TORONTO -- Some Canadians are warning that they face an increased risk of self-harm due to a severe global shortage of a drug used to treat depression, anxiety and panic attacks.
The Canadian manufacturer of antidepressant Nardil, also known as phenelzine sulfate, announced in March that it wouldn’t be able to offer a constant stock of Nardil due to a global shortage of the medication’s active ingredient.
While pharmacies were able to acquire some supply from manufacturer ERFA Canada 2012 in August, Health Canada now expects the shortage to last until April 2021.
Toronto resident Ahmad Maliki says he won’t survive that long without Nardil.
Maliki told CTVNews.ca on Nov. 18 that he has been on Nardil for 17 years, but had to suddenly go off the medication in March because of the shortage.
"The effects of the first shortage [were] extremely devastating. During that month, I had chronic suicidal ideation, I barely ate, I was unable to leave home and work. It basically compromised my whole immune system," Maliki said. "It has cost me my income, relationships, it even sent me to the hospital because of my panic attacks."
Nardil is a monoamine oxidase inhibitor that is used to treat certain types of depressed patients clinically characterized as "atypical," "nonendogenous" or "neurotic," according to Health Canada.
Nardil has been listed on Health Canada’s Tier 3 list of shortages since June. Tier 3 shortages are those with the greatest impact on supply, and drugs on this list are considered to be in high demand.
The drug is typically recommended for patients who have failed to respond to other medications more commonly prescribed for these conditions, making it difficult for patients to switch to alternative treatments when there is a shortage.
Maliki was able to go back on Nardil in August, when his pharmacist acquired some supply from ERFA and says he has been doing "much better" since being back on the medication.
However, Maliki says he only has enough Nardil to last until January, and he worries that having to go off it again will bring back suicidal thoughts.
"With Nardil everything is good. My work is good, but when this happened, it just devastated me," Maliki said. "Believe me, this will be the death of me. I will die if another short happens."
Christine Bayens, who runs a Facebook information and support group for Nardil patients, told CTVNews.ca on Nov. 18 that she has heard from members who expect they will turn to self-harm if the shortage persists.
"I get a lot of DMs from the people in my group and they're already planning, putting affairs in order because they intend on [dying by] suicide," Bayens said in a telephone interview from Edmonton.
"Nardil is people's lifeline. As long as we have our medications, we can function and be contributing and valuable members to society. But without that medication, you're bedridden," she added.
Bayens, who has severe panic disorder, has been taking Nardil since 1980. She had to quickly come off the medication when shortages first began in March and became "extremely ill."
"I had suicidal ideation; the suicide emergency [team] came to my place three times. But I didn't want to go to the hospital because how am I going to kill myself in the hospital? I can do it here at home, but pretty hard in the hospital," Bayens said.
Bayens says she does not have an alternative treatment for Nardil as the antidepressant is the only medication that has shown to work for her.
"I have spoke to my doctor, and I broke down crying. I told her I cannot go through this again, and many people will say that they can't go through the withdrawal. There is no medication to replace Nardil… so this is dire," she said.
PHENELZINE SUPPLY ISSUES
Despite supply issues and delays, manufacturer ERFA has confirmed that Nardil has not been discontinued, and the shortage is only related to the medication’s active ingredient.
"We are committed to work with manufacturers in order to get the next lot as soon as possible," a spokesperson for ERFA said in an email to CTVNews.ca on Nov. 19.
While some countries going through a similar shortage have been able to acquire Nardil's active ingredient elsewhere, ERFA noted that it cannot use "any phenelzine" to make Nardil -- it has to be "regulated and approved by Health Canada."
ERFA added that when the company released its last supply in August, it notified doctors and pharmacists that they should transition Nardil users to other treatments, as the next lot would not arrive until spring 2021.
Health Canada told CTVNews.ca in an emailed statement that the agency recognizes how important Nardil is to Canadian patients and is "actively working" to identify measures to mitigate the impact of the current shortage including looking at alternatives and exploring access to foreign supply.
"Providing Canadians with access to the medications they need is a priority for the Government of Canada," Health Canada said in the statement. "When national critical drug shortages occur, Health Canada plays an active role in mitigating the impact of these shortages on Canadians."
Health Canada says it provided a number of recommendations to health-care professionals in June amid the ongoing shortage, such as not starting any new patients on Nardil and safely switching patients to other treatments.
However, Mina Tadrous, an assistant professor with the faculty of pharmacy at the University of Toronto, says Nardil does not have a comparable alternative.
"For some drugs, you might have the brand name and then you have like 30 different generic options, but with a drug like this that's older and not commonly used, it’s the only option," Tadrous explained in a telephone interview on Wednesday.
Despite this, Tadrous says Nardil users should still consult their doctors. While there may not be an exact replacement for Nardil, Tadrous said there are two alternatives that are similar and may work for some Nardil patients amid the shortage.
Tadrous said those concerned about the shortage should not suddenly stop using Nardil without consulting a health-care provider as doing so may be dangerous. He added that patients should talk to their doctors about other treatment options before they run out of Nardil.
"Don't wait until the last day of your pills, go talk to your doctor now and start having that conversation now about what needs to be done," Tadrous said.
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If you or someone you know is in crisis, here are some resources that are available.
Kids Help Phone (1-800-668-6868)
Canada Suicide Prevention Helpline (1-833-456-4566)
Centre for Addiction and Mental Health (1 800 463-2338)
Crisis Services Canada (1-833-456-4566 or text 45645)
If you need immediate assistance call 911 or go to the nearest hospital.
