The finding showed wide variation in the global prescription, distribution, and use of psychotropics. Brauer, et al. (2021) reported that the global consumption of psychotropic medicine increased from 28.54 defined daily dose (DDD) per 1,000 inhabitants in 2008 to an estimated 34.77 DDD per 1,000 inhabitants in 2019. Antidepressants showed the largest increase in DDD per 1,000 inhabitants, with a relative average increase of 3.5% per year. Antidepressants are closely followed by antipsychotics, with a relative average increase per year of 2.49%. Consumption trends for SSRIs, on the other hand, showed a change from 8.79 DDD per 1,000 inhabitants in 2008 to an annual average increase of 0.26 DDD per 1,000 inhabitants per day. A relative average decrease per year was reported for tranquilizers, hypnotics, sedatives, and mood stabilizers. When the values are spread over years and the trend is observed, the reports are slightly different. In 2019, the aggregated consumption of psychotropic medications was estimated at 123.61 DDD per 1,000 inhabitants in high-income countries; 13.52 DDD per 1,000 inhabitants per day in upper-middle- income countries; and 6.77 DDD per 1,000 inhabitants per day in lower-middle-income countries. In the same vein, high-income countries showed the largest absolute increases in sales of psychotropic medications from
2008 to 2019, at 3.31 DDD per 1,000 inhabitants per day. The trend in the average annual change in sales was also statistically different when compared between countries. With an average annual change in sales, upper-medium-income countries recorded a greater rate, at 1.94 DDD per 1,000 inhabitants per day compared to lower-middle-income countries at 0.8 DDD per 1,000 inhabitants per day. Comparing units of psychotropic medications sold, there was an increase in the sales of psychotropic medications in lower-middle-income countries, except for tranquilizers. In high-income countries, the direct unit sales record for tricyclic antidepressants, typical antipsychotics, tranquilizers, and sedatives or hypnotics decreased. It appears that trends in antidepressant consumption in upper-middle- income countries largely mimic those of high-income countries for SSRIs and other antidepressants. The direct unit sales in high-income-countries for tranquilizers (0.14 DDD per 1,000 inhabitants per day) and sedatives or hypnotics (0.04 DDD per 1,000 inhabitants per day) are greater than those in upper- middle-income countries. These findings established a statistical link between the income level of inhabitants of a country and the trends in psychotropic medication prescription, sales, and distribution. See Figure 1.
Figure 1. Correlation between Psychotropic Medicine Consumption and Healthcare Spending in 64 Countries and Regions in 2018 by Income
Note . From “Psychotropic medicine consumption in 65 countries and regions, 2008–19: a longitudinal study,” by Brauer, et al., 2021. Lancet Psychiatry , 8(12): pp. 1071-1082. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9766760/). Courtesy of the National Library of Medicine (NLM).
There appears to also be a correlation between the trend of psychotropic medication use and the average life expectancy of the inhabitants of a country. The same holds for a country’s average health expenditures over time. Checking the data in this regard, the association between these metrics is largely driven by upper-middle-income countries. The association between changes in the consumption of psychotropic medication and life expectancy was strong for countries of all income levels. For lower-middle-income countries and upper-middle-income countries, there was an association between changes in psychotropic medicine consumption and health expenditures. See Figure 2.
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