Table 1.
Global trends of psychotropic medicine consumption by medicine class in 65 middle-income and high-income countries and regions, 2008–19
|
Consumption (DDD per 1000 inhabitants per day) |
Average annual change in DDD per 1000 inhabitants per day (95% CI) | p value for income level | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | ||||
| All psychotropics | 28·54 | 9·61 | 30·05 | 31·31 | 30·87 | 31·81 | 32·00 | 32·62 | 33·05 | 33·54 | 34·12 | 34·77 | 2·61 (2·37 to 2·85) | <0·0001 | |
| Lower-middle income | 4·97 | 5·24 | 5·43 | 5·89 | 5·83 | 6·03 | 5·98 | 6·25 | 6·53 | 6·59 | 6·97 | 6·77 | 0·88 (0·62 to 1·13) | .. | |
| Upper-middle income | 5·81 | 6·24 | 6·79 | 7·96 | 8·78 | 9·28 | 9·85 | 10·55 | 10·94 | 11·70 | 12·50 | 13·52 | 1·94 (1·45 to 2·44) | .. | |
| High income | 108·42 | 112·21 | 114·57 | 116·92 | 113·73 | 117·11 | 117·33 | 118·80 | 119·94 | 121·04 | 121·91 | 123·61 | 3·31 (3·01 to 3·61) | .. | |
| All antidepressants | 13·20 | 13·87 | 14·38 | 15·16 | 14·98 | 15·68 | 16·12 | 16·83 | 17·39 | 17·99 | 18·77 | 19·76 | 1·33 (1·22 to 1·44) | 0·0003 | |
| Lower-middle income | 1·38 | 1·53 | 1·65 | 1·84 | 1·95 | 2·07 | 2·19 | 2·34 | 2·49 | 2·62 | 2·86 | 2·95 | 0·43 (0·33 to 0·52) | .. | |
| Upper-middle income | 2·45 | 2·69 | 3·03 | 3·56 | 3·95 | 4·26 | 4·62 | 5·08 | 5·40 | 5·94 | 6·44 | 7·09 | 0·70 (0·58 to 0·82) | .. | |
| High income | 51·98 | 54·42 | 56·71 | 58·72 | 57·18 | 59·77 | 61·07 | 63·29 | 65·22 | 66·97 | 69·43 | 72·93 | 1·84 (1·68 to 2·00) | .. | |
| SSRI antidepressants | 8·79 | 9·26 | 9·61 | 10·15 | 9·94 | 10·34 | 10·62 | 11·06 | 11·40 | 11·72 | 12·19 | 12·82 | 0·26 (0·22 to 0·31) | 0·0008 | |
| Lower-middle income | 0·87 | 0·97 | 1·05 | 1·18 | 1·26 | 1·33 | 1·41 | 1·50 | 1·60 | 1·69 | 1·84 | 1·93 | 0·13 (0·09 to 0·17) | .. | |
| Upper-middle income | 1·82 | 2·00 | 2·26 | 2·67 | 2·92 | 3·15 | 3·39 | 3·75 | 3·95 | 4·31 | 4·59 | 5·00 | 0·15 (0·10 to 0·20) | .. | |
| High income | 34·31 | 36·00 | 37·52 | 38·84 | 37·40 | 38·80 | 39·61 | 40·85 | 41·96 | 42·77 | 44·31 | 46·47 | 0·35 (0·28 to 0·42) | .. | |
| SNRI antidepressants | 1·80 | 1·92 | 2·01 | 2·13 | 2·19 | 2·33 | 2·44 | 2·62 | 2·74 | 2·90 | 3·08 | 3·32 | 0·09 (0·08 to 0·11) | 0·0048 | |
| Lower-middle income | 0·09 | 0·12 | 0·14 | 0·17 | 0·19 | 0·21 | 0·23 | 0·24 | 0·26 | 0·29 | 0·32 | 0·34 | 0·02 (0·01 to 0·03) | .. | |
| Upper-middle income | 0·19 | 0·23 | 0·27 | 0·33 | 0·39 | 0·46 | 0·55 | 0·64 | 0·71 | 0·82 | 0·98 | 1·16 | 0·05 (0·03 to 0·06) | .. | |
