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Tuesday, April 13, 2004 Dear Editors: This is a letter of appeal on behalf of all the mentally ill persons in Belize. Our mentally ill persons have suffered for too long. Your input in this regard could effect positive changes. Thank You. Science is on the side of the mentally illBelize needs to catch up “Antipsychotic drugs are available to control acute psychosis, but unfortunately many of the older agents are associated with a high rate of undesirable side effects. However, this is being improved by the newer antipsychotic drugs…The first-generation antipsychotics are associated with a high risk of side effects, which can be inconvenient, disabling and dangerous and occur in 40-50% of those treated. Second-generation antipsychotics are generally more widely prescribed to treat schizophrenia, as they cause fewer side effects. Despite the superiority of the second-generation antipsychotics, few people who experience a psychotic episode are treated with these drugs….” Lundbeck Institute (A specialist in psychiatry and pioneer in neurology) 2004 Very few persons in Belize seem to know what it is like to be a mentally ill person. These special persons have to bear the results of taking their medications which come with a lot of side effects. The medications now being consumed by patients’ today saps out their lives and as a result they cannot contribute to the Belizean economy. First of all, a priority for all mental patients in Belize is to have medications with fewer side effects. Medications like Stelazine©, used to relieve the symptoms of Schizophrenia and other illnesses are still being used on patients in Belize. It must be immediately stated that those who dispense it are not at fault. There are no other options open to them. Stelazine is a cheap drug and Government can buy it in large amounts and give it to the mental patients. But Stelazine makes its recipients tremble and cause nausea. For all of these years these effects have only been known to the recipients. Psychiatric nurses working in the field can readily attest to seeing patients lying for long hour having to bear all the side effects. As stated before, Stelazine and other medications like it relieve symptoms but it comes at a high price for mental patients. For many years patients have had to endure all these terrible side effects. Most patients at Rock View can tell you that their current medications give them such a bad feeling, to cause them to smoke many packs of cigarettes for the day. Let us take time and talk to one of these patients today. There were feelings of despair for the mentally ill for all these years and no glimmer of hope as Government complained of little money in the coffer. Things have changed a lot in the last decade to the degree that there would be no Rockview today if proper measures were taken to create more productive lives. Let us take time and review some of these recommendations. First of all there needs to be awareness that there is a great difference in the use of the older type of drugs and the newer ones used to take treat the various forms mental illness. The newer drugs now on the market, mostly in the developed countries, bring with it less side effects. Let us examine one of these drugs and discover how it works. Take the example of the patented drug Risperdal© used to treat those suffering from Schizophrenia. The older drugs worked by blocking the production of excess Dopamine in the brain. Stelazine does this effectively but in doing so it creates disequilibrium in the neurotransmitters and as a result the patient experiences great depression and other debilitating effects. The new drug, Risperdal, however blocks the production of Dopamine and at the same time regulates Serotonin, which is another neurotransmitter associated with moods and other critical body functions. Risperdal wins Stelazine because it controls two neurotransmitters at the same time, dopamine and serotonin, giving the patient less side effects. According to the Scientific American January 2004 edition, scientists have recently discovered another neurotransmitter in the brain of the schizophrenic called glutamate. The drug that can regulate dopamine, serotonin and glutamate has not yet been discovered, but when it is discovered it will bring great relief to patients. When that given drug, which can control three important brain chemicals and others associated with happiness is discovered it will mean that there will be no side effects with the medications. As may be noticed science in the field of neuropharmacology has advanced so much that we in Belize need to do a lot of catching up. Here is why we need to update our pharmacy list. Imagine a world where Belizeans with either Schizophrenia or Bi-Polar Disorder are treated with Risperdal instead of Stelazine. Such recipients would lead happier lives and allow them to contribute to the economy. However the reality is that patients are given Stelazine because, the blue colored pill is cheaper. Risperdal is much more expensive. But let us all balance it out. If the Government invests in Risperdal and other state of the art psychotherapeutic drugs like it, the results would come back in a remarkable ten fold. The patients would not have to spend the rest of their lives in Rock View. Government would not have to spend money in infrastructure to hold these patients. By investing in the modern drugs Government will save a lot because the patients will become integrated into Society, to lead happy and normal lives. Think of what results if the patients continue to be prescribed with drugs like Stelazine. The side effects of this drug will be so great that the patient will have to be fed and housed in special institutions. In addition Government would have to pay the salary of those who would be taking care of the adversely medicated patients. It is guaranteed that the day that Government commits itself to get the most modern medications for patients there would no longer be a great need for Rockview; indeed there would be few souls under its roof. This is the trend in the developed countries where patients are being integrated into society with the use of new drugs. It is self evident that these modern drugs that regulate the chemical imbalances in the brain are expensive. Drugs like Risperdal are available at private institutions in Belize. The cost of one Resperdal Tablet at the Belize Medical Associates is $7.20 and for one tablet at Brodies is $6.90 These medications are unreachable to most of the patients, who usually come from low socio-economic backgrounds. A reason for this is almost obvious. The brain is the primary headquarters needed in the dealings for this life–to make money. Mentally ill persons have imbalanced brains that are in no measure capable to make calculations to make enough money to buy Risperdal or any other of the expensive drugs that are guaranteed to relieve their symptoms. Such persons are not expected to get rich and buy the needed modern medication for their gyroscope is not rotating in a well balanced fashion. What is the result of all this? Too often these individuals are left to win their lives in the streets. Let us thing for a second the grave results of our actions when we deprive the mentally ill of their needed treatment of modern medications– that come with less side effects. Why have all the mentally ill people not “spoken up”. The answer lies in the fact that the mentally ill is the least capable of self-defense. Side effects are being stressed here because in reality patients who are on the old drugs, called First Generation Atypical Antipsychotics, do not take these drugs willingly and will eventually go off them. On the other hand, drugs like Risperdal, which come with a lot less of side effects, are taken by the patients with great enthusiasm. The mentally ill who does not take their administered drug, whether it be the old or the new classes of drugs are bound to have a relapse. It is therefore argued that if Government buys the more expensive Second Generation Antipsychotics, the patient is more likely to take it and become less of a burden to society. The time is now that we should act to help all the mentally ill persons in Belize. While there are good intentioned efforts to relieve them of their suffering by using the traditional drugs, there should be a switch to the newer mediations for the aforementioned reasons. As your Ministry reviews the formulary list, please, consider taking the recommendations from the experts –that the newer medications with fewer side effects be included. If this is done, Rockview and the rest of Belize are bound to gain! Let us choose the Second-generation antipsychotic drugs. (1) First-generation antipsychotic drugs(More Side Effects) Chlorpromazine (2) Second-generation antipsychotic drugs(Less Side Effects) Clozapine Cordially Yours, Orlando Pulido Chairperson Belmopan Consumer Organization Belmopan Consumer Organization General Delivery, # 46 Western Highway, Santa Elena Town, Cayo District Belize, Central America Tel/Fax: 824-2807 Vice-President–Patty Enriquez–Tel: 802-1196 Treasurer–Christine Chiac–Tel: 600-5370 Secretary–Claudelle Rubateau–Tel: 822-0604 Other Address Acute Psychiatric Unit Western Regional Hospital Feloner Drive, Belmopan City Belize, Central America Fax: 822-2518/8220512
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