Slightly over a year ago, in May 2015, we were prescribed seroquel, a mood stabilizer by our psychiatrist.  This psychiatrist also doubled as our therapist and up to that point, he was by far the best therapist we had ever had. He validated our mental state and suggested diagnoses we believe to be correct.  Unfortunately, when we brought up that we are transgender, he was immediately  actively harmful on that axis, among other things, telling us he believed we should not be allowed to get surgery.  We were left with a decision: continue seeing a therapist who was actively harmful to us to ensure we would continue to have access to mood stabilizers, or walk away and risk losing access to an important medication.  After many stressful weeks of deliberation, we decided to walk away and take our chances.  Fortunately our primary care physician was willing to prescribe seroquel.  We were lucky.

Not everyone is as fortunate as we were.  Right now, as we are writing this, we have a friend who moved from Washington to Nebraska.  They have been taking an antidepressant but have not yet found a prescriber since their move.  They are currently going through SSRI withdrawal while waiting for their Medicaid application to go through and are doing their best to hold themselves together in the meantime.  Another friend is currently in a situation where they may lose access to their psychiatrist and medications.  In response, they are attempting to taper off their medications with their remaining supply, resulting in  withdrawal symptoms they should not have to experience.  In the past, another friend ran out of antipsychotics and had to go to the emergency room for an emergency refill.

There are many potential barriers that prevent people from getting medications they need.  Consider a hypothetical person, Alice, who wants to get a prescription for antidepressants.  The first step is for Alice to check whether or not she has health insurance.  Many employers do not offer health insurance and the process for obtaining government health insurance such as Medicaid can take as long as two months.  Once she does have health insurance, she must check to see what her plan covers.  Some high-deductible plans require patients to pay thousands of dollars out of pocket before their insurance plan covers anything.  Cost is a serious concern: an initial evaluation from a psychiatrist commonly costs hundreds of dollars and monthly appointments afterwards are also expensive., .

After Alice determines that her PPO will help her afford a psychiatrist, she must choose amongst the potentially hundreds available and schedule an appointment.  For someone dealing with depression, the task of choosing a psychiatrist from a long list can be daunting.  If the psychiatrist has a full practice or if no open appointment slots fit within Alice’s schedule, she must return to the search again.  Alice has a job and kids leaving little time in her schedule so she must repeat this process many times before she manages to schedule an appointment with a psychiatrist who has a compatible schedule.  Alice is lucky, she has a car she can drive to her appointment.  Without access to a car, Alice would have to deal the additional potential constraints of public transportation, making schedules and location a far more serious concern..

Eventually, Alice arrives at her initial appointment.  She is fortunate that she gets along well with her psychiatrist and her psychiatrist believes antidepressants may be helpful..  After this, she must continue to see her psychiatrist monthly or risk losing access to a now critical medication..  If she ever has any disagreements with her psychiatrist, she must choose whether to express her concerns and risk being told she should find a new psychiatrist or to hide her concerns to guarantee access to her medication.  Alice knows that if she ever moves, she will have to go through this entire process again.  If it takes too long after moving to find a new psychiatrist, Alice runs the risk of running out of antidepressants and going into SSRI withdrawal, a process which commonly increases suicidal thoughts.

Giving people consistent access to generic medications which cost less than $100 per year – less than the cost of a single doctor’s appointment – would be revolutionary

The long and difficult process of gaining access to a psychiatrist results in many Americans lacking consistent access to medications they need.  In many cases, these medications are inexpensive generics which cost less than $100 per year.  Many mood stabilizers, antidepressants, and antipsychotics fall into this category.  Giving people consistent access to generic medications which cost less than $100 per year – less than the cost of a single doctor’s appointment – would be revolutionary.  Removing the stress of having to wonder where your next prescription will come from or whether it will come at all would free mental energy for other pursuits.  For some, consistent access to needed medications could make the difference between stable employment and homelessness.  For others, it could be the difference between independent living and requiring periodic hospitalization.

One option to achieve this is to sell medications with low risk of abuse, such as antidepressants, antipsychotics, and mood stabilizers, over the counter.  This would remove the need for people to see a doctor to gain access to medications critical to their well being.  It would also reduce the cost of obtaining these medications since a single doctor’s appointment often costs significantly more than a year’s supply of the medication.  Another option would be to give pharmacists the ability to prescribe these medications after a brief consultation.  Pharmacists have to go through many years of education followed by a residency and are very well trained in the effects and risks of medications and interactions between different medications.  This would ensure people are not taking these medications without knowledge of their risks while giving people the ability to obtain them by just going to their closest pharmacy.  Allowing this would also reduce costs by removing a doctor’s appointment as a necessary step.

Whatever the solution is, we must find a way to give people access to the medications they need for their day to day functioning.