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Articles   |    
Consumption of Antidepressants in Italy: Recent Trends and Their Significance for Public Health
Maria Rosaria Gualano, M.D.; Fabrizio Bert, M.D.; Alice Mannocci, Ph.D.; Giuseppe La Torre, M.D.; Patrizia Zeppegno, M.D.; Roberta Siliquini, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300510
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Dr. Gualano, Dr. Bert, and Prof. Siliquini are with the Department of Public Health Sciences, University of Torino, Torino, Italy (e-mail: mariarosaria.gualano@unito.it). Dr. Mannocci and Prof. La Torre are with the Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome. Prof. Zeppegno is with the Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  The study assessed the consumption of antidepressants in Italy between 2000 and 2011 and identified trends in use.

Methods  Data on use of antidepressant drugs between 2000 and 2011 were collected from the Italian Medicines Agency database. Data were expressed as the daily defined dose (DDD) per 1,000 inhabitants. Trends in drug consumption were ascertained by logarithmic transformation of incidence rates by using the formula ln(y)=b × x, where y is the incidence rate, b is the regression coefficient, and x represents the calendar years. Time trends were expressed as expected annual percentage change (EAPC). A significance level of .05 was chosen.

Results  Antidepressant consumption increased drastically between 2000 and 2011, from 8.18 to 36.12 DDD per 1,000 inhabitants per day. A single joinpoint (time point with a significant trend change) occurred in 2002 (EAPC=56.4%, 2000–2002, and 6.2%, 2002–2011). The trend analysis stratified by type of drug showed a huge increase in consumption of selective serotonin reuptake inhibitors and other antidepressants and a decrease in consumption of tricyclic antidepressants.

Conclusions  Mental disorders are less stigmatized now than in the past. In Italy and elsewhere, antidepressant use is growing, and it would be important to monitor this trend, especially considering the possible effects of the current economic crisis on mental health. In this scenario, the role of public health in mental health promotion has become fundamental.

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Figure 1 Trend in consumption of antidepressants in Italy between 2000 and 2011a

a The trend is expressed by expected annual percentage change (EAPC) in defined daily dose per 1,000 inhabitants per day. A significant trend change (joinpoint) occurred in 2002. EAPC 1 (2000–2002) and EAPC 2 (2002–2011) were statistically significant (p≤.05).

Figure 2 Trend in consumption of tricyclic antidepressants in Italy between 2000 and 2011a

a The trend is expressed by expected annual percentage change (EAPC) in defined daily dose per 1,000 inhabitants per day. The EAPC was statistically significant (p≤.05).

Figure 3 Trend in consumption of selective serotonin reuptake inhibitors in Italy between 2000 and 2011a

a The trend is expressed by expected annual percentage change (EAPC) in defined daily dose per 1,000 inhabitants per day. A significant trend change (joinpoint) occurred in 2002. EAPC 1 (2000–2002) and EAPC 2 (2002–2011) were statistically significant (p≤.05).

Figure 4 Trend in consumption of other antidepressants in Italy between 2000 and 2011a

a The trend is expressed by expected annual percentage change (EAPC) in defined daily dose per 1,000 inhabitants per day. The EAPC was statistically significant (p≤.05). Other antidepressants included S-adenosylmethionine (ademetionine), bupropion, duloxetine, hypericum, mirtazapine, oxitriptan, reboxetine, trazodone, trimipramine, and venlafaxine.

Anchor for Jump
Table 1Expected annual percentage change (EAPC) in consumption of antidepressants in Italy, 2000–2011a
Table Footer Note

a Significant changes in the consumption of all antidepressants and selective serotonin reuptake inhibitors (SSRIs), or joinpoints, occurred in 2002.

Table Footer Note

b Tricyclic antidepressants

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