The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index.
“We Always Live in Fear”: Antidepressant Prescriptions by Unlicensed Doctors in India
Open accessAbstract
In India, psychopharmaceuticals have seeped deep into both formal and informal pharmaceutical markets, and unlicensed "quack" doctors have become ready prescribers of psychotropics. These ethnographic insights trouble policies that aim at closing the treatment gap for psychiatric medications by "task shifting" to low-skilled health workers as if medications were exclusively available by prescription from public sector psychiatrists. This article describes what these doctors, known as rural medical practitioners (RMPs), know about psychotropics and how they use them in everyday practice. Unlicensed doctors learn about psychopharmaceuticals through exchanges with licensed doctors, through visits by drug companies' sales representatives, and through prescriptions brought by patients. Although the RMPs exist outside the margins of legitimacy, they are constrained by a web of relations with patients, licensed doctors, pharmacists, drug wholesalers, and government agents. The RMPs do not only prescribe but also dispense, which leads to conflicts with licensed medicine sellers. They "always live in fear" both because they are illegal prescribers and because they are illegal sellers of medications. The article shows that any form of strategic ignorance among policy makers about the local importance of informal practitioners in India can only lead to lopsided interventions.
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“For example, Ecks (2014Ecks ( , 2017) ) showed a sharp increase in private sector prescriptions of psychotropic drugs in India.”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Ecks 2014
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“Authors have also noted particular risks associated with the prescription of psychotropic treatment in lowresource settings, as in these contexts psychopharmaceuticals are more likely to be prescribed in experimental dosages and 'polypharmaceutical' combinations (Good 2010), and by primary health care workers or unlicensed professionals rather than psychiatrists (Ecks and Basu 2014), thus outside”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Ecks and Basu 2014
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“Data for lowincome countries is not yet available in international databases, likely mirroring the early stages of this trend; however, it is worth noting that, as shown by Ecks (2014), the circulation of psychopharmaceuticals in the Global South often takes place outside of institutional public health channels and is thus generally less likely to be captured by official statistics.”
From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Ecks 2014
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Metadata
- Authors
- Ecks, S., & Basu, S.
- Affiliations
- University of Edinburgh (GB)
- Corresponding author
- Ecks, Stefan
- ORCID
- Ecks, Stefan
- Venue
- Culture, Medicine, and Psychiatry
- Published
- 2014-04-05
- Volume
- 38
- Issue
- 2
- Pages
- 197-216
- ISSN
- 0165-005X (ISSN-L)
- 1573-076X
- OpenAlex
- W2035638452
- Cited by
- 46
- References
- 26
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 3 · 2022: 17 · 2021: 3 · 2020: 4 · 2019: 3 · 2018: 1 · 2017: 6 · 2016: 3 · 2015: 1
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- www.springer.com/tdm (tdm)
- Locations
- Culture Medicine and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- Fondation Brocher
- Department for International Development
- Economic and Social Research Council (RES-167-25-0110)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Health Sciences › Nursing › Issues, ethics and legal aspects › Pharmaceutical industry and healthcare
- Keywords
- antidepressant prescribing, psychotropic drugs, task shifting, medication dispensing
- MeSH terms
- Antidepressive Agents, Clinical Competence, Patient Care, Health Personnel, Humans, India, Interprofessional Relations, Legislation, Medical, Licensure, Medical, Marketing of Health Services, Drug Prescriptions, Psychotropic Drugs, Rural Health Services
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