Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market
Rigshospitalet afsnit 3343 The Nordic Cochrane Center Copenhagen, Denmark
Background: During the last 20 years, the usage of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has increased dramatically.
Objective: Our primary aim was to compare the usage of benzodiazepines and SSRIs within the primary care sector in Denmark, and to relate changes in usage to number of indications and number of products on the market.
Methods: We used data from a number of sources to get an overview of usage of psychoactive drugs in the period 1970 to 2007. The data were based on the anatomic therapeutic classification (ATC) system and defined daily doses (DDD). We sought data about change in indications and information about products on the market in The Danish Pharmaceutical Catalogue
Results: The sales and usage of psychoactive drugs fluctuated over time in a way that cannot be explained by disease prevalence or by the number of doctors. The fluctuations were mainly caused by changes in usage of benzodiazepines and SSRIs. We found a decline in the usage of benzodiazepines after a peak in 1986, likely because of the recognition that they cause serious dependency and by initiatives on a national level to curb their use. From a low level of usage in 1992, we found that the usage of SSRIs increased almost linearly, and by a factor of 18, up to 44 DDD per 1000 inhabitants, which was closely related to a similar increase in the number of products on the market (a factor of 16 in the same period). In 2007, the sales of psychoactive drugs were so large that almost a fifth of the population could be treated with either an anxiolytic, a hypnotics or an antidepressant continuously.
Conclusions: The sales of antidepressant drug are mainly determined by marketing pressures. The current level of use suggests overtreatment.