As the novel coronavirus slowly grinds the world to a halt, people are fundamentally rethinking how to provide for themselves. One concern among many has been whether supply chains disrupted by the virus might lead to drug shortages in the U.S. For people taking psychoactive drugs, such as antidepressants or anti-anxiety drugs, this is particularly worrying, since stopping those medications “cold turkey” can have serious consequences including withdrawal symptoms and relapse. So should we be preparing for a potential shortage of antidepressants?
Coronavirus-related drug shortages have arrived
Such shortages have been a persistent problem going back decades, even under the best conditions. We’re now facing extremely uncertain conditions, and the Food and Drug Administration revealed at the end of February that it had seen the first shortage caused by the COVID-19 outbreak. (Though the agency won’t reveal which drug or its origin, a move criticized by experts, some speculate it’s an antibiotic or antimicrobial, likely one from China.)
In that case, the FDA reassured the public that alternatives were available. It may not always be that simple, and with COVID-19 clearly here to stay, it’s reasonable to wonder whether more shortages are in the future.
“It’s certainly possible that we will see shortages,” said Sharona Hoffman, a professor of law and bioethics at Case Western Reserve University School of Law who’s written about the recurring problem. Hurricane Maria hitting Puerto Rico in 2017, she noted, is a similar event that caused shortages of many drugs because manufacturing plants there were closed.
The storm also underscored the fragility of our pharmaceutical system, even when it’s not stressed. “Shortages have been a persistent problem in this country even without any public health emergencies,” Hoffman said. Partly that’s a function of the U.S. approach to manufacturers; the FDA can only encourage companies to make drugs—it can’t force them. If companies don’t see a profit, they won’t produce needed medicine. They can price drugs however they like (people continue to die because of the high price of insulin, for example), and the government has very little recourse.
There’s no way to predict which drugs the pandemic will affect
The general public even has a tough time knowing which drugs might run low. That’s because the sources of drugs are considered trade secrets for manufacturers, according to Michael Ganio, director of pharmacy practice and quality at the American Society of Health-System Pharmacists (ASHP).
While we know that a large portion of our drugs come from China, either directly or through other countries, you can’t know for sure that your antidepressant is one of them. That makes it much harder to prepare for broad shortages during, say, a pandemic. “The supply chain is not transparent enough to know which drugs, and which quantities, we should be worried about,” he said.
Ganio noted there’s been some progress on this front: the FDA has identified about 20 drugs sourced solely from China, and has been monitoring them, with no signs of shortages as of February 27. The FDA did not name the medicines but the agency noted that “these drugs are considered non-critical drugs.”
The ASHP supports legislation that would give the FDA more tools to prevent shortages—earlier warnings from manufacturers and a requirement that they give reasons for their disruptions, for example—and give pharmacists a better chance of mitigating the problem. Ganio noted that pharmacists have some professional discretion in overriding refill notifications, for example; someone worried about going on vacation—or in this case, being stuck at home—could get an early refill to carry them through. (White House advisor Peter Navarro has also made some noise about an executive order designed to reduce the U.S. dependence on Chinese drugs.)
What to do if you’re worried about running out of your meds
For now, Ganio says anyone worried about running out of their medication should reach out to their doctor, psychiatrist, or pharmacist. “Being in communication and understanding your medications is really important,” he said. Many antidepressants should not be stopped abruptly; a pharmacist can help facilitate early refills and consultation with prescribers for anyone in danger of that.
“The other thing is not to panic, especially right now, with coronavirus and everyone trying to stock up on things,” he said. “You don’t need six months of medication at home.” One month should be fine; Ganio says he’s cautiously optimistic that the FDA has things in hand, as Chinese production comes back online. Some insurance plans will let you get a three-month supply.
Under the new regime of “social distancing,” though, other aspects of mental health treatment may also become challenging. Michelle Riba, a clinical professor and associate director at the University of Michigan Comprehensive Depression Center, echoed many of Ganio’s points about pharmacists being a valuable point of first contact for patients.
In these anxious times, she noted, it’s also important for people to not feel isolated; many therapists and patients should consider how they can keep up appointments, even if that means unconventional options such as FaceTime, Skype, or phone. Establishing a daily routine can help as well, and Riba encouraged everyone to keep exercising and eating healthily. And look out for each other: “Giving and being altruistic really helps people's mental health,” she said.
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