Self-medication and drug overdose are common practices in the absence of proper regulation. Instead of going to a physician, a large number of people buy medicines over the counter and consume these in more than the required quantity.

In many cases, it is possible to buy prescription medicines without producing a prescription and in whatever quantity the customers want to.

Patients suffering from stress, anxiety and depression are more likely to take an overdose of medicines. Without consulting a psychiatrist, they decide what mental ailment they suffer from and what medicines to take. Those who want to play safe, talk to a friend, relative or an acquaintance experiencing similar symptoms and getting proper psychiatric treatment. Without realising the risks involved, they start taking the same medicines that a particular person is taking or prescribes.

Dr Ehsan ul Haq Chishti, a Consultant Neuropsychiatrist and CEO, Recovery Clinic, Johar Town, Lahore, disapproves of this practice. He says the medicines used by such patients are mostly tranquilisers, though some go for anti-depressant drugs as well. The tranquilisers, he says, hardly have anything to do with the treatment of mental ailments and simply help improve one’s sleep pattern and relax muscles.

Chishti says excessive use of tranquilisers, like Lexotanil and Xanax, may result in memory impairment, irritability, muscle pain and so on. "They give you a feeling of numbness for the time being but with the passage of time the symptoms re-appear." The tranquilisers are addictive as opium but they cannot help restore the balance of chemicals in one’s brain."

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Muhammad Ali Butt, who runs his medicines business in Lahore, affirms that medicines for anxiety and mental illnesses are available at medical stores without one showing a prescription. The locals expect a medical store staff in their neighbourhood not to ask for prescriptions. If they do they are considered discourteous and may lose their customers. "But in the case of walk-in customers we are quite strict."

"Small medical stores thrive on the sale of over-the-counter medicines. Customers carrying prescriptions go to big stores, hoping they would find all the prescribed medicines from one place," says Butt.

People with depression-related symptoms seek information through search engines, blogs, interactive online forums, etc. This does have a therapeutic effect because a person using such forums does not feel alone in the presence of so many others in the same condition. Secondly, success stories where patients have defeated depression serve as morale boosters. The anonymity with which one can participate in these online discussions (often with a pseudo name) helps one disclose everything in one’s mind, something that they would never otherwise.

Dr Khalid Jamil, neurologist and head, department of rehabilitation at Mayo Hospital, Lahore, acknowledges the importance of online forums when it comes to speaking one’s heart out and finding a keen audience. But, on the other hand, he says, "these do not replace the psychiatrists and the detailed interview required to diagnose a person’s mental illness."

He says whatever is mentioned on online forums may be correct but one person’s experiences cannot be related to others. Unfortunately, he says, "a large number of depressed people visit general practitioners, use tranquilisers for extended periods, try to find cure solely through therapy and change in living habits and visit psychiatrists only when they suffer from a breakdown."

When this happens, he says, "mostly due to severe imbalance in brain chemicals, recovery takes some time. To avoid this situation, people close to a patient must take him to a doctor on the very outset of symptoms of depression. Therapy is good but the neurological functions of the brain cannot be normalised without using concerned medicines."

Dr Chishti says many patients who visit him have already done research on their disease through search engines and certain online platforms. "Though they have basic knowledge of mental illnesses they do not realise there is a very fine line between different types that only a qualified psychiatrist can identify," he says. "The psychiatrist’s advice is crucial as he suggests the best combination, the initial dose one must take, how to increase it, and eventually come off it gradually."

Mental ailments have overlapping symptoms that only a psychiatrist can analyse. "For example, if a patient of bipolar disorder takes anti-depressants, without taking care of other manifestations of the disease, he may enter a severe phase of mania."