“We Always Live in Fear”: Antidepressant Prescriptions by Unlicensed Doctors in India

Abstract

SSRIs such as fluoxetine (Prozac). He estimated that, on average, one patient a day received an antidepressant drug from him. These patients complained of sleeping badly, feeling low, or not wanting to talk to anyone. SSRI antidepressants were effective treatments, but only if taken for at least three months. Unfortunately, few patients were willing to take drugs for such a long time.Previously he dispensed antidepressants "in large quantities," but people were less keen these days. Mr Ghosh also tried to minimize antidepressant prescriptions because patients needed a continuous, long-term supply, yet the illegality of his RMP practice did not allow him to stock drugs in greater quantities. Officially, RMPs have no license to act as medical prescribers, but in practice the government tolerates them because they fill deep gaps left by the state health system. Even more dangerous than prescribing was storing drugs without the required licenses: "We always live in fear. At any point in time, we might get arrested. The only crime is that we have such huge stocks of medicines without a valid drug license."This article explores how RMPs in rural India are using antidepressant drugs. Next to nothing is known about if and why informal providers, in India and other poorer countries, prescribe psychopharmaceuticals. This gap in the literature is surprising because both "global

mHealth and the management of chronic conditions in rural areas: a note of caution from southern India

“…They practise with no formal medical qualification, and typically flourish where the formal health sector – both government and private – is absent or largely avoided (except for maternal and child health services). There is a small but growing literature on RMPs or their equivalents (not all writers use the term RMP) by social scientists from different parts of India: Ecks and Basu (2009, 2014), Gautham et al (2014), George and Iyer (2013), Lakshman and Nichter (2000), May, Roth, and Panda (2014) and Pinto (2004). Some writers identify the ‘R’ in RMP as standing for Rural, but in Guntur and indeed more widely in the south it was said to denote ‘Registered’: an irony, as RMPs have historically never been registered and most remain unregistered. …”

“…Various writers (Ecks 2005; Ecks and Basu 2009, 2014; Jain and Jadhav 2009) have examined some of the profound cultural and economic complexities of the heavy reliance on pharmacological treatments, including in rural areas and informal practice. Others have explored what Lang and Jansen (2013) call the ‘appropriation of depression’ by biomedical frames of understanding (see also Halliburton 2005; Quack 2012).…”

Global Side Effects: Counter-Clinics in Mental Health Care

“…During the same period, however, the use-including off-label use-of psychoactive medications has continued to rise worldwide (Jenkins 2010a;Ecks 2010;Oldani, Ecks, and Basu 2014;Petryna, Lakoff, and Kleinman 2006;Sugarman et al 2013). In some contexts, these medications are prescribed less often by psychiatrists than by primary health care providers (Oldani 2014) or even by unlicensed practitioners (Ecks 2010;Ecks and Basu 2014), in the absence of psychotherapeutic relationships, and often in experimental dosages and combinations unstudied in clinical trials, a practice known as "polypharmacy" (Good 2010).…”

The Self Nominated Doctors: Irrational the practice; Headache the professionals; Harming the public; National the problem - The industry of Quackery.

“…Quacks are untrained, often illiterates who have some experience with medical profession involved in medical practice for earning easy money. Even a medical personal from other branch of medicine those are practicing allopathic medicine to earn easy money [1,2,22]. In my childhood I had got severe ear pain in the middle of the night duetoaccumulation of wax and I was treated by a quack with injections and by removing my ear wax with some instruments.…”