Psychiatrists have expressed serious concern that the list of anti-depressant medications which are available for free as part of the government’s Pharmacy of Your Choice scheme has not been updated for “decades”.

Malta also does not have the broadest range of psychiatric medications that are available in other countries, psychiatrist Etienne Muscat told The Malta Independent on Sunday.

A study conducted by Caritas last week, which calculated the average prices and expenditure of three types of low-income families for food, as well as medicine and healthcare, highlighted an observation made by pharmacists consulted for the pricing exercise.

The pharmacists said that they saw an increase in clients who were buying anti-depressant medication.  The cost was not included in the study. Should it have been added, it would have accounted for an additional rise in the cost of healthcare for individuals suffering from mental challenges.

Noting a worldwide trend, Muscat pointed out that, especially after the pandemic, there has been an increase in demand for mental health services.

He said that more people are seeking these services, which are becoming “swamped”.

Muscat continued that it is more likely nowadays for individuals to be treated with medication for their mental health, rather than non-medical approaches.

He also pointed out that one of the biggest problems with regards to anti-depressant medication available is that the list on the Pharmacy of your Choice (POYC) for these medications is limited, and outdated.

“I do not believe that there has been a new anti-depressant medication added to the list in the past 10 to 20 years,” Muscat said.

Muscat also agreed that certain anti-depressant medications are expensive and it is also significantly more expensive for individuals to take a non-medication approach.

He continued that some individuals who were prescribed an anti-depressant by medical professionals have been put in a less-than-ideal fallback position, where they would have to regularly change prescriptions, and the medications’ availability, if they depend on the POYC scheme, due to costs.

Also contacted by The Malta Independent was psychiatrist Joe Cassar, who raised concerns about the types of anti-depressant medications available for free to the public.

He said that the medications on the government formulary are “old” medications, which generally, psychiatrists avoid prescribing, due to the side effects they cause.

Cassar said that psychiatrists tend to recommend the newer types of anti-depressants, which are not available on the POYC list.

He also said that the situation is the same for anti-psychotics, one of which used to be given for free to the public, but government stopped giving it out.

When asked if the increase of people coming forward to seek help for mental illnesses is a question of more awareness, Cassar said that this is not the only reason.

Increased stress and pressures on the population, as well as an increase in abuse of illicit substances, has contributed to more individuals suffering from a mental illness, Cassar said.

Working in the Emergency Room, Cassar said that he has seen a definite increase in substance misuse, which he said poses a substantially higher risk for depression and anxiety.

Cassar said he has seen an increase in the use of cocaine, “which in itself, is a substance which increases mental illnesses, such as depression”.

An increase in population also means an increase in pressures on society, most of which being psychosocial issues individuals would be going through, such as financial issues, stress at work, or family problems, he said.

Another problem he highlighted is an issue with pharmaceutical companies abroad, ones which are responsible for the provision of more medication to Malta.

“Malta is a small market and these companies are not sending newer medicines to the country. Patients cannot even purchase certain medicines here,” Cassar said.

He also said that patients have been approaching psychiatrists telling them that they have found the prices of medication in Italy much cheaper, and more available. Cassar said that one must question the pharmaceutical industry in this regard.

The president of the Maltese Association of Psychiatry (MAP) Rachel Taylor-East, said that the Caritas’ study, and pharmacists’ observation on the matter, is valuable.

“Our members have also come forward with concerns regarding the government formulary,” Taylor-East said.

She said that mental health medication, which is available for purchase in a pharmacy, is very different to what is available for free, describing the formulary as “much more limited”.

Taylor-East explained that upon listening to concerns by their members on what is available for free, the association brought it up with the Health Ministry, and asked for the government formulary to be reviewed.

Asked if the anti-depressant medication list has truly not been updated for decades, she said that it has probably been one or two decades since the last changes were made.

“MAP has been assured that funding has been allocated for more medications for psychiatry. However, we have yet to see this come to means, for the provision of more options for our patients,” Taylor-East said.

She continued that “we have not had any new medications, specifically anti-depressants, for many years”.

Taylor-East also said that first-line anti-depressants, meaning those of highest quality, are not available on the government formulary and are only available for the patient to buy.

“Why does it have to take so long? Our patients deserve to have the best, evidence-based medication, which is suited to that patient’s individual needs, for free,” she said.

Taylor-East also raised concerns patients have expressed, such as inequality and issues with access to care and type of treatment.

She mentioned antipsychotics, and the “desperate” need for long-acting injectable antipsychotics, which are so important for a relapse phase in a mental illness case.

“Mental health is still not treated on the same level as physical health and we must see it as something that needs to be done,” Taylor-East said.

A source from the psychiatric industry told this newsroom that a departmental meeting was held before the last election, where it was said that all psychiatric medications, which were recommended to be included in the government formulary, were going to be given for free.

Until today, none of the suggested medicines have been included in the formulary, the source said, and medications for mental health have not been upgraded since before 2010.