Global consumption of antidepressants (AD) has increased dramatically over the last two decades, with Europeans being the largest consumers.
Data from the Organization for Economic Co-operation and Development (OECD) show that antidepressant use increased nearly 2.5-fold from 2000 to 2020 in 18 European countries.
OECD data also show a dramatic increase in anxiety and depression during the COVID‑19 pandemic. Happiest countries use less AD drugs? How do researchers explain the surge in antidepressant consumption?
The OECD dataset shows the defined daily dose (DDD) consumption of ‘N06A-Antidepressants’. According to the World Health Organization (WHO), this group “consists of preparations used to treat both intrinsic and extrinsic depression”.
Average antidepressant consumption in 18 European countries rose from 30.5 DDD per 1,000 people per day in 2000 to 75.3 DDD in 2020, an increase of 147%.
However, this overall average hides very different starting points for antidepressant use in 2000 in certain countries, from 6.4 DDD in Estonia to 70.5 DDD in Iceland.
The Czech Republic recorded the highest increase at 577%, while France only increased by 38%, the lowest change among these countries between 2000 and 2020, albeit at relatively high levels. .
Over the same period, it increased by 304% in Portugal, 256% in the UK, 208% in Spain and 200% in Germany.
A closer look at five countries—France, Germany, Portugal, Spain, and Sweden—over 20 years shows how antidepressant use varies.
France has seen a very low rate of increase, especially over the last 15 years, while Portugal has seen a sharp increase over the last 20 years.
The bar chart also shows that antidepressant consumption increased year-on-year in European countries. Alzheimer’s drug use more than doubled in 14 of 18 countries.
Which country has the highest consumption of antidepressants?
Looking at changes over the last decade, we have data for 24 European countries.
In 2020, AD drug consumption per 1,000 people per day varied from 20 DDD in Latvia to 153 DDD in Iceland. This is followed by Portugal (131 DDD), UK (108 DDD in 2017), Sweden (105 DDD) and Spain (87 DDD).
The average usage in these 24 countries in 2020 was 68 DDD. The three most populous countries, Turkey (49 DDD), France (55 DDD) and Germany (62 DDD) all have below average usage.
Is there any correlation between happiness and antidepressant use?
The short answer is no. Data from European countries do not suggest that people who consume less antidepressants are happier.
Iceland, the world’s second happiest country in 2020, has the highest consumption of antidepressants in Europe, according to the World Happiness Report.
Ranked 6th in the Happiness Report, Sweden is the 4th highest antidepressant use country in DDD.
According to the report, people in Finland, the happiest country, use 82 DDD antidepressants, placing Finland 7th out of 24 countries.
Latvia, with the lowest consumption of 20 servings per day, was ranked 34th in the World Happiness Report.Hungary, behind Latvia with 30 DDD, was 43rd in the happiness rankings.
Denmark is the only country in the last decade to see a decline in antidepressant consumption
Consumption of Alzheimer’s drugs increased by 36.5% between 2010 and 2020 in 24 European countries, with average daily usage increasing from 49.8 DDD to 68 DDD. Denmark is the only country where his antidepressant use has decreased by 4% in the last decade.
Estonia recorded the highest increase at 133%, while France saw only a 2% increase in consumption.
It doubled in the UK and increased by 50% in Turkey. The change was less than 25% in 10 countries.
What about spending on antidepressants?
The cost of antidepressants is a burden 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 countries with the highest spending on antidepressants.
The ratio of antidepressant spending to total pharmaceutical sales suggests a substantial cost in some countries.
Antidepressants accounted for 4% of pharmaceutical sales in Portugal in 2020, compared with 2.7% in Spain, 2.2% in Austria, 1.9% in Turkey and 1.4% in Germany.
Prevalence of chronic depression in Europe
There are no official, comparable data on the proportion of people who report having chronic depression or consulting a psychologist, psychotherapist, or psychiatrist.
However, findings published by Eurostat provide some insight. In 2019, Eurostat found that 7.2% of her EU citizens reported having chronic depression, only a small increase compared to her 2014 (+0.3 %point).
Among EU countries, Portugal (12.2%) had the highest proportion of the population reporting chronic depression in 2019, 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 for reporting chronic depression, Iceland (15.6%) and Portugal (12.2%), will have the highest consumption of antidepressants in 2020 with 153 DDD and 131 DDD respectively. That’s it.
Impact of COVID on Mental Health
A recent study released by the OECD found that mental health has deteriorated significantly since the start of the COVID‑19 pandemic.
Since March 2020, 15 selected OECD countries, including several European countries, have increased the prevalence of anxiety and depression.
The prevalence of anxiety disorders in early 2020 was double or more than double that observed 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 more than double that observed in previous years in Mexico, Australia, Belgium, Canada, France, the Czech Republic, Mexico, Sweden, the United Kingdom and the United States. .
However, due to differences in survey methods, comparisons cannot be made reliably across countries.
Has antidepressant consumption increased during COVID?
With the prevalence of anxiety and depression rising significantly during the COVID-19 pandemic, has antidepressant consumption also increased?
The 14 OECD countries with available data will see consumption increase by more than 10% between 2019 and 2021. For example, usage increased by 22% in Latvia during those two years, but only by 1% in Hungary.
However, this is against the backdrop of a steady trend of increasing consumption of antidepressants over the past two decades. Further research is therefore needed to understand the impact of the pandemic on these recent increases.
Why Is Antidepressant Consumption Increasing?
There are several potential explanations for this rise over the last two decades.
Researchers who studied the impact on antidepressant prescribing trends in the UK from 1995 to 2011 found that this increase was due to improved depression awareness, availability of new AD medications, and patient/GP attitudes. suggested that it may be due to change, availability of therapeutics, and evolving clinical practice. guidelines and expanding the range of indications treated in AD.
