Psychiatric medicine runs out in Lebanon amid mounting demand

Patients are being forced to stop taking their tablets as pharmacy shelves run empty

A mask-clad man waits to receive medication from the pharmacy of the Amel NGO in Lebanon's southern coastal city of Tyre. AFP

The sixth of the Lebanese population who take psychiatric drugs will soon have to search outside the country for their medicine, healthcare professionals said.

They sounded the alarm over a shortage in the country of seven million people after receiving repeated calls and messages from patients complaining none of their prescribed medicines were available.

Medical supplies started to run dry a few months ago.

“They took away my sanity, and now they’re taking away what I need to keep whatever’s left of it,” tweeted Sara, a young woman on antidepressants.

Lebanon’s economic meltdown, political instability, the pandemic and Beirut port blast have left the country’s people drained.

“There are nearly one million in Lebanon who are on some form of antidepressants, antipsychotics, tranquillisers or other medications from this family,” estimated Dr Joseph El Khoury, associate professor of psychiatry at the American University of Beirut. “This is a full-fledged crisis.”

In the past few years, Dr El Khoury was able to handle occasional supply disruptions by prescribing alternatives. "That choice is no longer available, which sets a dangerous precedent," he told The National.

With no substitutes, patients are forced to abruptly cut off their medication. Withdrawal symptoms, psychosis and suicidal thoughts are among the dangers of quitting medicine abruptly, without a plan.

For patients with Alzheimer’s disease and dementia, stopping antidepressants is a “slow death”, said private nurse Sahar Saridar.

In severe cases, patients who quit their treatment may require hospital stays after quitting their medication, which sets an even bigger challenge for health workers already facing Covid-19.

Overflowing wards and overwhelmed medical staff  make it hard to accommodate other admissions.

“Patients who [experience] a breakdown cannot be hospitalised unless they have a negative PCR. This is problematic because patients should usually be admitted within a two-hour time frame. Meanwhile, obtaining a PCR result and finding a hospital bed is now a timely process,” Dr El Khoury said.

Afraid to go through similar withdrawal symptoms, a patient who chose to remain anonymous reported having to fight with pharmacies for a box of his antianxiety medicine.

He recalled going from one pharmacy to another with a prescription of every possible medication and a full list of alternatives in the hopes of finding what he needed, only to be turned down every time.

The patient's uncle, a 72-year-old man who "never used medication in his lifetime", is now on antidepressants, he told The National.

“After the Beirut blast, he lost his home and had to withdraw his deposits in Lebanese pounds, then convert them to US dollars to cover repair costs,” he said. “This slashed his savings by more than 80 per cent due to the devaluation of the local currency.”

“He told me he would never be the same person again after what he had gone through.”

Lebanon’s economic crisis, deemed one of the worst in the country’s history, has been a major trigger for worsening mental health in the country, said Mia Atoui, co-founder of Embrace, a non-profit organisation raising awareness on mental health.

“There is no mental health if the basic needs of living are not secured. Access to food, shelter, education, employment and health services is crucial for a stable life and mental health, but it’s now out of reach for many vulnerable families,” she said.

Embrace Lifeline (1564) received more than 6,100 calls to its hotline in 2020 compared with 2019, when it received about 2,500 calls.

“This highlights more levels of distress, more need for support, and also more awareness on mental health and its importance, especially post-Covid-19 and post-Beirut blast,” Ms Atoui said.

According to a Post Beirut Blast Update Report that Embrace assembled between August and November 2020, more than 60 per cent of callers reported feeling emotionally distressed and 28 per cent had thought about suicide.

The report said 12 per cent of calls were related to the Beirut explosion while 7 per cent cited socioeconomic worries, and 6 per cent had Covid-19 concerns.

With the shortage of medication, physicians are forced to switch to alternatives, which in turn negates any progress and leads to relapse, said Dr Nabil Naja, medical director at Dar Al Ajaza Al Islamia Hospital and geriatrician at Clemenceau Medical Centre.

“For the 50 per cent of Alzheimer’s patients who respond to treatment, cutting off their medication will make their state worse. It affects the quality of their life, and that of their families,” Dr Naja said.

As with other crises currently gripping Lebanon, there is no solution in sight.

“We have no answers,” Dr El Khoury said. “We were promised by health ministry officials that medication would be available around October, but four months later we still have nothing.”

Embrace Lifeline can be reached within Lebanon on 1564