Mental health in the world and in Europe

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The world is grappling with a mental health crisis: e.g. in Europe, antidepressant consumption has more than doubled during last twenty years. According to recent OECD report, this dramatic increase in consumption of antidepressant drugs, AD – at least in the EU – is mainly due to recent pandemic. However, it is still unclear whether the “happiest countries” use fewer AD and/or what’s the reason of the sharp rise in the consumption of antidepressants?   

Recent OECD datasets demonstrate a defined daily dose (DDD) consumption of a most available medication, i.e. the “N06A-Antidepressants”; this group, according to the World Health Organisation “comprises preparations used in the treatment of endogenous and exogenous depressions”.
So far, the Europeans are the largest consumers: in average, AD-consumption in 18 European countries was 30.5 DDD per 1,000 people per day in 2000 rising to 75.3 DDD in 2020, i.e. almost 150 per cent increase. But this overall average conceals very different starting points for antidepressant use in 2000 in certain countries, ranging from 6.4 DDD in Estonia to 70.5 DDD in Iceland.
The Czech Republic recorded the highest increase with 577 per cent while it only rose by 38 per cent in France making it the lowest change in these countries between 2000 and 2020, albeit from a relatively high level. It rose by 304 per cent in Portugal, 256 per cent in the UK, by 208 per cent in Spain and 200 per cent in Germany in the same period.
In the Nordic countries the increase is over 130 percent; in five selected countries (France, Germany, Portugal, Spain, and Sweden) over two decades 20 years the use of antidepressant pharmaceuticals varies: while the increase is very low in France, especially in the last 15 years, it rocketed in Portugal.

In most European countries, consumption of AD pharmaceuticals per 1,000 people per day varied from a lowest 20 DDD in Latvia to the higest 153 DDD in Iceland, followed by Portugal (131 DDD), the UK (108 DDD in 2017), Sweden (105 DDD) and Spain (87 DDD), with an average use across these 24 countries was 68 DDD.
The largest three European countries by population were Turkey (49 DDD), France (55 DDD) and Germany (62 DDD): i.e. they all recorded below average use.

“Depressed” happiness: no proof
OECD data on European countries suggests, that there are no direct proof that countries with “the happier people” are less antidepressant’s consumers: i.e. Iceland, which was the second happiest country in the world in 2020 (according to the World Happiness Report), has had the highest antidepressant consumption in Europe.
Sweden, which ranked sixth in the happiness report, has the fourth highest use of antidepressants with 105 DDD. Finnish people, who were the happiest nation according to the report, used 82 DDD antidepressants which placed Finland on the seventh rank out of 24 countries.
Latvia which has the lowest consumption with 20 daily doses while ranked 34th in the global happiness report; and Hungary which follows Latvia with 30 DDD was on the 43th place in the happiness report.
The consumption of AD drugs increased by 36.5 per cent during 2010-20 in 24 European countries with average daily use up from 49.8 DDD to 68 DDD. Denmark is the only country with a decrease consumption of antidepressants in the last decade with a 4 percent decline.
Estonia recorded the highest increase with 133 per cent; while consumption only increased only by 2 per cent in France but it doubled in the UK and increased by 50 per cent in Turkey. The statistics show that “positive changes” were recorded in less than 25 per cent in 10 countries.

Cost of consumption
The cost of antidepressant drug spending 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 spending on antidepressants. The ratio of spending on antidepressants to total pharmaceutical sales suggests that it is a significant cost in some countries. In 2020, antidepressant drugs accounted for 4 per cent of pharmaceutical sales in Portugal, compared to 2.7 per cent in Spain, 2.2 per cent in Austria, 1.9 per cent in Turkey and 1.4 per cent in Germany.
Source: OECD report “Antidepressants consumption Daily Defined Dose per 1 000 people per day”.

Levels of chronic depression and anxiety
Among EU countries in 2019, Portugal (with over 12 per cent) had the highest share of the population reporting chronic depression, followed by Sweden (11.7 per cent), with Germany and Croatia (both 11.6 per cent).
The share of people reporting chronic depression –at least in Europe – was lowest in Romania (about one percent), Bulgaria (2.7 percent) and Malta (3.5 percent).
It is interesting that the top two countries Iceland (15.6 per cent) and Portugal (12.2 per cent) in reporting chronic depression also had the highest antidepressant consumption with 153 DDD and 131 DDD in 2020 respectively.
Recent OECD-surveys found that mental health has deteriorated significantly since the start of the covid-pandemic. Thus, since mid-2020, the prevalence of anxiety and depression increased in 15 OECD countries, including several European states: e.g. anxiety was more than doubled in Belgium, France, Italy, Mexico, New Zealand, the UK and the US. The prevalence of depression in early 2020 was also double or greater than double that observed in previous years in Mexico, Australia, Belgium, Canada, France, the Czech Republic, Mexico, Sweden, the UK and the US. However, since the survey methods differ between studies, it is not possible to offer any robust cross-country comparisons.

Some research suggested that increase of the antidepressant consumption during last two decades was due, in part, to the following factors: improved recognition of depression, availability of new AD drugs, changes in patient attitudes, availability of therapies, evolving clinical guidelines, and a broadening of the range of indications treated with ADs. On another hand, scientists believe that covid-pandemic may have altered peoples’ personalities, especially young adults; besides, the issue of a “sharp rise in the consumption of antidepressants” is still far from being clear.

Main source and reference: https://www.euronews.com/next/2023/02/25/europes-mental-health-crisis-in-data-which-country-uses-the-most-antidepressants?utm_source=newsletter&utm.

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