France is facing a shortage of antidepressants and other psychiatric drugs, which psychiatrists warn is putting pressure on the country's already strained health system, as patients unable to fill their prescriptions resort to emergency care.
France's national medicines safety agency (ANSM) has been alerted to shortages of 14 psychiatric medications since the start of the year – including sertraline, an antidepressant sold under brand names including Zoloft and widely prescribed to treat depression and anxiety disorders.
Patients prescribed sertraline and some other psychiatric drugs have had to visit multiple pharmacies to have their prescriptions filled – if they are able to at all.
"We're having a lot of trouble getting these drugs. We don't have zero stock, but we do have very, very tight stocks and we cannot fill all prescriptions," pharmacist Christine Bihr told RFI.
Overloaded services
For people with depression and other disorders such as schizophrenia, a break in medication can lead to mental health crises.
"Each break in treatment is likely to cause acute decompensation and unbearable mental suffering," a group of psychiatrists and other healthcare professionals wrote in a letter published in mid-April in French newspaper Le Monde, warning of the impact of medication shortages.
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France’s already stretched healthcare system has had to contend with an increase in emergency psychiatric admissions, and the letter warned that a lack of access to medication will "further overload already overburdened psychiatric services".
It added that: "It is estimated that around 20 percent of untreated bipolar patients die by suicide."
The group has called for transparency on stocks and supplies so that doctors and pharmacists can anticipate needs.
The group, along with other healthcare advocates, has called on France’s health authorities to "take urgent measures to resolve this crisis".
Worldwide issue
There are several reasons behind the shortages – which have also impacted other medications, including drugs for diabetes and asthma as well as antibiotics and painkillers.
The problem is being seen worldwide. The European Directorate for the Quality of Medicines & Healthcare, which sets drug quality standards in the European Union, says drug shortages were already an issue prior to 2020, but were "exacerbated by events related to the consequences of the Covid-19 pandemic and an unstable geopolitical situation".
In France, production problems have intersected with a growing consumption of psychiatric drugs over recent years.
Antidepressant consumption increased by 60 percent among French 12 to 25-year-olds between 2019 and 2023, according to a report by the country's public health insurance scheme.
However, production has not kept up either demand. Many drugs are produced outside of France, and psychiatrists say the French public health system keeps the prices too low to interest manufacturers, who sell elsewhere for more profit.
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Temporary setbacks have also impacted some drugs, such as quality control issues that slowed down a production plant in Greece which supplies 60 percent of the French market for quetiapine – sold under the brand name Seroquel and used to treat schizophrenia, bipolar disorder and depression.
Other factors in the shortage include European regulations that require some laboratories to export part of their production even if there is demand at home, and French restrictions put in place to protect hospital stocks.
Alternative solutions
The situation has been improving for some medications, including quetiapine, although the ANSM said at the end of April that activity at the plant in Greece had "not yet returned to normal levels".
Supplies of teralithe – lithium salts used to treat bipolar disorder – are expected to return to normal in June. But the situation remains critical for SSRI antidepressants such as sertraline and venlafaxine.
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To address the shortages, the ANSM has introduced measures such as prescription restrictions and allowing pharmacists to issue single tablets instead of entire packages.
Last week the agency made it possible for pharmacists to make magisterial preparations – custom-made medicines prepared by a pharmacist by mixing compounds – as an alternative.
However, the pharmacists' union has refused to endorse this procedure, saying that the price set for such preparations is too low to be worth it for pharmacists.
