Antidepressants, anxiety medicine and other psychiatric drugs in Spain

Terms used

• Médico de familia — The médico de familia is your family doctor (GP), your first contact in the Spanish public health system.
• Visado — The visado is prior authorisation from the health system that some medicines need before a pharmacy can dispense them.
• Estupefacientes — Estupefacientes are narcotics, such as methadone and opioids, which need a special prescription.
• Psicotropos — Psicotropos are psychotropic drugs, such as benzodiazepines and stimulants, which have stricter prescription controls.
• Principio activo — The principio activo is the active ingredient of a medicine, the same in every country whatever the brand name.
• Aportación — The aportación is the share of a prescription's price you pay in the public system.

Key rules

• Ordinary drugs: Antidepressants and most antipsychotics need only an ordinary prescription, and your GP can write it.
• Controlled drugs: Narcotics and psychotropic drugs such as benzodiazepines and stimulants carry extra controls, and pharmacies keep a record of these prescriptions.
• Non-EU prescriptions: A prescription from outside the EU or EEA has no formal recognition, so you need a Spanish doctor to issue a new one.
• Brand names: Use the active ingredient, not the brand name, when you ask for your medicine in Spain.

Who prescribes psychiatric medicine

A Spanish GP (médico de familia) can prescribe most of what you need. GPs routinely prescribe antidepressants such as SSRIs, and anxiety and sleep medicines such as benzodiazepines. They also manage stable, long-term cases.

Psychiatrists usually start or manage the more complex treatments: lithium, clozapine, long-acting injectable antipsychotics and ADHD stimulants. Some of these need a specialist report or a visado (prior authorisation) before the pharmacy can dispense them. Once a specialist has started a treatment, the public system often lets your GP keep renewing it.

Which drugs have special controls

Antidepressants and most antipsychotics are ordinary prescription-only medicines. No special form is needed.

Two groups are different:

• Narcotics (estupefacientes), such as methadone and opioids, need a special prescription. Today this is mostly electronic. The older paper version was a special narcotic prescription.
• Psychotropic drugs (psicotropos), such as benzodiazepines and stimulants like methylphenidate, are more strictly controlled. Most benzodiazepines and many sleep medicines use an ordinary prescription marked as controlled, limited in duration, often to a maximum of 30 days. The pharmacy keeps and records these prescriptions.

Rules for stimulants and special formats differ by region, so ask your prescriber how it works where you live.

Bringing a prescription from abroad

From another EU or EEA country: a Spanish pharmacy can dispense it if it was issued by an authorised professional and contains all the required data. The pharmacist can still refuse if in doubt. Medicines not authorised in Spain, and controlled drugs, are generally refused.

From outside the EU/EEA: it has no formal recognition. A Spanish doctor must issue a Spanish prescription. In an emergency, a pharmacist can sometimes dispense a continuing treatment without a prescription, but do not count on it.

If you take a controlled drug, book a Spanish prescriber early. Do not rely on your foreign prescription.

Brand names differ: use the active ingredient

Brand names change from country to country. Look for the active ingredient (principio activo) on your box or leaflet and use that. Spanish public-system prescriptions are normally written by active ingredient. A pharmacist or doctor can confirm that the Spanish product matches your dose and form. The checklist below shows how to search the official medicines database.

What you pay

In the public system you pay part of the price (aportación). The share depends on your income and status. Some psychiatric drugs count as chronic treatment, which brings the rate down to 10% with a monthly cap. Many are cheap generics anyway. Private prescriptions are paid in full. The checklist below has the rates.

Do not stop or switch your medicine during the move. The warning below explains how to bridge your supply.

Documents you need

• A prescription from another EU or EEA country, issued by an authorised professional and containing all the data a prescription needs, which Spanish pharmacies can dispense for medicines authorised in Spain.

• A Spanish prescription issued by a doctor in Spain, which you need if your prescription comes from outside the EU or EEA, since those have no formal recognition.

