BEIRUT: For months now, psychiatrist Dr. Joseph al-Khoury receives a message from patients at least three times a day asking for an alternative medicine to what he originally prescribed.

The dearth of medicines in Lebanon, including psychiatric and antidepressant drugs, like benzodiazepines and escitalopram, which treat anxiety, depression and insomnia, has added further strain to a population already suffering from a collective depression as a result of 18 months of instability.

“At one point, whatever you prescribed you were going to get a message from the patient saying it wasn’t available,” Khoury told The Daily Star.

With medicines being one of the last items to remain fully subsided by the cash-strapped state, which ensures prices are set at the Central Bank’s official LL1,500 to the dollar pegging, which is now comparatively cheap to the black market rate of LL12,000 to the dollar in recent days, citizens have rushed to stock pile.

State support is expected to be lifted in the coming months as the Central Bank’s reserves run dry, and commentators are warning of an impending ‘social collapse’.

The extreme events of last year in Lebanon; the economic collapse, the COVID-19 pandemic, and the deadly Aug. 4 explosion in Beirut, alongside bickering politicians who have left the state without a government for almost 250 days, have resulted in many struggling to believe that better days lie ahead.

“The political system has the main responsibility for the mental wellbeing of the population. It’s not simply about feeding people, it’s about feeding people hope,” Khoury said.

“And unfortunately, it’s not happening, and people are surviving on crumbs.”

In Lebanon the topic of mental health was long regarded as taboo, with shame attached to those in difficulty. Although, in recent years conversation has improved, according to Khoury, and more are accepting it as important as keeping one’s physical health in check.

The lack of centralized data regarding mental health cases in Lebanon makes it difficult to comprehend the scale of the problem. Embrace, a local NGO which provides awareness and support around mental health, reported they had received three times as many calls to their hotline as the same period last year, which indicates a concerning depreciation in citizen’s mental wellbeing.

In addition, 60 percent of callers to their National Lifeline, 1564, were between the ages of 18-35.

The falling quality of life in Lebanon, which was once considered a middle-income country, has pushed over half of the population into poverty and struggling to afford basic necessities.

With no solution or recovery plan in sight for the country’s woes, the overlapping shocks have upturned the lives of people living in Lebanon and caused immense instability.

Now adding to an already anxious state of living is the concern over the availability of medicines.

Pharmacist Toni Abou Habib, who runs a pharmacy in Antelias, spoke to The Daily Star about why his shelves have been regularly emptying: “There is now a great number of people who take antidepressants because of the situation [in Lebanon].”

He explained that the events of 2020 caught business forecasts by surprise and subsequently supply could not meet the rise in demand for medication, and only the Central Bank has the ability to change pharmacies supply quota.

Moreover, the Lebanese pound’s devaluation on the black market, which stooped to an historic low of LL15,000 to the dollar in March, has fueled an influx of foreign buyers with access to dollars taking advantage of the weak pound.

“People are coming from Egypt, Libya, Jordan, Iraq or Syria,” Abou Habib said, equipped with “thousands of dollars” to exchange on the black market, and then overbuying on medicine sold at a fraction of the price, making a profit at least eight times over.

Over the last few months, the constant threat of subsidy withdrawal has caused panic buying in supermarkets across Lebanon, which has sometimes turned violent as people become desperate to access subsidized foodstuffs like cooking oil, rice and sugar.

Just last week a man was shot dead and two others injured in a fight over food packages in Tripoli.

“You’ve seen what’s happened in the supermarkets? It’s kind of happening in the pharmacies but in a lighter way,” Abou Habib said. He now reserves medication to avoid letting down regular customers.

Furthermore, if a patient suffering from a mental illness was unable to access their medication, the health risks are dangerous.

“Antidepressants should never be stopped abruptly, because they can cause withdrawal symptoms …You might get suicidal thoughts, you might get a relapse into your initial depression or anxiety within matters of weeks,” Khoury explained.

“If you’re on Xanax to begin with, and you stop abruptly, you could have a seizure, rebound anxiety and you might end up in hospital.”

Khoury, who practices with the American University of Beirut Medical Center, warned of the long-term consequences of the population’s crumbling mental health.

“Even if it’s not killing us, it’s killing us softly as they say. And that’s worse, because these are a generation that are going to have a new generation to come, and you have all these people who have suffered irreversible mental blows and psychological distress.”

“It’s going to impact Lebanon for a very long time.”