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Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications

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Abstract

Purpose

Drug utilization studies have applied different methods to various data types to describe medication use, which hampers comparisons across populations. The aim of this study was to describe the time trends in antidepressant prescribing in the last decade and the variation in the prevalence, calculated in a uniform manner, in seven European electronic healthcare databases.

Methods

Annual prevalence per 10,000 person-years (PYs) was calculated for 2001–2009 in databases from Spain, Germany, Denmark, the United Kingdom (UK), and the Netherlands. Prevalence data were stratified according to age, sex, antidepressant type (selective serotonin re-uptake inhibitors [SSRIs] or tricyclic antidepressants [TCAs]) and major indications.

Results

The age- and sex-standardized prevalence was lowest in the two Dutch (391 and 429 users per 10,000 PYs) and highest in the two UK (913 and 936 users per 10,000 PYs) populations in 2008. The prevalence in the Danish, German, and Spanish populations was 637, 618, and 644 users per 10,000 PY respectively. Antidepressants were prescribed most often in 20- to 60-year-olds in the two UK populations compared with the others. SSRIs were prescribed more often than TCAs in all except the German population. In the majority of countries we observed an increasing trend of antidepressant prescribing over time. Two different methods identifying recorded indications yielded different ranges of proportions of patients recorded with the specific indication (15–57 % and 39–69 % for depression respectively).

Conclusion

Despite applying uniform methods, variations in the prevalence of antidepressant prescribing were obvious in the different populations. Database characteristics and clinical factors may both explain these variations.

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Acknowledgements

The research leading to these results was conducted as part of the PROTECT consortium (Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium, www.imi-protect.eu), which is a public–private partnership coordinated by the European Medicines Agency. Roman Gerlach and Martin Tauscher from the KVB (National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany) are acknowledged for their support in data acquisition.

Funding

The PROTECT project has received support from the Innovative Medicine Initiative (IMI) Joint Undertaking (www.imi.europa.eu) under Grant Agreement no. 115004, the resources of which are composed of financial contributions from the European Union’s Seventh Framework Programme (FP7/2007-2013) and the kind contribution of the EFPIA companies. In the context of the IMI Joint Undertaking (IMI JU), the Department of Pharmacoepidemiology, Utrecht University, also received a direct financial contribution from Pfizer. The views expressed are those of the authors only and not of their respective institutions or companies.

The Division of Pharmacoepidemiology and Clinical Pharmacology has received unrestricted funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the privately/publically funded Top Institute Pharma (www.tipharma.nl), includes co-funding from universities, government, and industry), the EU Innovative Medicines Initiative (IMI), the EU 7th Framework Program (FP7), the Dutch Ministry of Health, and industry (including GlaxoSmithKline, Pfizer, and others).

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Authors and Affiliations

  1. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, P.O. Box 80 082, Utrecht, The Netherlands

    V. Abbing-Karahagopian, P. C. Souverein, H. G. M. Leufkens, F. de Vries, M. C. H. de Groot, O. H. Klungel, T. P. van Staa, L. van Dijk, A. C. G. Egberts, H. Gardarsdottir & M. L. De Bruin

  2. BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain

    C. Huerta, M. Gil & B. Oliva

  3. Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain

    F. de Abajo

  4. Department of Pharmacology, School of Medicine, University of Alcalá, Madrid, Spain

    F. de Abajo & G. Requena

  5. MEB, Medicines Evaluation Board, Utrecht, The Netherlands

    H. G. M. Leufkens & M. L. De Bruin

  6. EMA, European Medicines Agency, London, UK

    J. Slattery & Y. Alvarez

  7. Merck KGaA, Geneva, Switzerland

    M. Miret

  8. National Institute for Health Data and Disease Control, Copenhagen, Denmark

    U. Hesse

  9. Department of Clinical Pharmacy and Toxicology University Medical Center Maastricht and School for Public Health and Primary care (CAPHRI), Maastricht University, Maastricht, The Netherlands

    F. de Vries

  10. Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig-Maximilians-Universitaet, Munich, Germany

    M. Rottenkolber

  11. Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany/Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic, Wuppertal, Germany

    S. Schmiedl

  12. Pfizer, New York, NY, USA

    R. Reynolds

  13. Global Clinical Epidemiology, Novartis Pharma AG, Basel, Switzerland

    R. G. Schlienger

  14. CPRD, Clinical Practice Research Datalink, London, UK

    T. P. van Staa

  15. NIVEL, Netherlands Institute for Healthcare Research, Utrecht, The Netherlands

    L. van Dijk

  16. UMCU, University Medical Center Utrecht, Utrecht, The Netherlands

    A. C. G. Egberts & H. Gardarsdottir

Authors
  1. V. Abbing-Karahagopian
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  2. C. Huerta
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  3. P. C. Souverein
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  4. F. de Abajo
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  5. H. G. M. Leufkens
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  6. J. Slattery
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  7. Y. Alvarez
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  8. M. Miret
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  9. M. Gil
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  10. B. Oliva
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  11. U. Hesse
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  12. G. Requena
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  13. F. de Vries
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  14. M. Rottenkolber
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  15. S. Schmiedl
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  16. R. Reynolds
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  17. R. G. Schlienger
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  18. M. C. H. de Groot
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  19. O. H. Klungel
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  20. T. P. van Staa
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  21. L. van Dijk
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  22. A. C. G. Egberts
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  23. H. Gardarsdottir
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  24. M. L. De Bruin
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Corresponding author

Correspondence to M. L. De Bruin.

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Abbing-Karahagopian, V., Huerta, C., Souverein, P.C. et al. Antidepressant prescribing in five European countries: application of common definitions to assess the prevalence, clinical observations, and methodological implications. Eur J Clin Pharmacol 70, 849–857 (2014). https://doi.org/10.1007/s00228-014-1676-z

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