Global consumption of antidepressant (AD) drugs has increased dramatically over the past two decades, with Europeans being the largest consumers.
The use of antidepressants increased nearly two and a half times from 2000 to 2020 in 18 European countries, according to data from the Organization for Economic Co-operation and Development (OECD).
OECD data also show 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 increase in antidepressant use?
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OECD datasets demonstrate Defined Daily Intake (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 use of antidepressants in 18 European countries was 30.5 DDD per 1,000 people per day in 2000, rising 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 some countries, ranging from 6.4 DDD in Estonia to 70.5 DDD in Iceland.
The Czech Republic recorded the highest increase at 577%, while France increased by only 38%, which represents the lowest change in these countries between 2000 and 2020, albeit from a relatively high level.
In the same period it increased by 304% in Portugal, by 256% in the United Kingdom, by 208% in Spain and by 200% in Germany.
A closer look at five selected countries – France, Germany, Portugal, Spain and Sweden – over 20 years shows how the use of antidepressant drugs varies.
While the increase is very low in France, especially over the past 15 years, it has soared in Portugal over the past two decades.
The rush bar graph also shows how the consumption of antidepressants has increased year on year in European countries. In 14 out of 18 countries, AD drug use more than doubled.
Which countries have the highest consumption of antidepressants?
Looking at the changes over the last decade, we have data for 24 European countries.
In 2020, AD drug consumption per 1,000 people per day ranged from 20 DDD in Latvia to 153 DDD in Iceland. This 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 DDDs. The three largest countries by population, Turkey (49 DDD), France (55 DDD) and Germany (62 DDD), all had below-average consumption.
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 they consume antidepressants.
Iceland, which was the second happiest country in the world in 2020 according to the World Happiness Report, has the highest use of antidepressants in Europe.
Sweden, which ranked sixth in the Happiness Report, has the fourth highest use of antidepressants with 105 DDDs.
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The Finns, who were the happiest nation according to the report, used 82 DDD antidepressants which placed Finland seventh out of 24 countries.
Latvia, which has the lowest consumption at 20 daily doses, was ranked 34th in the World Happiness Report. Hungary, which follows Latvia with 30 DDDs, was 43rd on the happiness list.
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Consumption of AD drugs increased by 36.5% between 2010 and 2020 in 24 European countries with average daily consumption rising from 49.8 DDD to 68 DDD. Denmark is the only country to see a decrease in antidepressant use over the past decade with a 4% drop.
Estonia recorded the highest increase with 133%, while consumption increased by only 2% in France.
It doubled in the UK and increased by 50% in Turkey. The variation was less than 25% in 10 countries.
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What about spending on antidepressant medications?
The cost of spending on antidepressant drugs weighs heavily on citizens and their countries.
In 2020, Germany spent $812 million (€783 million) on antidepressants. Spain ($649 million or €626 million) and Italy ($456 million or €440 million) are the other leading countries in antidepressant spending.
The ratio of antidepressant spending to total drug sales suggests that this is a significant cost in some countries.
In 2020, antidepressant drugs accounted for 4% of pharmaceutical sales in Portugal, compared with 2.7% in Spain, 2.2% in Austria, 1.9% in Turkey and 1.4% in Spain. Germany.
The prevalence of chronic depression in Europe
There are no comparable official data on the percentage of people who reported having chronic depression or having consulted 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 suffering from chronic depression, which is only a small increase compared to 2014 (+0.3 percentage points).
In 2019, among EU countries, Portugal (12.2%) had the highest percentage of its population suffering from chronic depression, followed by Sweden (11.7%), Germany and Croatia (both 11.6% ).
The proportion of people reporting chronic depression was lowest in Romania (1.0%), Bulgaria (2.7%) and Malta (3.5%).
Interestingly, the top two countries Iceland (15.6%) and Portugal (12.2%) in reporting chronic depression also had the highest antidepressant use with 153 DDDs and 131 DDDs in 2020 respectively.
The impact of COVID on mental health
Recent surveys published by the OECD have found that mental health has deteriorated significantly since the onset of the COVID-19 pandemic.
From March 2020 onwards, the prevalence of anxiety and depression has increased in 15 selected OECD countries, including several European countries.
The prevalence of anxiety at the start of 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 at the start of 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 between studies, robust cross-country comparisons cannot be offered.
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Has antidepressant use increased during COVID?
While the prevalence of anxiety and depression has increased significantly during the COVID-19 pandemic, has the use of antidepressant medications also increased?
Between 2019 and 2021, consumption increased by 10% or more in the 14 OECD countries for which data are available. For example, usage increased by 22% in Latvia over these two years, but by only 1% in Hungary.
However, this is against the backdrop of a steady upward trend in 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 potential explanations for this increase over the past two decades.
Researchers studying the influences on antidepressant prescribing trends in the UK between 1995 and 2011 suggested that the increase may be attributed to improved recognition of depression, availability of new AD drugs, changes in attitude of the patient/general practitioner, the availability of therapies, the evolution of clinical guidelines and an expansion of the range of indications treated with AD.
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