Most of the studies on antidepressant use come from the USA and the UK, although the pattern also seems to hold for other European countries. The rapid rise of antidepressants from niche drugs to mega-sellers is perhaps the single biggest change in the way medicine treats mental illness since the invention of psychiatric drugs.
But while a rise in sales has been observed in many countries, that doesn't mean the same causes were at work in every case. For example, in the USA, there is good evidence that more people have started taking antidepressants over the past 15 years.
In the UK, however, it's a bit more tricky. Antidepressant prescriptions have certainly risen. However, a large 2009 study revealed that, between 1993 and 2005, there was not any significant rise in people starting on antidepressants for depression. Rather, the rise in prescriptions was caused by patients getting more prescriptions each. The same number of users were using more antidepressants.
Now a new paper has looked at antidepressant use over much the same period (1995-2007), but using a different set of data. Pauline Lockhart and Bruce Guthrie looked at pharmacy records of drugs actually dispensed, not just prescribed, and their data only covers a specific region, Tayside in Scotland. The 2009 study was nationwide.
So what happened?
The new paper confirmed the 2009 survey's finding of a strong increase in the number of antidepressant prescriptions per patient.
However, unlike the old study, this one found an increase in the number of people who used antidepressants each year. It went up from 8% of the population in 1995, to 13% in 2007 - an extremely high figure, higher even than the USA.
In other words, more people took them, and they took more of them on average - adding up to a threefold increase in antidepressants actually sold. The increase was seen across men and women of all ages and social classes.
There's no good evidence of an increase in mental illness in Britain in this period, by the way.
But why did the 2009 paper report no change in antidepressant users, while this one did? It could be that the increase was localized to the Tayside area. Another possibility is that there was an increase nationwide, but it wasn't about people with depression.
The 2009 study only looked at people with a diagnosis of depression. Yet modern antidepressants are widely used for other things as well - like anxiety, insomnia, pain, premature ejaculation. Maybe this non-depression-based use of antidepressants is what's on the rise.
Lockhart, P. and Guthrie, B. (2011). Trends in primary care antidepressant
prescribing 1995–2007 British Journal of General Practice
2 comments:
France is way ahead of GB in consumption. I believe it is has the highest rate of Europe. All over the world it rises.
Such coincidences do not exist without a deus ex machina.
The french think the found the reason so just recently proposed outlawing drug representatives doing doctor visits except in some exceptional predeterminded cases.
from Le Monde online:
Mardi 20 septembre, la commission des affaires sociales de l'Assemblée nationale examine pour la deuxième fois le projet de loi relatif au renforcement de la sécurité sanitaire du médicament et des produits de santé. Une loi qui a pour objectif "de redonner confiance aux Français dans notre système du médicament", selon les dires de son instigateur, le ministre de la santé, Xavier Bertrand.
Grâce à ce texte, présenté comme une "refonte" du système, le gouvernement entend réformer la profession des visiteurs médicaux. Ces représentants des laboratoires pharmaceutiques vont à la rencontre les médecins pour vanter les mérites des derniers produits mis sur le marché par leur société, et accessoirement les vendre.
Si le texte est voté en l'état, les visiteurs médicaux devront s'adresser à un collège de médecins et non plus à un seul praticien, en face à face. Une mesure expérimentale, qui ne sera tentée qu'en milieu hospitalier pendant deux ans, les médecins de ville n'étant pas concernés pour le moment.
Tuesday, September 20, the Social Affairs Committee of the National Assembly for the second time examining the bill on enhancing the safety of the drug and health products. A law that aims "to restore confidence to the French in our system of medicine", in the words of its creator, the Health Minister, Xavier Bertrand.
With this text, presented as a "reform" of the system, the government intends to reform the profession of medical representatives. These representatives of pharmaceutical companies are going to meet the doctors to sing the praises of the latest products marketed by their company, and incidentally sell.
If the text is passed in the state, visitors should go to a medical college of physicians and not to a single practitioner, face to face. An experimental measure, which will be attempted only in hospitals for two years, the medical profession is not concerned yet
I agree with the non-depression use as pathway for more prescriptions. Along with your non-depression indications for antidepressants I would add:
1. chronic pain syndromes
2. diabetic neuropathy
3. migraine headache prophylaxis
4. menopausal "hot flash" symptoms
5. motor recovery following stroke
This list is not exhaustive but I think it speaks to a wider therapeutic benefit for these compounds.
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