Access to life-saving anti-depression drugs needs to improve

Public drug plans are lagging far behind, write Dave Grauwiler and Ron Campbell.

With one in five Canadians with a mental illness, including depression, it is alarming that so many Albertans continue to face impossible decisions between paying for groceries and paying for medication because Alberta’s public drug plan does not provide access to a full range of mental health treatments.

While Alberta’s recently released report Valuing Mental Health: Next Steps offers 18 “actions” to reflect the government’s commitment to coordinate mental health services across health and service sectors, it was silent on providing equitable access to medications for those living with mental illnesses, in particular depression. And that’s just not good enough.

Believing that equitable access to depression medications is among the most pressing health concerns of the 21st century and should be the foundation of Canada’s health care system, mental health leaders formed Canadians for Equitable Access to Depression Medication (CEADM) in May. Members include national and regional mental health advocates, doctors, researchers and people with lived experience.

Federal and provincial/territorial governments have yet to develop a co-ordinated strategy to tackle Canada’s growing mental health challenge, where over 7 million Canadians have a mental illness, 4,000 people die by suicide every year, including about 1,000 children, and the economic and social burden is estimated at $51 billion a year.

Of Canada’s $187.51/person total investment in health care (2011 dollars), a mere $5.22/person represents the mental health care portion. Compare this to three other OECD countries: $62.22/person in the United Kingdom; $98.13/person in Australia; and $198.93/person in New Zealand.

Beyond this poor investment record is a huge access issue that affects the ability of the most vulnerable segments in our society — the marginalized, unemployed, single parents, veterans, seniors, people on low incomes, Indigenous peoples — to receive a broad range of choice in depression medications. Unlike those who benefit from private drug plan coverage, these vulnerable citizens only have access to a limited range of largely older medications developed to treat the mood symptoms of depression.

As research shows, depression is a complex illness, with a staggering 227 combinations of symptoms that affect one’s emotional, cognitive and physical health. Newly developed medications address a broader range of symptoms, thus offering a greater probability of recovery.

Despite the fact that a range of innovative medications has been approved as safe and effective treatments by Health Canada, a complex multi-stage review process is preventing these medications from being approved for public drug-plan coverage. Newly approved drugs are submitted to a health technology assessment by the Canadian Agency for Drugs and Technologies in Health (CADTH). Of the 21 new mental health drug submissions filed to CADTH between 2004 and 2015, 76.2 per cent were given negative recommendations for public drug-plan coverage.

Of particular interest is the fact that all of the drugs used to treat depression were rejected. Compare this to the 134 non-mentalhealth drug submissions, where almost half were approved (48.5 per cent). The review process was also considerably lengthier, at 242 days for mental health drugs versus 192 for non-mental health drugs.

Over the past half century, leading drug researchers have made great strides in developing innovative depression treatments.

But these treatments should not be available to only those with private health plans. Now’s the time to advance the country’s public drug plan system so all Canadians can benefit. Improving the mental health of millions of Canadians who have major depressive disorder should not be an employment lottery, where only a select few have timely access to a broad range of medications to treat such a complex illness.

CEADM calls on the Government of Alberta to include on its public drug plan all Health Canada-approved medications to treat depression. Making sure that all Albertans have access to all depression medications will go a long way to addressing what is the most significant public health issue of the 21st century.