| High income | 7·50 | 7·96 | 8·37 | 8·75 | 8·86 | 9·39 | 9·74 | 10·35 | 10·77 | 11·29 | 11·78 | 12·58 | 0·13 (0·12 to 0·15) | .. | |
| Tricyclic antidepressants | 1·23 | 1·22 | 1·20 | 1·22 | 1·20 | 1·22 | 1·20 | 1·19 | 1·19 | 1·17 | 1·15 | 1·12 | −0·02 (−0·02 to 0·02) | 0·058 | |
| Lower-middle income | 0·35 | 0·37 | 0·37 | 0·39 | 0·40 | 0·41 | 0·42 | 0·47 | 0·50 | 0·50 | 0·53 | 0·51 | 0·00 (−0·00 to 0·01) | .. | |
| Upper-middle income | 0·31 | 0·30 | 0·32 | 0·35 | 0·37 | 0·36 | 0·37 | 0·37 | 0·37 | 0·39 | 0·38 | 0·37 | −0·00 (−0·01 to 0·00) | .. | |
| High income | 4·35 | 4·30 | 4·25 | 4·24 | 4·07 | 4·20 | 4·10 | 3·96 | 3·93 | 3·82 | 3·71 | 3·66 | −0·03 (−0·04 to 0·03) | .. | |
| Monoamine oxidase inhibitors | 0·04 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·02 | 0·02 | −0·00 (−0·00 to 0·00) | 0·14 | |
| Lower-middle income | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 (0·00 to 0·01) | .. | |
| Upper-middle income | 0·01 | 0·01 | 0·01 | 0·01 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | 0·00 | −0·00 (−0·00 to 0·00) | .. | |
| High income | 0·16 | 0·14 | 0·14 | 0·13 | 0·13 | 0·13 | 0·12 | 0·12 | 0·11 | 0·11 | 0·11 | 0·10 | −0·00 (−0·01 to 0·00) | .. | |
| Antidepressants not otherwise specified | 1·35 | 1·44 | 1·52 | 1·62 | 1·63 | 1·76 | 1·82 | 1·94 | 2·04 | 2·17 | 2·31 | 2·47 | 0·10 (0·9 to 0·11) | 0·0004 | |
| Lower-middle income | 0·06 | 0·07 | 0·08 | 0·09 | 0·10 | 0·12 | 0·13 | 0·14 | 0·14 | 0·14 | 0·16 | 0·16 | 0·03 (0·01 to 0·05) | .. | |
| Upper-middle income | 0·14 | 0·15 | 0·18 | 0·21 | 0·26 | 0·28 | 0·31 | 0·33 | 0·37 | 0·41 | 0·48 | 0·56 | 0·03 (0·02 to 0·03) | .. | |
| High income | 5·67 | 6·03 | 6·44 | 6·75 | 6·72 | 7·25 | 7·50 | 8·01 | 8·44 | 8·98 | 9·52 | 10·12 | 0·16 (0·14 to 0·18) | .. | |
| Mood stabilisers | 0·06 | 0·06 | 0·06 | 0·06 | 0·06 | 0·07 | 0·06 | 0·07 | 0·07 | 0·07 | 0·07 | 0·07 | −0·001 (−0·001 to 0·00) | 0·98 | |
| Lower-middle income | 0·01 | 0·01 | 0·01 | 0·01 | 0·02 | 0·02 | 0·02 | 0·02 | 0·02 | 0·02 | 0·02 | 0·02 | 0·0001 (−0·00 to 0·0003) | .. | |
| Upper-middle income | 0·02 | 0·02 | 0·02 | 0·02 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·03 | 0·04 | −0·000 (−0·001 to 0·000) | .. | |
| High income | 0·22 | 0·22 | 0·22 | 0·23 | 0·22 | 0·23 | 0·22 | 0·22 | 0·22 | 0·22 | 0·21 | 0·21 | −0·001 (−0·001 to 0·001) | .. | |
| Tranquilisers | 7·13 | 7·27 | 7·14 | 7·36 | 7·09 | 7·22 | 7·07 | 7·01 | 6·90 | 6·72 | 6·56 | 6·40 | −0·09 (−0·13 to 0·05) | 0·16 | |
| Lower-middle income | 2·45 | 2·48 | 2·45 | 2·59 | 2·34 | 2·38 | 2·21 | 2·16 | 2·19 | 2·14 | 2·21 | 2·10 | −0·02 (−0·05 to 0·01) | .. | |
