“Addiction to medication is cruel. After the pills, however, there must also be effective therapy. The problem in our country is that even the cheapest psychotherapy sessions cost between 20 and 35 BGN, and many people with problems need to visit a specialist at least once a week for months."
Here is what Prof. Vihra Milanova, head of the Department of Psychiatry at the Medical University in Sofia and head of the Psychiatry Clinic at Aleksandrovsk Hospital, shared on the subject.
Recently, it seems that there are more people with mental problems in our country. Are there any statistics, Prof. Milanova?
- We have to admit that there are no statistics, no statistics are kept on the number of sick people and their illnesses. But transferring what I know from other countries, it can be said that the incidence of diseases is the same everywhere in the world. Another question is how these people are cared for.
Do you take them through clinical pathways?
- With us, people are treated regardless of whether they are insured or not. They are en titled to hospital treatment if they meet the criteria for such treatment.
Financing comes from the state budget through the Ministry of He alth. For each patient, the institution receives a certain amount, regardless of the length of stay and the assistance received.
Is this money enough?
- They are not enough. According to a rough calculation, it takes 8-9 days, and a mentally ill person is not treated for that long. Our average stay at the clinic, because we also have a lot of seriously ill patients, is about three weeks.
Does this mean that after these 8-9 days are over, the hospital facility takes over the treatment of the patients?
- Yes, we remain in the red. This includes patients who have passed through other hospitals, did not receive the necessary treatment and need more competent help and a second opinion. Fewer came directly from Emergency Services. This means they need more research and counseling.
Our society defines them as “crazy”, the fear of them is also present…
- There is a stigma, but it is everywhere in the world. All societies are sensitive about the subject, but there must be a balance. The fact is that the longer these people stay in hospital, the more expensive society pays. Keeping it outside, looking at it outside, keeping it in a state where it can be useful to itself and to society as a whole, is much more effective.
There is no relief for these people, no protected jobs for example. There are two or three reintegration centers in Sofia, which gather about a hundred people. What are they for a city of two million?! Social, medical, municipal services are needed, to provide accommodation, to be tolerant, to provide wages for these people…
What kind of addiction is drug addiction?
- Drug addiction almost always has a mental rather than a physiological basis. Taking many medicines is a kind of habit for people. But this "infatuation" sometimes leads to the so-called drug addiction. In many cases
the body can cope without drugs
I've always wanted the truth to be known - as long as our stress levels rise and access to medication remains relatively unproblematic, the number of addicts will skyrocket. However, the seriousness of the problem remains hidden due to the existing stigma surrounding seeking psychological help in our modern society. Acknowledging a psychological problem is still taboo in the region, as are the methods associated with its removal.
Can such people work?
- Addiction to drugs makes people numb - both to their families and to their work. Imagine these people teaching your children, driving the bus you ride, or running the electrical grids in your home…
Sedatives can no longer be bought without a prescription in Sofia. They are sold only with the so-called green prescription from licensed pharmacists, and sales are strictly recorded in special notebooks. However, the sale of antidepressants is less controlled. Although they also require a prescription, it is common and it is still possible to buy them without a prescription from small neighborhood pharmacies where there is trust between pharmacists and their customers.
"For years, a business woman has been coming to me and buys a package of Deankist every month," says my friend, a pharmacist from Sofia. "I know her and that's why I give her over-the-counter, something to go to her doctor every month," she explains, and I just shake my head in helplessness. Because this patient
with a 90% probability of ending up in psychiatry
where they will treat her for long weeks for her addiction. It should be known - drug addiction is like drugs - you think you can't live without them!
Are there any patients in your clinic now because of a missing medicine on the market?
- Yes, three women and one man. For three months we have been fighting the addiction to "Rivotril". It was prescribed universally by neurologists for lack of sleep, anxiety, for relaxation, even seizures of another nature. It is also given to epileptic children. Patients describe to us as a feeling of ice sweat, nausea, impaired vision, a feeling of insurmountable cold, muscle pain, numbness in the limbs and face, increased pulse, increased blood pressure, difficulty breathing - this is the state they fall into when it is withdrawn.
What does its prolonged use lead to?
- It is addictive, many of the patients are already addicted to it. These are usually elderly people who suffer from a number of physical ailments as well as the anxiety typical of their age. Stopping their medication would be much more traumatic for their body and psyche than continuing to take it, many doctors believe. I invite them to the clinic to see
he alth damage
and the body of such people…
How do you treat them?
- Giving up after years of abuse is not an easy task. Stopping after such a long period is associated with the risk of intense anxiety, insomnia and even seizures. It requires a very cautious approach. Gradual tapering of doses rather than sudden discontinuation of the medication is critical.
Unlike smoking and alcohol withdrawal, there is no unified treatment for benzodiazepine withdrawal. We act according to the rules and according to the condition and attitude of the patient. As soon as he was admitted to the clinic, infusions began to help the body cleanse itself of the poison. We add drugs to suppress his absence, but the sight is shocking - when they can get out of bed, they walk like ghosts, with darkened faces, they don't eat, they don't talk.
Is there a case when they start taking it again?
- Yes, that happens too. One of the women mentions that she can't breathe without it. In fact, she does not know that for three days her Rivotril has already been stopped, she is taking another medication. From what the patient is sharing, I think after she gets out of here she will probably continue taking it until her supply runs out.
See you again then…
Unfortunately, many drug addicts end up in drug addiction centers. The body's defense mechanisms wear out, and then even the smallest problem can push you to the pills. They make people allergic to thinking and unable to see their real problems. Depressed people are sometimes so confused that they cannot begin effective therapy without taking medication to balance them and organize their thoughts.
This must end!