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Cited by 204Mental Health Treatment and AccessPharmaceutical Economics and PolicyHistorical Psychiatry and Medical Practices

Psychotropic medicine consumption in 65 countries and regions, 2008-19: A longitudinal study

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Brauer, Ruth, Alfageh, Basmah, Blais, Joseph E, Chan, Esther W, Chui, Celine S L, Hayes, Joseph F, Man, Kenneth K C, Lau, Wallis C Y +5 more·2021·The Lancet Psychiatry
DOI 10.1016/s2215-0366(21)00292-3PMC PMC9766760
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Abstract

Background The WHO Comprehensive Mental Health Action Plan 2013-2030 encourages routine collection and reporting of a set of essential mental health indicators, including the availability of psychotropic medicines. The global monitoring of country-level psychotropic medicine consumption trends can provide information on the extent of the availability of psychotropic medicines. The primary objective of this study was to investigate global trends in psychotropic medicines consumption from 2008 to 2019 across 65 countries and regions according to country income level and geographical region. Methods In this longitudinal trends study, we used pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS). We analysed monthly sales data of psychotropic medicines between Jan 1, 2008, and Dec 31, 2019. Total psychotropic medicine consumption included sales of antidepressants, antipsychotics, tranquilisers, sedatives or hypnotics, and mood stabilisers. Population estimates of each country or region (eight lower-middle-income countries, 19 upper-middle-income countries, and 38 high-income countries) were based on the UN World Population Prospects 2019 report. Average annual sales trends of psychotropic medicines, expressed as defined daily dose (DDD) per 1000 inhabitants per day, were estimated using a random-effects model adjusted for income level and region. Relative changes in the annual consumption of psychotropic medicines by income, expressed as DDD per 1000 inhabitants per day, were assessed as percentage change for each medicine class. Findings Psychotropic medicine sales increased from 28·54 DDD per 1000 inhabitants per day in 2008 to 34·77 DDD per 1000 inhabitants per day in 2019, corresponding to a 4·08% (95% CI 2·96-5·21) relative average increase annually. The absolute annual increase was greater in high-income countries (3·31 DDD per 1000 inhabitants per day, 95% CI 3·01-3·61) compared with upper-middle-income countries (1·94 DDD per 1000 inhabitants per day, 1·45-2·44) and low-middle-income countries (0·88 DDD per 1000 inhabitants per day, 0·62-1·13; p<0·0001). The relative average annual increase in psychotropic medicine sales from 2008 to 2019 was greater in upper-middle-income countries (7·88%, 95% CI 6·99-8·77) than in lower-middle-income countries (2·90%, 2·40-3·39) and high-income countries (1·02%, 0·80-1·24). In 2019, the regional consumption of psychotropic medicines varied greatly, with the highest sales of all psychotropic medicine classes reported in northern America (167·54 DDD per 1000 inhabitants per day) and lowest sales reported in Asia (5·59 DDD per 1000 inhabitants per day). 17 countries had very low consumption of psychotropic medicines in 2019, including high-income countries and countries with a high prevalence of mental disorders. Interpretation The consumption of psychotropic medicines has increased over a 12-year period, and although the absolute growth rate was highest in high-income countries, the relative growth is highest in middle-income countries and especially upper-middle-income countries. Disparities in psychotropic medicine consumption of countries can only partly be explained by geographical location and income. Greater efforts are needed to increase the availability of psychotropic medicines in countries with very low consumption, which is probably due to financial or cultural reasons as well as scarcity of trained health-care professionals to prescribe psychotropic medicines. Funding None.

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  • Recent Lancet data indicate highest relative growth in psychopharmaceutical use between 2008 and 2019 occurred in lower-middle-income countries across the Global South.

    “Recent data published in The Lancet indicate that the highest relative growth in psychopharmaceutical use between 2008 and 2019 took place in lower-middle-income countries across the Global South (Brauer et al. 2021).”

    From Throwing therapy at the problem mental health and humanitarian intervention in Palabek refugee settlement, northern Uganda (2023) · cites this paper as Brauer et al. 2021

    The Results report the greatest annual percentage increase in standard units per person in lower-middle-income countries (1.99%). But by the paper’s other consumption measure, defined daily doses, relative growth was greatest in upper-middle-income countries (7.88% versus 2.90%). The paper groups countries by income and region; it does not establish the claim’s broader ‘across the Global South’ characterization. (LLM, conf=0.86)

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  1. [39]Vicente Sánchez MP Macías Saint-Gerons D de la Fuente Honrubia C González Bermejo D Montero Corominas D Catalá-López F [Trends of use of anxiolytics and hypnotics in Spain from 2000 to 2011] Rev Esp Salud Pública 87 2013 247 255 23892676
  2. [48]National institute for Health and Care Excellence Depression in adults: recognition and management https://www.nice.org.uk/guidance/cg90/chapter/Context 2009 31990491

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Authors
Brauer, R., Alfageh, B., Blais, J. E., Chan, E. W., Chui, C. S. L., Hayes, J. F., Man, K. K. C., Lau, W. C. Y., Yan, V. K. C., Beykloo, M. Y., Wang, Z., Wei, L., & Wong, I. C. K.
Affiliations
  • UCL School of Pharmacy (GB)
  • King Saud University (SA)
  • University of Hong Kong (HK)
  • Laboratory of Data Discovery for Health (HK)
  • University College London (GB)
Corresponding author
Wong, Ian C K
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2021-12
Volume
8
Issue
12
Pages
1071-1082
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(21)00292-3
PMC
PMC9766760
OpenAlex
W3215716001
Cited by
203
References
39
Citations by year
2026: 55 · 2025: 68 · 2024: 30 · 2023: 31 · 2022: 17 · 2021: 2
FWCI
19.60
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
  • National Institute for Health Research
  • Amgen
  • European Commission
  • Bristol-Myers Squibb
  • National Health and Medical Research Council
  • Pfizer
  • National Natural Science Foundation of China
  • NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
  • Hospital Authority
  • Novartis
  • Food and Health Bureau
  • Takeda Pharmaceutical Company
  • Innovation and Technology Commission - Hong Kong
  • Janssen Pharmaceuticals
  • Wellcome Trust (211085/Z/18/Z)
  • Research Grants Council, University Grants Committee
  • GlaxoSmithKline
  • University of Hong Kong
  • Bayer
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
  • Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
Keywords
psychotropic drugs, antidepressants, antipsychotic drugs, sedative-hypnotic drugs, mood stabilizers, defined daily doses, drug sales, mental health indicators, country income level, global trends, mental health policy, access to mental health care, mental health funding
MeSH terms
Mental Disorders, Drug Utilization, Health Services Accessibility, Humans, Longitudinal Studies, Psychotropic Drugs

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