Global Trends in Antidepressant, Atypical Antipsychotic, and Benzodiazepine Use: A Cross-sectional Analysis of 64 Countries

Background: Antidepressant, atypical antipsychotic, and benzodiazepine rates of use vary among countries. This study aims to compare trends in mental health drug treatments in countries of different economic statuses.

Objectives: To describe the change in use of antidepressants, atypical antipsychotics, and benzodiazepines among high-, middle-, and low-income countries.

Methods: A cross-sectional time-series analysis by country from July 2014 to December 2019 utilizing IQVIA's Multinational Integrated Data Analysis database was conducted. This dataset comprises hospital and retail medication purchasing data from 64 countries. Population controlled rates of use were calculated in number of standard units of medications per drug class per population size using population data from the United Nations. The United Nations' 2020 World Economic Situation and Prospects was used to group countries into the categories of high-, middle-, and low-income. Percent change in rates of use per drug class were calculated from July 2014 to July 2019. Linear regression analyses were conducted to assess the predictability of percent change in use by utilizing a country's rate of use and economic developmental status as predictor variables.

Results: A total of 64 countries were included: 33 high-, 6 middle-, and 25 low-income countries. The average rates of antidepressant and atypical antipsychotic use across all countries were 0.96 and 0.32 standard units per population, respectively. The rate of use increased in most countries, with an average percent change of 43% for antidepressants (p=0.026) and 58% for atypical antipsychotics (p=0.054). Benzodiazepine use increased in 16, decreased in 46, and remained the same in 2 countries. The average rate of benzodiazepine use across all countries was 1.15 standard units per population, decreasing by 4.67% (p=0.038) from 2014-2019. Average percent change in use for antidepressants in high-, middle-, and low-income countries was 20%, 69%, and 42%, respectively. For atypical antipsychotics it was 27%, 78%, and 69%, respectively. For benzodiazepines, it was -13%, 4%, and -5%, respectively. There was an inverse relationship between economic status and the percent change in use for antidepressants (p=0.916), atypical antipsychotics (p=0.23), and benzodiazepines (p=0.027).

Conclusions: All countries of interest, on average, have experienced increasing rates of antidepressant and atypical antipsychotic use with high-income countries demonstrating a higher rate of treatment utilization compared to low- middle-income countries. Benzodiazepine rate of use has, on average, decreased globally especially for high-income countries. This study highlights potential disparities in mental health treatment among countries and can be used to promote policies to improve treatment utilization globally.