| Upper-middle income | 1·90 | 1·96 | 1·99 | 2·38 | 2·49 | 2·50 | 2·52 | 2·62 | 2·63 | 2·70 | 2·77 | 2·84 | 0·14 (0·04 to 0·24) | .. | |
| High income | 24·40 | 24·89 | 24·68 | 24·62 | 23·62 | 24·24 | 23·84 | 23·43 | 22·95 | 22·16 | 21·21 | 20·63 | −0·22 (−0·26 to 0·18) | .. | |
| Sedatives or hypnotics | 5·33 | 5·49 | 5·46 | 5·59 | 5·53 | 5·53 | 5·36 | 5·26 | 5·19 | 5·21 | 5·07 | 4·84 | −0·09 (−0·12 to 0·06) | <0·0001 | |
| Lower-middle income | 0·50 | 0·55 | 0·57 | 0·63 | 0·64 | 0·65 | 0·63 | 0·60 | 0·62 | 0·58 | 0·57 | 0·56 | 0·004 (−0·01 to 0·02) | .. | |
| Upper-middle income | 0·69 | 0·75 | 0·78 | 0·85 | 0·95 | 1·00 | 1·02 | 1·09 | 1·12 | 1·21 | 1·31 | 1·47 | 0·04 (0·02 to 0·06) | .. | |
| High income | 21·65 | 22·24 | 22·36 | 22·67 | 22·25 | 22·21 | 21·49 | 21·00 | 20·64 | 20·72 | 19·96 | 18·66 | −0·17 (−0·22 to 0·11) | .. | |
| All antipsychotics | 2·82 | 2·92 | 3·01 | 3·14 | 3·20 | 3·31 | 3·39 | 3·46 | 3·51 | 3·56 | 3·66 | 3·70 | 0·22 (0·20 to 0·24) | 0·0002 | |
| Lower-middle income | 0·62 | 0·68 | 0·75 | 0·81 | 0·87 | 0·91 | 0·95 | 0·95 | 1·03 | 1·06 | 1·12 | 1·15 | 0·19 (0·13 to 0·25) | .. | |
| Upper-middle income | 0·75 | 0·82 | 0·96 | 1·14 | 1·37 | 1·49 | 1·66 | 1·72 | 1·76 | 1·86 | 1·99 | 2·08 | 0·20 (0·16 to 0·23) | .. | |
| High income | 10·17 | 10·44 | 10·60 | 10·69 | 10·45 | 10·67 | 10·71 | 10·87 | 10·92 | 10·98 | 11·10 | 11·17 | 0·24 (0·21 to 0·27) | .. | |
| Typical antipsychotics | 0·90 | 0·88 | 0·89 | 0·91 | 0·89 | 0·88 | 0·89 | 0·84 | 0·80 | 0·78 | 0·76 | 0·71 | −0·02 (−0·03 to 0·01) | 0·15 | |
| Lower-middle income | 0·22 | 0·23 | 0·25 | 0·23 | 0·24 | 0·23 | 0·22 | 0·19 | 0·18 | 0·18 | 0·19 | 0·18 | 0·02 (−0·02 to 0·07) | .. | |
| Upper-middle income | 0·34 | 0·33 | 0·40 | 0·48 | 0·52 | 0·52 | 0·58 | 0·55 | 0·54 | 0·53 | 0·54 | 0·53 | 0·05 (0·03 to 0·07) | .. | |
| High income | 3·01 | 2·94 | 2·89 | 2·82 | 2·65 | 2·61 | 2·55 | 2·44 | 2·32 | 2·25 | 2·15 | 1·94 | −0·06 (−0·07 to 0·04) | .. | |
| Atypical antipsychotics | 1·89 | 2·01 | 2·08 | 2·19 | 2·27 | 2·40 | 2·47 | 2·59 | 2·67 | 2·74 | 2·87 | 2·96 | 0·24 (0·22 to 0·25) | 0·0001 | |
| Lower-middle income | 0·39 | 0·43 | 0·49 | 0·56 | 0·62 | 0·66 | 0·71 | 0·74 | 0·83 | 0·86 | 0·92 | 0·95 | 0·16 (0·13 to 0·20) | .. | |
| Upper-middle income | 0·40 | 0·47 | 0·55 | 0·64 | 0·84 | 0·96 | 1·06 | 1·15 | 1·21 | 1·31 | 1·44 | 1·53 | 0·15 (0·13 to 0·17) | .. | |
| High income | 7·05 | 7·38 | 7·60 | 7·77 | 7·69 | 7·96 | 8·07 | 8·34 | 8·51 | 8·65 | 8·87 | 9·15 | 0·30 (0·28 to 0·32) | .. | |
DDD=defined daily dose.