The global consumption of antidepressant (AD) medications has increased dramatically in the last two decades, with Europeans being the largest consumers.
The use of antidepressants increased almost two and a half times between 2000 and 2020 in 18 European countries, according to data from the Organization for Economic Co-operation and Development (OECD).
OECD data also shows a dramatic increase in anxiety and depression during the COVID-19 pandemic. Do happier countries use fewer AD drugs? How do researchers explain the sharp rise in antidepressant use?
OECD data sets demonstrate Defined Daily Dose (DDD) consumption of “N06A antidepressants”. This group “includes preparations used in the treatment of endogenous and exogenous depressions”, according to the World Health Organization (WHO).
The average consumption of antidepressants in 18 European countries was 30.5 DDD per 1000 people per day in 2000 and increased to 75.3 DDD in 2020, an increase of 147%.
But this overall average hides very different starting points for antidepressant use in 2000 in certain countries, ranging from 6.4 DDD in Estonia to 70.5 DDD in Iceland.
The Czech Republic recorded the highest increase at 577 percent, while it only increased by 38 percent in France, making it the lowest change in these countries between 2000 and 2020, albeit from a relatively high level.
It rose 304 percent in Portugal, 256 percent in the UK, 208 percent in Spain and 200 percent in Germany in the same period.
A closer look at five selected countries (France, Germany, Portugal, Spain and Sweden) over 20 years demonstrates how the use of antidepressant drugs varies.
While the increase is very low in France, especially in the last 15 years, it has skyrocketed in Portugal in the last two decades.
The bar race graph also shows how the use of antidepressants has increased year over year in European countries. In 14 of 18 countries, AD drug use more than doubled.
Which countries have the highest consumption of antidepressants?
Looking at the changes in the last decade, we have data for 24 European countries.
In 2020, the consumption of AD pharmaceuticals per 1,000 people per day ranged from 20 DDD in Latvia to 153 DDD in Iceland. It is followed by Portugal (131 DDD), the United Kingdom (108 DDD in 2017), Sweden (105 DDD) and Spain (87 DDD).
In 2020, the average usage in these 24 countries was 68 DDD. The three largest countries by population, namely Turkey (49 DDD), France (55 DDD), and Germany (62 DDD), recorded below-average usage.
Any correlation between happiness and antidepressant use?
The short answer is no. Data from European countries does not suggest that the happier people are, the less antidepressants they take.
Iceland, which was the second happiest country in the world in 2020 according to the World Happiness Report, has the highest consumption of antidepressants in Europe.
Sweden, which was ranked sixth in the Happiness Report, has the fourth highest use of antidepressants at 105 DDD.
The Finns, who were the happiest nation according to the report, used 82 DDD antidepressants, putting Finland seventh out of 24 countries.
Latvia, which has the lowest consumption at 20 daily servings, was ranked 34th in the World Happiness Report. Hungary, which follows Latvia with 30 DDD, was ranked 43rd on the happiness list.
The consumption of antidepressants decreased only in Denmark in the last 10 years
AD drug consumption increased by 36.5 percent between 2010 and 2020 in 24 European countries with average daily use from 49.8 DDD to 68 DDD. Denmark is the only country to see a decline in antidepressant use in the past decade with a 4 percent decline.
Estonia recorded the largest increase at 133 percent, while consumption only increased by 2 percent in France.
It doubled in the UK and increased by 50 percent in Turkey. The change was less than 25 percent in 10 countries.
What about spending on antidepressant medications?
The cost of spending on antidepressant medications is a burden on citizens and their countries.
In 2020, Germany spent $812 million (€783 million) on antidepressants. Spain (649 million dollars or 626 million euros) and Italy (456 million dollars or 440 million euros) are the other leading countries in spending on antidepressants.
The ratio of spending on antidepressants to total pharmaceutical sales suggests that it is a significant cost in some countries.
In 2020, antidepressant drugs represented 4% of pharmaceutical sales in Portugal, compared to 2.7% in Spain, 2.2% in Austria, 1.9% in Turkey and 1.4% in Germany.
The prevalence of chronic depression in Europe
There are no official comparable data on the proportion of people who reported having chronic depression or consulting a psychologist, psychotherapist or psychiatrist.
However, the survey results published by Eurostat provide some insights. In 2019, Eurostat found that 7.2% of EU citizens reported having chronic depression, which represented only a small increase compared to 2014 (+0.3 percentage points).
In 2019, among EU countries, Portugal (12.2 percent) had the highest proportion of the population reporting chronic depression, followed by Sweden (11.7 percent), Germany, and Croatia (both 11.6 percent). hundred).
The proportion of people reporting chronic depression was lowest in Romania (1.0 percent), Bulgaria (2.7 percent), and Malta (3.5 percent).
Interestingly, the top two countries, Iceland (15.6%) and Portugal (12.2%) for chronic depression, also had the highest antidepressant use with 153 DDD and 131 DDD in 2020, respectively.
The impact of COVID on mental health
Recent surveys released by the OECD found that mental health has deteriorated significantly since the start of the COVID-19 pandemic.
As of March 2020, the prevalence of anxiety and depression increased in 15 selected OECD countries, including several Europeans.
The prevalence of anxiety in early 2020 was double or more than double that seen in previous years in Belgium, France, Italy, Mexico, New Zealand, the United Kingdom, and the United States.
The prevalence of depression in early 2020 was also double or more than double that seen in previous years in Mexico, Australia, Belgium, Canada, France, the Czech Republic, Mexico, Sweden, the United Kingdom, and the United States.
However, as survey methods differ across studies, it is not possible to provide robust comparisons across countries.
Did the consumption of antidepressants increase during COVID?
While the prevalence of anxiety and depression increased significantly during the COVID-19 pandemic, has the use of antidepressant medications also increased?
There is an increase of 10 per cent or more in consumption between 2019 and 2021 in the 14 OECD countries for which data is available. For example, usage increased by 22 percent in Latvia in these two years, but only 1 percent in Hungary.
However, this is against a background of a steady trend in increasing antidepressant use over the past 20 years. Therefore, more research is needed to understand any possible impact of the pandemic on these recent increases.
Why is the consumption of antidepressants increasing?
There are a number of possible explanations for this increase in the last two decades.
Researchers studying influences on antidepressant prescription trends in the UK between 1995 and 2011 suggested that the increase can be attributed to improved recognition of depression, the availability of new Alzheimer’s drugs, changes in patient/GP attitudes, availability of therapies, clinical course. guidelines, and an expansion of the range of indications treated with AD.
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