert Opin Drug Saf 2006;5:719-28.
30. Boullata J. Natural health product interactions with medication. Nutr Clin Pract 2005;20:33-51.
31. Geil P, Shane-McWhorter L. Dietary supplements in the management of diabetes: potential risks and benefits. J Am Diet Assoc 2008;108:S59-S65.
32. Sørensen JM. Herb-drug, food-drug, nutrientdrug, and drug-drug interactions: mechanisms involved and their medical implications. J Altern Complement Med 2002;82:293-308.
33. De Smet PA. Herbal remedies. N Engl J Med 2002;347:2046–56.
34. Gardiner P, Phillips R, Shaughnessy AF. Herbal and dietary supplement – drug interactions in patients with chronic illnesses. Am Fam Physician 2008;77:73-8.
35. Ravindran AV, Lam RW, Filteau MJ, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. V. Complementary and alternative medicine treatments. J Affect Disord 2009;117:S54-S64.
36. Ernst E. Second thoughts about safety of St. John’s wort. (erratum in Lancet 2000;355:580). Lancet 1999;354:2014–6.
37. Beckman SE, Sommi RW, Switzer J. Consumer use of St. John’s wort: a survey on effectiveness, safety, and tolerability. Pharmacotherapy 2000;20:568 –74.
38. Brown TM. Acute St. John’s wort toxicity. Am J Emerg Med 2000;18:23.
39. Lantz MS, Buchalter E, Giambanco V. St. John’s wort and antidepressant drug interactions in the elderly. J Geriatr Psychiatry Neurol 1999;12:7– 10.
40. Yue QY, Bergquist C, Gerden B. Safety of St John’s wort (Hypericum perforatum). Lancet 2000;355:576–7.
41. Johne A, Brockmoller J, Bauer S, Maurer A, Langheinrich M, Roots I. Pharmacokinetic interaction of digoxin with an herbal extract from St John’s wort (Hypericum erforatum). Clin Pharmacol Ther 1999;66:338–45.
42. Ernst E. St. John’s wort supplements endanger the success of organ transplantation. Arch Surg 2002;137:316–9.
43. Mai I, Stormer E, Bauer S, Kruger H, Budde K, Roots I. Impact of St John’s wort treatment on the pharmacokinetics of tacrolimus and mycophenolic acid in renal transplant patients. Nephrol Dial Transplant 2003;18:819–22.
44. Piscitelli SC, Burstein AH, Chaitt D, Alfaro RM, Falloon J. Indinavir concentrations and St John’s wort. Lancet 2000;355:547–8.
45. Strum R, Sherbourne CD. Are barriers to mental health and substance abuse care still rising? J Behav Health Serv Res 2001;28:81–8.
46. Perron BE, Jarman CN, Kilbourne AM. Access to conventional mental health and medical care among users of complementary and alternative medicine with bipolar disorder. J Nerv Ment Dis 2009; 197:287–90.
47. Yoon SJL, Horne CH. Herbal products and conventional medicines used by communityresiding older women. J Adv Nurs 2001;33:51-9.
48. Loya AM, González-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border. Drugs Aging 2009;26:423-36.