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A shadowy figure of a man darts behind him. Footsteps pound closer as his heart skips a beat. Then a loud — bang!
Without warning, a gunshot shattered 21-year-old Juan Miguel Antonio’s (not his real name) sleep. It is 3 a.m.
He shot up in bed. Cold bullets of sweat trickled down his temples. Ragged gasps escaped from his lips. His left hand clutched his chest as he fought to steady his breath. His other hand - trembling - rummaged through the small bedside drawer.
Inside was a pack of alprazolam, a medication he kept close to manage his panic attacks during nights exactly like this. His eyes were shut as he swallowed the white pill.
Yet, his heartbeat could not sit still.
He reached for another blister pack of medicine. This time, a pink tablet—propranolol—popped out. Without even a sip of water, he drank it to tame the palpitations and his anxiety. Fifteen minutes later, his heartbeat returned to normal.
For the likes of Antonio, who suffer from post-traumatic stress disorder (PTSD), every night looks like… that white-knuckling night.
On top of keeping himself appeased during these troubled times, Antonio noticed that the blister packs were down to their last tablet. The empty gray foil now meant he had to scour every drugstore nearby again to replenish his stocks before his next episodes occurred.
Getting diagnosed
Antonio has been experiencing persistent nightmares and anxiety that disrupted his sleep for years. His parents then did not believe in psychiatrists or psychologists.
It was not until 2025, after much convincing, that he was able to consult a mental health professional.
Antonio revealed that he experienced abuse as a child—emotionally, physically, and sexually—by his relatives. Even into adulthood, he continued to face insults, criticisms, and emotional withholding that perpetuated his condition.
The World Health Organization (WHO) said PTSD is a condition where a person suffers from a psychological disorder after an encounter with terrifying events.
And treating this has not been easy, said Antonio.
Psychiatric medications, including alprazolam and antidepressants like sertraline prescribed by his psychiatrist, are hard to come by in the market.
After his PTSD diagnosis in June last year, Antonio had to make 30-minute trips to De La Salle University Medical Center just to purchase the medications.
“It’s even more frustrating because sometimes that’s the only [pharmacy] store where I can buy my medication and occasionally, they’re out of stock of the cheaper alternatives,” Antonio said.
Everything has a risk
Venella Angeles, a store pharmacist in Manila with seven years of experience, said psychiatric drugs are tagged by the Food and Drug Administration (FDA) as “regulated drugs” or “dangerous drugs” that cannot be easily purchased over the counter.
According to the FDA-verified drug safety information, alprazolam carries a known risk of abuse and diversion.
“Drug abuse is a known risk for alprazolam and other benzodiazepines, and patients should be monitored accordingly when receiving alprazolam,” the document read.
Reports reviewed by the FDA have linked alprazolam abuse, particularly when combined with opioids, alcohol, and other benzodiazepines—which are central nervous system depressant drugs used medically for anxiety, insomnia and seizures, to overdose-related deaths.
In addition to overdose risks, the FDA cautioned against abrupt discontinuation of alprazolam. Sudden dose reduction or stopping the medication without medical supervision can trigger withdrawal symptoms and severe complications, including seizures and convulsions.
Meanwhile, sertraline, the prescribed antidepressant to Antonio, is associated with several side effects. While effective for many patients, FDA recent guidance highlighted that caution was still warranted when taking the medication.
FDA also urged caution in prescribing antidepressants to pediatric and young adult patients due to evidence of an increased risk of suicidal thoughts and behaviors in these age groups.
Short-term studies also note that prescriptions should be limited to the smallest number of tablets necessary, especially for high-risk patients.
“Closely monitor all antidepressant-treated patients for clinical worsening and for emergence of suicidal thoughts and behaviors,” the FDA-verified sertraline information read.
The agency said safety for both alprazolam and sertraline have not been established in patients under 18 years of age.
Taking a toll
Angeles said the customers seeking antidepressant medications in their store range from five to 10 each day, most of whom are students.
Over her seven years as a store pharmacist, she observed that the increase in demand began to spike during the height of the Covid-19 pandemic.
