No lithium tablets: anti-depressant shortage looms
Patients who need anti-psychotics or common anti-depressants from clinics and hospitals as well as private doctors are being turned away, as there are no lithium tablets available here or anywhere else in the world.
Lithium is a mood stabiliser used to treat the manic episodes of bipolar disorder (formerly known as manic depression).
These symptoms include hyperactivity, rushed speech, poor judgment, reduced need for sleep, aggression and anger. Lithium also helps in preventing or lessening the intensity of manic episodes.
As early as September last year, the Department of Health acknowledged it was facing a severe shortage of anti-depressants and anti-psychotics used for schizophrenia, due to challenges with suppliers. There were also shortages of common anti-depressants such as Prozac and medicine such as Lexamil, which is prescribed for anxiety. The reason was ascribed to global shortages of the pharmaceutical ingredients, production problems and industrial action at local production facilities.
The department at the time said in a statement that there are eight companies on tender to produce these medicines and they have been unable to supply the quantities which have been ordered.
Now, lithium tablets are not in short supply, but in no supply.
One patient we spoke to on condition of anonymity, said she ran out of lithium tablets last Friday. Her psychiatrist said he would have to increase the dosage of other tablets, but that there is no 100% replacement for lithium.
Departmental Spokesperson Popo Maja said the medicines most affected are citalopram, fluoxetine, haloperidol and olanzapine. The shortage of the anti-psychotic drugs amitriptyline, chlorpromazine, clonazepam and risperidone has, however, been addressed in the short term, the department said.
“Medicine shortages are a global problem affecting all countries from time to time. The medicine supply chain is very long and complex and a breakdown in any part of this chain will result in medicine shortages in a health facility.”
The Depression and Anxiety Group (Sadag) highlighted the severe impacts of a shortage of certain antidepressants and antipsychotics currently being experienced countrywide, saying this may lead to patient relapse.
Sadag Operations Director Cassey Chambers said the organisation was concerned about the announcement and its potential impact.
“It could have serious consequences for people living with mental illnesses such as depression, bipolar disorder or schizophrenia. Often, these medications are chronic so patients cannot skip or not be on their medication.”
She likened the announcement to telling a diabetic patient that their insulin was not in stock and to come back for it next month.
“It would have serious repercussions for the patient, the same of patients with mental illness. Without the medicine, patients are at risk.”
The shortage is ascribed mainly to the containment measures implemented in China, which have disrupted manufacturing and transit of medicines and active pharmaceutical ingredients (APIs), threatening dangerous supply shortages. Medicines may be manufactured in India, South Africa, Switzerland, Israel, the US, but the active pharmaceutical ingredients in medicines, the ingredients in medicines that make them work, preventing, controlling or curing the illnesses or conditions for which medicines are prescribed, come most often from China. Chinese manufacturers dominate the global market for APIs and companies in India, South Africa, the US and beyond rely on exports from China for these critical ingredients.
The National Department of Health’s Director of Affordable Medicines, Khadija Jamaloodien said the department convened a meeting of all companies contracted on tender to supply medicines to the public health sector on 14 February to assess potential supply threats.
She said the biggest concern is ensuring the availability of anti-retroviral treatment. More than five million people in South Africa take a daily combination of lifesaving ARVs to protect their health and prevent the ongoing transmission of HIV. Supply concerns have also been raised with regards to antibiotics, given their essential role in enabling a functioning health system and preventing common bacterial infections from progressing into life-threatening conditions. China produces more than 80% of the ingredients.
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