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 psychopharmcotherapy). 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.

Key words::

• ADHD
• Africa
• antidepressants
• antipsychotics
• developing countries
• medication
• mood stabilisers
• pharmacology
• psychiatry
• psychopharmacology
• tranquilisers

Acknowledgements

The authors would like to thank the Final Year Medical Students, Class of 2010, at the University of The Gambia for their excellent and enthusiastic support with this research: Chimeka Anyta-Coker, Yorro Bah, Kajali Camara, David M. Ellis, M. Yarkpalo Harris, Lamin F. Jarju, Miriam Joof, Sabina Kangakan, Abdulhamid Kanteh, Aji-Binta Njie, Momodou A. I. Tekayi, Uchenna Usanakpo, Momodou Lamin Waggeh, Joy Williams.

Statement of Interest

JT has received financial support (including paritially for this paper) from the following pharmaceutical companies: AstraZeneca, Bristol-Myers Squibb, Janssen-Cilag, Lilly, Lundbeck, MEDICE, Merz, Novartis, Pfizer, Servier, Shire.