A scientific brief by the WHO noted that the global anxiety and depression cases surged by 25 percent in the first year of the pandemic.
Antidepressants market trends reflect the same rise as it has grown from $17.33 billion in 2024 to a projected $17.9 billion last year, according to the Antidepressants Market Report 2025 by Research and Markets, a global research market store.
Antonio’s eyes wandered across every drugstore in Cavite—as they often did when he woke up in the middle of the night to hunt for his medicine stash that might bring him relief—only to find the medicine costs higher than he could bear.
The thought of shelling out money for what he described as “already expensive” medication added to his worries, aside from keeping himself relieved during restless nights when nightmares clawed at his mind.
“My psychiatrist charges a fee of P3,000 already, while my psychotherapy reaches P2,000 per session,” he said.
Adding to Antonio’s treatment were the P44 sertraline antidepressant tablets he needed to take twice a day and the P98 alprazolam daily. Antonio spends around P4,260 every month for his medications.
“I’m also experiencing psychotic episodes, like seeing things that are not really there or I start believing in things that are not true,” Antonio said.
With this, his psychiatrist required him to also purchase other medicines, such as aripiprazole to prevent his antipsychotic episodes, and anxiety medications hydroxyzine and propranolol, all three of them priced at around P30 per tablet.
Antonio spends close to P12,000 monthly for the treatment of his PTSD, higher than his monthly allowance of P8,000. To sustain his treatment, he slashes his budget for food and gives up unnecessary spendings.
“I’m often embarrassed to ask my parents again, knowing I’d be adding to their expenses. So I spend what little I have, even if it means giving up my own needs,” Antonio said.
The first few weeks of psychotherapy and psychomedication stretched into long, suffocating days for Antonio. Progress, he said, felt painfully slow.
He had sunk to what he described as rock bottom where it rendered him thoughts of veering away from the nightmares that kept him awake at night is inescapable.
Until the idea of ending his own life started to creep in.
Hurt by rising costs
What made it worse for Antonio were the remarks he received from some of his academic professors.
He would often find himself dragging himself to attend laboratory sessions, especially on days when simply getting out of bed already felt exhausting.
“Anxiety and post-traumatic stress disorder were not even considered valid reasons for being absent,” Antonio, fourth-year medical laboratory science student in De La Salle Medical and Health Sciences Institute, recalled.
There was a point, Antonio said, when he was almost forced to repeat a year—not because he failed his exams—but because he failed to show up in class most of the time.
Antonio then wanted one thing to be clear: mental health care should be treated the same as physical health, with equal recognition, support, and resources.
For many students, managing mental illnesses becomes a constant trade-off, where they would rather tame the voices in their heads than the growl in their stomachs.
Jessica Waren*, not her real name, who takes antidepressant medications for her mixed anxiety and depression, said buying medicines is non-negotiable as it is the only way of keeping herself stable.
However, Waren shared that there was a time last year when she stopped taking her medication temporarily due to rising costs.
“There’s a possibility that it could get worse since the effects just come back to you. So even though I felt the price increase—even just P5 per tablet—I continued buying it,” said Waren, a medical biology junior from University of Santo Tomas.
Her monthly allowance is P8,000, from which she discreetly sets aside P400 per week, keeping her situation private from her family. She allocates her savings to cover her medication needs for the entire month, with each tablet now costing P43.
Economic disruptions
While the Department of Health and the Pharmaceutical and Healthcare Association of the Philippines said the medicine costs will remain stable until June 2026, potential shortages and price spikes are anticipated later in the year driven by disrupted supply chains linked to the ongoing Middle East conflict.
Isha Mutia*, another third-year medical biology student, sacrifices her meals and endures long queues in medical institutions all for the chance of having a better mental well-being.
“I really try to prioritize my medication because I am getting better about my condition. I am even willing to do OMAD (one meal a day) just to afford the prescribed medicines and psychomedication,” Mutia, not her real name, said.
