Availability of psychiatric medication in an urban area of The Gambia/West Africa

Abstract

The use of a wide and differentiated arsenal of psychopharmacological substances is integral part of modern psychiatric treatment in addition to non-pharmacological interventions (e.g., psychotherapy). However, worldwide the access to such medication can vary considerably. In this study, access to a wide range of psychiatric medication including antidepressants, antipsychotics, tranquilisers, mood stabilisers and ADHD medication was analysed for the Western African country of The Gambia by surveying private pharmacies within the urban and sub-urban areas of Banjul, the country's capital. The results show that most of these pharmacies tend to keep a very limited range of psychiatric drugs in stock. In many instances only a tricyclic antidepressant (e.g., amitriptyline), the neuroleptic haloperidol and the benzodiazepine diazepam were readily available. None of the pharmacies kept ADHD medication in stock, and only very few had mood stabilisers. However, several pharmacies reported to be able to obtain at request most of the drugs from international sources, including atypical antipsychotics, SSRIs, and dual-acting antidepressants. Therefore, it can be concluded that in rapidly growing urban centres of developing countries exemplified by Banjul, the infrastructure for modern psychopharmacotherapy is well established, and that the lack of immediate access to modern psychopharmacological compounds represents not so much a genuine lack of availability, but rather a lack of demand which may be associated with the considerable cost-implications of such treatment and the absence of prescribers (i.e. psychiatrists and other doctors with an expertise in modern psychopharmacotherapy). To our knowledge this is the first such study for The Gambia and results might be representative for the wider Western African region. It also exemplifies the challenges psychiatry is facing in developing countries worldwide. It is essential that government-sponsored so-called "essential medication lists" are continuously updated in order to reflect the progress in medical research including psychopharmacology. Further research into how to facilitate psychopharmacotherapy is urgently needed in order to further improve psychiatric services.

Medication challenges for patients with severe mental illness: experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania

“…In Tanzania, patients with epilepsy attend the same outpatient clinic with patients with mental illness and that they all receive the same benefits including free medication as that provided for mental illness. Furthermore, in Gambia and other West African countries, it is reported that lack of demand associated with the considerable cost-implications of treating patient with mental illness and the absence of prescribers are the reason for lack of availability of psychotropic medication [ 21 ]. In Tanzania, patients with epilepsy attend the same outpatient clinic with patients with mental illness and they all receive the same benefits including free medication as that provided for mental illness.…”

Sexual violence against female sex workers in The Gambia: a cross-sectional examination of the associations between victimization and reproductive, sexual and mental health

“…This could include supporting the efforts of local organizations to build the capacity of clinical and non-clinical staff to respond to survivors’ needs, engage in community sensitization efforts surrounding mental health disorders, FSW, and violence, as well as increase resource allocation for improved service delivery. Research in The Gambia, from 2011, has suggested that providing medication for depression and other mental health disorders may not be a feasible immediate strategy to treat depression, given the current cost-barriers and absence of prescribers, which greatly limits widespread use [ 67 ]. Intermediate strategies to support FSW and survivors of violence in The Gambia could include psychotherapeutic support groups, which has shown some promise as a depression intervention among HIV positive adults in Uganda [ 68 ], sociotherapy to build social bonds, and group interpersonal therapy which have both shown positive results in responding to the mental health needs of survivors of violence in Rwanda [ 69 ] and rural Uganda [ 70 ].…”

Availability, Price and Affordability of Psychotropic Medicines in Addis Ababa, Ethiopia

“…Also those medications are available in Gambia. 31 In Ethiopia there are only two hospitals providing child psychiatry, 5 and the limited expansion of the service, and inadequate information about the prevalence of those diseases and the required medication could be the reason for the unavailability of those medications.…”