• A Spanish controlled prescription from a Spanish doctor for narcotics (estupefacientes) or psychotropic drugs (psicotropos) such as benzodiazepines or methylphenidate; foreign prescriptions are generally refused for these, and the pharmacy keeps and records the prescription.

Checklist

• Find the active ingredient (principio activo) of your current medicine on the box or leaflet, and use it instead of the brand name, because brands differ between countries.

• Search the online medicines database CIMA by brand or ingredient to see the Spanish brands, generics, dosage forms and leaflet (prospecto).

• Ask your Spanish doctor to write the prescription by active ingredient, which is the normal way in the public system.

• Work out your copayment (aportación) in the public system: working people pay 40% of the retail price below 18,000 euros a year, 50% between 18,000 and 100,000 euros, and 60% above 100,000 euros.

• If you are a pensioner, check your monthly cap on the 10% you pay; if you receive minimum income, unemployment subsidy without benefit or a non-contributory pension, check that you are exempt.

• Ask your doctor whether your medicine counts as chronic treatment, which brings the rate down to 10% with a cap.

• Ask the pharmacist for a cheaper generic version, since many psychiatric drugs have one.

Stopping or switching psychiatric medicine during a move

• Do not stop or switch abruptly: Stopping or switching antidepressants, benzodiazepines, antipsychotics, lithium or anticonvulsants suddenly can cause withdrawal symptoms, rebound or relapse. Benzodiazepine withdrawal can cause seizures. Reduce doses only gradually with a doctor, and let your prescriber plan any switch. If you run out while moving, see a GP or psychiatrist quickly instead of stopping.

• Plan a supply bridge: You can bring a personal supply for the length of your trip, usually up to 90 days, in original packaging with a copy of the prescription or a doctor's letter. For psychotropic or narcotic drugs, travellers from Schengen states need a Schengen certificate endorsed by their health authority, valid up to 30 days. Travellers from outside Schengen should carry a doctor's letter and prescription and may need to declare controlled substances to customs. Pack enough to last until your first Spanish appointment. For a stay over 30 days, see a Spanish doctor for a local prescription.

• Line up a prescriber in Spain: If you are running out, you can book an urgent same-day appointment at a public health centre once you hold a tarjeta sanitaria (health card), or go to hospital urgencias if it is urgent. Controlled drugs such as benzodiazepines and stimulants are harder to get quickly. A private psychiatrist, GP or Spain-registered telehealth service is an alternative. Bring your old prescription, a medical report or discharge letter, and the active-ingredient name. A pharmacist can advise and sometimes give a short emergency supply of non-controlled medicine.

• Match medicines by active ingredient: Brand names differ between countries, so a brand you know may not exist in Spain. Give the principio activo (active ingredient) to the doctor or pharmacist. You can search brand or ingredient in the AEMPS online medicines database (CIMA) to see Spanish brands, generics, forms and the leaflet, and ask a pharmacist to confirm the dose and form match.

Specialist mental health care quick answers

Can a Spanish GP prescribe antidepressants or anxiety medicine?

Yes, a Spanish GP (médico de familia) routinely prescribes antidepressants such as SSRIs and anxiety or sleep medicines such as benzodiazepines. Psychiatrists usually start complex treatments such as lithium, clozapine or long-acting injectable antipsychotics, and these may need a specialist report or visado (prior authorisation). Public GPs often continue prescriptions that a specialist began.

Do I need a psychiatrist to get ADHD medication in Spain?

Yes, in practice a psychiatrist, or a neurologist or specialist with ADHD experience, starts ADHD stimulants such as methylphenidate and lisdexamfetamine. These are controlled medicines with special prescriptions. Adult use is often off-label, and a GP does not usually start them, though some regions let a GP continue treatment with specialist reports.

Is addiction treatment free in the Spanish public system?

Yes, treatment in public addiction centres is generally free, including consultations, psychological care and medication such as methadone. Some regions charge part of the cost of long stays in therapeutic communities, and private centres charge fees. Ask the centre about any charge before you agree to a residential stay.