Mutia turns to Philippine General Hospital (PGH) to access free monthly consultation with a psychiatrist. However, securing a slot also comes with its own barriers.
“If you book in July, you might get a doctor by November,” Mutia said. “There’s a lack of doctors.”
The country’s medicine inflation rate last year averaged 2.6 percent, the slowest in three years, based on Philippine Statistics Authority (PSA) data. In 2024, medicine inflation stood at 2.7 percent and 4.2 percent in 2023, PSA data showed.
Layers of burden
Dr. Richelle Santiano, a psychiatrist and faculty member of the Faculty of Medicine and Surgery and College of Rehabilitation Sciences from the UST, said mental health conditions are a burden itself.
“Not just emotionally, but also mentally. If someone has a psychiatric disorder, it already impacts their daily functioning. Their social functioning and cognitive abilities can be affected,” Santiano said.
“But I think it becomes an even greater burden if a person has this condition and does not have access to proper medication or management,” she added.
The National Center for Mental Health charges P400 for consultation, while the cost of first-day admission typically ranges from P1,000 to P4,500 per session, according to a Congressional Policy and Budget Research Department policy brief.
The WHO noted that up to 40 percent of people diagnosed with PTSD recover within a year, and only one in four individuals in low-and-middle-income countries were able to seek help from professionals.
A study by the National Library of Medicine revealed that migrant populations face a higher risk of experiencing traumatic life events.
Santiano also said financial constraints remain one of the primary barriers to mental health care in the Philippines where patients could not afford to sustain treatment.
“Psychiatric medications are not cheap, to be honest. It’s hard to sustain,” she said.
The government has attempted to address affordability issues through Republic Act No. 9502, also known as the Cheaper Medicines Act of 2008, which allows price regulation of medicines, including psychiatric drugs.
Under the law, the Department of Health recommends which medicines need a price reduction, after which the President approves and sets the Maximum Retail Price (MRP). Drugstores are prohibited from selling these medicines above the MRP.
Pharmaceutical companies and drugstores that violate the rules and regulations face penalties, such as fines, imprisonment, or suspension of their business licenses.
Philippine reality
In a 2021 joint report, the WHO and the United Nations’ Development Programme (UNDP) estimated that the Philippine government needs to invest P143 billion in mental health care over the next decade, focusing on both clinical treatments and population-based preventive programs.
The estimated investment will yield P217 billion in economic returns for the Philippines over a 10-year period, the WHO and UNDP said.
The country's current burden of mental health conditions is estimated to reach around P69 billion annually or equivalent to 0.4 percent of its gross domestic product, the WHO estimated.
Broken down, about P2.7 billion in direct costs are incurred by Filipinos due to healthcare expenditures while P66.2 billion are estimated to be indirect costs because of loss of workforce and reduced productivity.
Beginning December 2025, the Department of Health-Metro Manila Center for Development offers free access to select mental health medications for Metro Manila residents. This includes antipsychotics such as Clozapine, Risperidone, Quetiapine and Paliperidone Palmitate; antidepressants like Escitalopram; and mood stabilizers such as Valproic Acid and Lithium Carbonate.
However, beyond medications, psychotherapy remains the first line of care to manage PTSD conditions, a process of helping the patients recognize and address problematic thoughts, behaviors, and emotions.
Santiano noted that access to care remains limited in the Philippines, where healthcare costs are paid out-of-pocket.
By understanding their own patterns of thinking and behavior, Santiano explained that patients can work toward reducing distress and regaining a sense of control over their mental health.
“But psychotherapy is also expensive. It’s also not cheap,” she said.
“Here in the Philippines, the reality is very different. Even public hospitals require patients to spend money on treatments, medications, and consultations,” she added.
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If you know someone struggling with thoughts of self-harm or suicide, help is available. You may contact the National Center for Mental Health Crisis at 1553, 180018881553, 09190571553 and 0917899872, or reach out to a trusted mental health professional.
This story was produced by Frenchshield Shayne Delovieres, a junior journalism student at the University of Santo Tomas, for her macroeconomic indicators class.
