Which Psychotropic Medicines are Preferred by Iranian Psychiatrists as the most Accessible Ones under Sanctions?

Document Type : Original Article

Authors

1 Department of Psychiatry, Taleghani Hospital Research Development Unit School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 SBMU Health Cohort Center, TaleghaniHospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Shahid Beheshti University of Medical Sciences, Social Determinants of Health Research Center, Tehran, Iran

Abstract

Background: Accessibility of medicines is one of the main building blocks of health. As a consequence of the decision of the US president to withdraw from the Joint Comprehensive Plan of Action, harsh sanctions were instigated on Iran.  Legally, medicines were exempted from the sanctions. But in practice, this action has caused serious shortage of medicines including psychotropics in Iran. As a domestic solution, the impact of this shortage on the patients could be mitigated by distributing the most needed medicines in pharmacies closest to public and private psychiatric clinics to reduce patients’ sense of bewilderment. We tried to identify the top 10 psychiatric medicines for this purpose. 
Methods: Through semi-structured interviews with all the 384 reachable psychiatrists of Iran, face to face or by phone, we prepared a list of psychiatric medicines preferred as priority.  Data were analyzed using c2 for relationships with contributing factors and controlling for confounders.
Results:  Medicines were ranked, and we ended up with a final list of ten. Sertraline ranked first followed by sodium valproate and risperidone. Age and years of experience were correlated with preferences. Comparison with the sales market ranking showed that the latter is mainly influenced by benzodiazepines not prescribed by psychiatrists.
Conclusion: We finalized a ranked list of psychiatric medicines useful for the food and drug administration of Iran to consider in distributing psychotropic medicines in the vicinity of public and private clinics. This will ease access and help in mitigating patients’ stress. Other medical groups can follow suit.

Keywords


  1. World Health Organization.  Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies.  2010; Available from: https://apps.who.int/iris/handle/10665/258734.
  2. Mousavi M, Alavinezhad R, Khazaei M. Psychotherapy approaches of Iranian psychiatrists and psychologists. J Fundam Ment Heal. 2018; 20(3):202-207. doi: 10.22038/JFMH.2018.10693.
  3. Khodaei MR, Mirabzadeh A, Shemshadi H, Ashtari Z, Ranjbar M, Feizzadeh G, et al . Pattern of Psychotropic Drug Prescription in the Elderly with Chronic Schizophrenia. Iranian Rehabilitation Journal. 2013; 11(17):20-7.
  4. Danaei G, Harirchi I, Sajadi HS, Yahyaei F, Majdzadeh R. The harsh effects of sanctions on Iranian health. Lancet. 2019; 394(10197):468-469. doi: 10.1016/S0140-6736(19)31763-5. 
  5. Salamat News. Fifty-seven medicines are scarce in Iranian drug market. 18 July 2018; Available from: https://www.salamatnews.com/news/248643. [In Persian].
  6. Mahdavi B. Shortage of schizophrenia medicines. 3 March 2021; Available from: https://www.ettelaat.com/mobile/?p=163621&device=phone. [In Persian].
  7. S. Department of the Treasury. Iran Sanctions: OFAC FAQs. 3 March 2021; Available from: https://home.treasury.gov/policy-issues/financial-sanctions/faqs/topic/1551.
  8. Shams A and reality check team. Iran sanctions: What impact are they having on medicines. BBC. Available from: https://www.bbc.com/news/world-middle-east-49051782.
  9. HRV-Human Rights Watch Report. “Maximum Pressure” US economic sanctions harm Iranians` right to health. 3 March 2021; Available from: https://www.ecoi.net/en/document/2019095.html
  10. Kheirandish M, Varahrami V, Kebriaeezade A, Cheraghali AM. Impact of economic sanctions on access to noncommunicable diseases medicines in the Islamic Republic of Iran. East Mediterr Health J. 2018; 24(1):42-51. doi: 10.26719/2018.24.1.42.
  11. Shahabi S. International sanctions: Sanctions in Iran disrupt cancer care. Nature. 2015; 520(7546):157. doi: 10.1038/520157b. 
  12. World Health Organization. Pharmacological treatment of mental disorders in primary health care; 2009. Available from: https://www.who.
    int/publications-detail-redirect/9789241547697.
  13. Shargh daily. Shortage of anti-anxiety medicines for psychiatric patients. 19 September 2019; Available from: https://sharghdaily.com/fa/main/print/238993. [In Persian].
  14. Salamat News. Psychiatrist wrote a petition to the Minister Of Health on the shortage of medicines. 3 August 2019; Available from: https://www.salamatnews.com/news/277088. [In Persian].
  15. Sadeghirad B, Haghdoost AA, Amin-Esmaeili M, Ananloo ES, Ghaeli P, Rahimi-Movaghar A, Talebian E, Pourkhandani A, Noorbala AA, Barooti E. Epidemiology of major depressive disorder in iran: a systematic review and meta-analysis. Int J Prev Med. 2010; 1(2):81-91. PMID: 21566767
  16. Grohol JM.  Top 25 psychiatric medications for 2018; 12 October 2017.  Available from: https://psychcentral.com/blog/top-25-psychiatric-medications-for-2018.