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14 - Medications for mental health problems

from Part 5 - Localising this manual for your area

Published online by Cambridge University Press:  24 March 2018

Vikram Patel
Affiliation:
Harvard Medical School
Charlotte Hanlon
Affiliation:
Addis Ababa University
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Summary

Choosing the right medication: cost and efficacy

Throughout the world, the cost of health care is rising. Particularly in low- and middle-income countries, this means making hard choices about which medications to prescribe. Many newer medications are protected by international patent laws. This means that only one company is allowed to produce that medication for a certain period of time. These medications are almost always much more expensive than older medications. When making a decision on whether to use an older, cheaper medication or a newer, more expensive medication, you must consider these issues:

  • • the cost of the medication

  • • the efficacy of the medication (how good it is)

  • • the side-effects

  • • the income bracket of the family.

  • Thus, a newer medication, which may be no better than an older medication in reducing the symptoms of mental health problems, may have lesser side-effects. This could be very important for some people. For example, older antipsychotic medications produce more stiffness and restlessness than newer ones. A person taking an older medication many feel so restless that they cannot work and, therefore, cannot earn any money. On the other hand, a person taking a newer antipsychotic medication may spend more money on the medications, but because they can work, they can more readily afford the treatment than would have been the case with the older medication.

    In choosing medications, the following situations may arise.

  • • The older, cheaper medication is more effective or just as good as the newer, expensive medication, and there are no differences in side-effects. Recommend the older, cheaper medication. A good example from medications for mental health problems is the choice between amitriptyline and nortriptyline, two tricyclic antidepressants. Whereas the former is cheaper than the latter, both are equally effective and have similar side-effects. Therefore, you should choose amitriptyline. Many of the newest psychiatric medications are no different from the ones produced a few years earlier in terms of both side-effects and efficacy. Do not recommend them.

  • • The older, cheaper medication is more effective or just as good as the newer, expensive medication, but there is a greater risk of side-effects with the older medication. A good example of such a choice is that between older antidepressants, such as amitriptyline, and newer antidepressants, such as fluoxetine.

  • Type
    Chapter
    Information
    Where There Is No Psychiatrist
    A Mental Health Care Manual
    , pp. 315 - 339
    Publisher: Royal College of Psychiatrists
    Print publication year: 2018
    Creative Commons
    Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
    This content is Open Access and distributed under the terms of the Creative Commons Attribution licence CC-BY-NC-ND 4.0 https://creativecommons.org/cclicenses/

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