Global consumption of antidepressants (AD) has increased dramatically over the last two decades, with Europeans being the largest consumers.
The use of antidepressants increased almost 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 shows a dramatic increase in anxiety and depression during the COVID-19 pandemic. Do the happiest countries use less AD drugs? How do researchers explain the sharp rise in antidepressant use?
OECD datasets show defined daily dose (DDD) consumption of “N06A-antidepressants”. This group “consists of preparations used for the treatment of endogenous and exogenous depressions”, according to the World Health Organization (WHO).
Average consumption 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 percent.
But this overall average hides very different starting points for antidepressant use in 2000 in specific countries, ranging from 6.4 DDD in Estonia to 70.5 DDD in Iceland.
The Czech Republic saw the largest increase at 577 percent, while France rose by just 38 percent, making it the lowest change in these countries between 2000 and 2020, albeit from a relatively high level.
It grew by 304 percent in Portugal, 256 percent in the United Kingdom, 208 percent in Spain and 200 percent in Germany over the same period.
A closer look at five selected countries – France, Germany, Portugal, Spain and Sweden – over 20 years shows how the use of antidepressant pharmaceuticals has varied.
Although the increase is very low in France, especially in the last 15 years, in Portugal it has increased in the last two decades.
The race table also shows how the consumption of antidepressants is increasing year on year in European countries. In 14 out of 18 countries, AD drug use has more than doubled.
Which countries have the highest consumption of antidepressants?
Looking at changes over the last decade, we have data for 24 European countries.
In 2020, consumption of AD pharmaceuticals per 1,000 people per day varied from 20 DDD in Latvia to 153 DDD in Iceland. Followed by Portugal (131 DDD), UK (108 DDD in 2017), Sweden (105 DDD) and Spain (87 DDD).
In 2020, the average use in these 24 countries was 68 DDD. The three largest countries by population, namely Turkey (49 DDD), France (55 DDD) and Germany (62 DDD) all recorded below average usage.
Is there a link between happiness and the use of antidepressants?
The short answer is no. The data for 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 consumption of antidepressants in Europe.
Sweden, which ranks sixth in the Happiness Report, has the fourth highest use of antidepressants at 105 DDD.
Finns, who were the happiest nation according to the report, used 82 DDD antidepressants, making 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, is ranked 43rd on the happiness list.
The consumption of antidepressants has 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 have seen a decrease in the use of antidepressants in the last decade, with a 4 percent drop.
Estonia saw the biggest increase with 133 percent, while consumption increased by only 2 percent in France.
In the UK it doubled, and in Turkey it increased by 50 percent. The change was below 25 percent in 10 countries.
What about going on anti-depressants?
The cost of spending on 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 other leading countries for antidepressant spending.
The ratio of antidepressant spending to total pharmaceutical sales suggests that it is a significant expense in some countries.
In 2020, antidepressants accounted for 4 percent of pharmaceutical sales in Portugal, compared to 2.7 percent in Spain, 2.2 percent in Austria, 1.9 percent in Turkey and 1.4 percent in Germany.
The prevalence of chronic depression in Europe
There is no official comparable data on the share of people who reported having chronic depression or consulted a psychologist, psychotherapist or psychiatrist.
However, the survey results published by Eurostat provide some insights. In 2019, Eurostat found that 7.2 percent of EU citizens reported having chronic depression, which is only a slight increase compared to 2014 (+0.3 percentage points).
In 2019, among EU countries, Portugal (12.2 percent) had the highest share of the population reporting chronic depression, followed by Sweden (11.7 percent), Germany and Croatia (both 11.6 percent).
The proportion of people who reported 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 percent) and Portugal (12.2 percent) in reporting chronic depression also had the highest consumption of antidepressants with 153 DDD and 131 DDD in 2020 respectively.
The impact of COVID on mental health
Recent research published by the OECD has shown that mental health has deteriorated significantly since the start of the COVID-19 pandemic.
From March 2020 onwards, the prevalence of anxiety and depression increased in 15 selected OECD countries, including several European ones.
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 UK and the US.
Prevalence of depression at the beginning of 2020 was also double or more than double that seen in previous years in Mexico, Australia, Belgium, Canada, France, Czech Republic, Mexico, Sweden, UK and USA.
However, because research methods differ between studies, it is not possible to offer any robust cross-country comparisons.
Has Antidepressant Consumption Increased During COVID?
While the prevalence of anxiety and depression has increased significantly during the COVID-19 pandemic, has the consumption of antidepressants also increased?
There is an increase of 10 percent 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 the background of a steady upward trend in the consumption of antidepressants over the last 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 who studied the influences on antidepressant prescribing trends in the UK between 1995 and 2011 suggested that the increase could be attributed to improved recognition of depression, availability of new AD drugs, changes in patient/GP attitudes, availability of therapies , the development of the clinical picture. guidelines and expanding the range of indications treated with AD.