Factors associated with high and increasing trends of antidepressant consumption: a nationwide study of Portugal.

Abstract

Abstract Background: Portugal ranks high among OECD countries in terms of antidepressant drug (AD) consumption. Between 2000 to 2020, AD consumption in Portugal experienced a 4-fold increase (from 32 DID to 131 DID). It is yet to be described how AD consumption evolved since then and whether AD consumption increased similarly across different populations or subgroups. This study aims to identify factors associated with higher rates and increasing trends of antidepressant dispenses in community pharmacies in Portugal from April 2017 until March 2022. Methods: This nationwide retrospective observational study analyzed pharmacy sales data of prescription-only antidepressants in Portugal using the Phollow database, covering 83% of total pharmacies. The study included individuals aged 12 years and older. Antidepressant consumption was measured in Defined Daily Doses per 1000 inhabitants per day (DID) and analyzed across various socio-demographic variables and healthcare settings. Linear regression models were used to assess trends and Analysis of Covariance (ANCOVA) was used to compare trends between groups. Results: The AD consumption increased at a rate of 0.80 DID per month, reaching an average of 131.41 DID in the last 12 months of the study. Females showed higher consumption rates and a greater increase over time compared to males (176.59 vs. 64.86 DID). AD use increased with age, with the highest consumption levels and rates on increase observed in individuals aged 85 and above (288.90 DID and 1.73 DID/month, respectively). Geographic disparities were noted, with rural areas showing rapid growth in AD consumption. Economic factors also influenced consumption, with the highest growth observed in municipalities with mid-range purchasing power. Conclusion: The study highlights significant trends and disparities in AD consumption in Portugal, influenced by gender, age, geographic location, and economic factors. These findings can inform public health interventions and policies to address mental health needs and reduce disparities in antidepressant consumption. Keywords: Portugal, Antidepressant consumption, Increasing trends, Dispensed drugs, Geographic variation, Socioeconomic factors.