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Shortage of last-resort antidepressant creating ‘scary situation’ for patients: pharmacists

Click to play video: 'Health Matters: Canadian patients struggle with shortage of ‘critical’ antidepressant' Health Matters: Canadian patients struggle with shortage of ‘critical’ antidepressant
Health Matters February 2: Patients and pharmacists are concerned about a global shortage of the antidepressant Nardil. As Su-Ling Goh reports, the drug is used as a 'last resort' by patients for whom other medications have failed. – Feb 2, 2021

The ongoing shortage of an antidepressant drug that is often used by Canadian patients as a last-resort treatment has some patients and providers very worried.

“Any time you’re talking about anything to do with mental health, it can be a fragile and scary situation for people who are trying to maintain a therapy that works,” Edmonton pharmacist Suhas Thaleshvar said.

Read more: Ontario doctors urge domestic drug manufacturing over fears of shortages due to pandemic

The drug is Nardil, which is also known as phenelzine sulfate.

Thaleshvar says it’s a critical mental health drug that’s used when nothing else works. Switching to another drug comes with a high risk of causing negative effects, he said.

“If somebody’s on this, there’s a really high chance that they’ve tried everything else already.”

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In March 2020, the Canadian manufacturer ERFA said there was a global shortage of the medication’s active ingredient: phenelzine. The drug company said that would impact its ability to offer consistent supplies.

“ERFA takes phenelzine from the only available manufacturer, which lately has had some manufacturing issues,” Mjellma Hatipi, the medical director for ERFA, told Global News in an email Monday.

Click to play video: 'More Edmonton pharmacists speak out about ongoing drug shortages' More Edmonton pharmacists speak out about ongoing drug shortages
More Edmonton pharmacists speak out about ongoing drug shortages – Nov 20, 2018

“In coordination with Health Canada, we have ensured that all Canadian stakeholders, physicians and patients are informed about the situation, the treatment options and the expected time of the resolution of the shortage. We have identified at least two available treatments, which belong to the same pharmacological group (Parnate, Manerix),” Hatipi said.

“Close collaboration between Nardil patients and their physicians remains crucial at this time.”

The company is targeting April 2021 as a re-supply date.

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Read more: Drug shortages in Canada: Why they happen and what you can do about it

Bill Jenkins is a teacher. The 67-year-old was diagnosed with persistent depressive disorder and has been prescribed Nardil for more than 20 years.

Due to the drug shortage, he couldn’t get it from May to January. He lost 10 pounds during that time and, because the shortage coincided with the pandemic, his mental health challenges were amplified and his depression worsened.

Read more: ‘A pandemic of its own’: How COVID-19 is impacting mental health

Jenkins had to wean himself off Nardil in order to try other antidepressants. He’s tried three since and none have been effective.

“After 20 years of taking something, it affects not only your brain chemistry; it affects your whole physiology,” he said.

He suffers headaches, loss of appetite and trouble sleeping.

“It got the point where I just couldn’t, I couldn’t do it. So I left my job.

“You don’t want to say to your employer: ‘I just can’t cope,’ but it got to be too much for me.”

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Click to play video: 'Levels of anxiety and depression rising during pandemic' Levels of anxiety and depression rising during pandemic
Levels of anxiety and depression rising during pandemic – Oct 4, 2020

The drug shortage has had huge negative implications on patients, he said.

“For some people, the withdrawal has been really severe. There’s even people who have feelings of self harm,” Jenkins said.

Read more: How the coronavirus is contributing to Canadian drug shortages

Jenkins managed to find a leftover supply of Nardil at a local drug store and has been back on it since January. He feels a lot better, has resumed his hobbies and started cooking. But he’s worried he’ll run out again and just hopes he has enough to last until the end of April.

In early June, phenelzine was added to Health Canada’s Tier 3 drug shortage list, which includes those that have the greatest potential impact on Canada’s drug supply and health care system.

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On June 24, 2020, Health Canada notified health-care professionals of the global shortage in Nardil tablets. The health agency says the drug shortage is expected to last until April 30, 2021.

Click to play video: 'Health Series: Anxiety and its impact on overall health' Health Series: Anxiety and its impact on overall health
Health Series: Anxiety and its impact on overall health – Jan 26, 2021

“A number of measures were recommended to preserve supply and minimize the impact on patients, including recommendations to not start any new patients on Nardil and to consider safely switching patients to alternative treatments, as appropriate,” Health Canada communications officer Geoffroy Legault-Thivierge told Global News.

“As treatment plans are patient-specific, patients are encouraged to work with their health-care professional to discuss potential alternative treatments.

“Health Canada recognizes how important Nardil is to Canadian patients who rely on it for the treatment of depression. The department is actively working in collaboration with provinces and territories, companies and stakeholders to identify measures to mitigate the impact of the current shortage on patients including looking at alternatives and exploring access to foreign supply,” Legault-Thivierge said.

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Read more: Impact of Canada-wide anti-depressant shortage has Alberta pharmacists worried

Thaleshvar said Nardil is one of the older antidepressants on the market. He said it fell out of favour a few years ago because it has a lot of drug and food interactions.

But for some patients, it’s absolutely critical.

“It’s maintained its presence because sometimes it’s just all that works for a lot of people,” Thaleshvar said.

Both the manufacturer and Health Canada don’t expect more supply until April, which could hurt patients.

“They may be looking and counting their pills in their bottle now and realizing that they may not make it.”

Thaleshvar also says the drug has a low half life, amplifying withdrawal symptoms if a patient stops taking it suddenly.

A Facebook group is offering support and an online petition is urging governments to do all they can to help.

If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.

The Canadian Association for Suicide PreventionDepression Hurts and Kids Help Phone 1-800-668-6868  all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.

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