Lebanese mental health patients struggle without medicine

Lebanon's widespread medicine shortages has caused patients to seek alternative means, through volunteer organisations or the black market
6 min read
20 August, 2021
As Lebanon suffers from more medicine shortages due to its current economic crisis, mental health patients are struggling to find their necessary drugs and are turning elsewhere for help.

"It would be better for me if I died. Even if the doctor told me right now that I have cancer, I'll probably get a bottle of whiskey and drink it all while waiting to die," 42-year-old Bilal tells The New Arab. "After the August 4 blast in Beirut, I lost all hope and my depression worsened, after years of progress, it all came back after the port explosion."

Bilal used to function normally while on his medication, Prozac, but since being unable to find it in local pharmacies, he has chosen to not leave his house unless he was absolutely forced to, as a way to limit outside triggers.

As the situation in Lebanon worsens due to many economic factors, the mentally ill have become the latest victims of the crisis.

Pharmacies have emptied their shelves of psychotropic medications and the ill are left with little to no choice to make. Some chose to lower their daily dosage, others relied on relatives and friends abroad to pack them in their bags and the rest looked on social media for help.

Hospitals in Lebanon have now become a luxury people can not afford. Many are charging high deposits or have limited the number of empty beds

Pages such as "medsforleb" and "medwatchlb" were created to help people in need locate the medicine they're looking for. Hassan, 35, successfully located his anti-depressant "Zoloft", after noticing the worrying behaviour from pharmacists since March.

"I would tell them to give me three boxes but they'd give me only one, so this is when I knew something was off," he told The New Arab.

Hassan's anxiety first got bad after the 2019 revolution. This made him completely reliable on his medicine but he and many others are aiming to completely get off them soon enough as the uncertainty of drugs shortages has left Lebanese mental health at risk of spiralling down even more.

"I used to take one pill per day, but now I'm down to two pills per week and the plan is to completely stop because it's not known when it's going to be available again nor its future price range. So I'm forced to do so, regardless of how my depression will manifest after that," Bilal explained.

Pharmacy of Lebanon
Pharmacies in Lebanon are operating at highly reduced services, with limited supply despite excess demand

For Joseph El Khoury, President-Elect of the Lebanese Psychiatric Society, those with anxiety and depression were still capable of managing their daily activities but many with more severe disorders began to be admitted to hospitals – which have now become a luxury people can not afford. Many are charging high deposits or have limited the number of empty beds.

El Khoury stressed the importance of hospitalisation for those with uncontrollable symptoms (OCD, psychosis, hallucinations, schizophrenia etc.), to help protect them and those around them, especially if they present dangerous behaviour. "These are the ones who can't function without medication and they are the ones that most concern us," he told The New Arab. 

Therapists and psychiatrists have taken matters into their own hands and are doubling their efforts to contain the situation. Some try to see their patients more frequently or connect with the families, others try to reach out to find the necessary medication.

"We talk to companies,  pharmacies, or to some doctors we know that have resources, or we talk to people abroad," he explained.

Despite their efforts, therapy has now become unaffordable as some therapists charge 5-6 times their original price before the economic crisis, leaving many without the needed treatment.

"We've been receiving more calls lately related to the blast," Christine El Zein, lifeline supervisor at Embrace, a Lebanese NGO that offers mental health services including a suicide hotline, told The New Arab. "Trauma doesn't have to show up immediately, sometimes it can take up to a year to surface."

Embrace's efforts are pointed towards the de-stigmatisation of mental illness in society as well as making mental health services accessible to all members of society. They have even opened up clinics where patients could be treated for free.

"If the medicines remain unavailable, we're going to hear about cases of people who have taken their own lives or people harming themselves or others"

However, stigma has also affected the number of suicides reported. As most religions in Lebanon deem suicide a sinful act, many families choose to keep it on the low and not report it. Therefore, it is impossible to attain the exact number of suicides per year in Lebanon. But those most likely to be affected were between the ages of 15-29.

El Zein also explained that the number of calls have almost doubled from around 550 in January this year, to 1,015 calls in May.

The mixture of the blast, Covid lockdowns, unemployment, and economic struggles that the country has witnessed in the last couple of years, has left its desperate people resorting to desperate measures.

For Ronald, 28, battling depression and mood swings, hash has recently become his daily go-to substance to relax and unwind after a long tiring day of unfulfilling work.

Anti-depressant medicine
Since anti-depressant medicine is nigh on impossible to get hold of, those diagnosed with mental health conditions have turned towards narcotics as a substitute

"It's affordable and accessible," he told The New Arab. "I try not to smoke too much to not get addicted but it lifts my mood."

According to Ronald, more and more people have started to use hash after Covid happened, as they had to stay at home for longer times, and the issue of unemployment made matters worse.

"The unemployed people that I know need hash to cope. Especially with therapy fees and the taboo around it. It's their only outlet and you can't blame them. It helps time pass quickly and less painfully."

The price of a small bag can vary from around 20 lira to around 150 lira, the cheapest being less than $1 at the new dollar to lira rate.

"Half of my building probably smokes up because people are depressed and they need something cheap and relaxing."

Hassan also mentioned that some of his friends have started using CBD oil from local shops to help them calm down without getting high.

But, even though hash has a temporary numbing effect, experts argue against using it as an alternative to pharmaceutical drugs.

Perspectives

El Khoury also warned against using CBD as it is not regulated yet so the true ingredients remain unknown to the consumer. As for hash, the risk of psychosis and anxiety are there so it could not be recommended by a health professional.

People in Lebanon are now left with little to work with as the odds keep stacking up against them, but for El Khoury, the real damages are yet to come.

"I predict that if the medicines remain unavailable, we're going to hear about cases of people who have taken their own lives or of people harming themselves or others. But we will need to wait a week or two or even a couple of months to see the real effect after people stop their medication. And this is a social warning that will affect all of us."

As for pharmacists, they claim that they have not received new batches of the needed drugs since March – but many question whether this is true. 

"I take Cipralex regularly for my depression but when I went to pharmacies they told me they didn't have it. However, three weeks ago, I went again and this time I put a $20 bill on the counter. The guy gave me a box immediately," an anonymous source told The New Arab.

Dana Hourany is a multimedia journalist based in Beirut.