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Pie charts showing the share of the market (in terms of DDD/1000 population/day) for each psychotropic class in 2000 and 2011. Note the 2011 figure is 58% larger in area to graphically represent the growth in the psychotropic drug market as a whole.
Source publication
Objective:
This study examined longitudinal trends in the dispensing of psychotropic medications in Australia from January 2000 to December 2011.
Method:
Dispensing data for the major classes of psychotropic medications (antidepressants, anxiolytics, sedatives, antipsychotics, mood stabilisers and attention-deficit hyperactivity disorder (ADHD)...
Contexts in source publication
Context 1
... results are reported in Figures 1-8. To enhance clarity, drugs that were only minimally dispensed are not presented in the figures, but are noted in the legends and in Table ...
Context 2
... all psychotropic drug classes were considered, the combined DDDs/1000/day was 82.4 in 2000 and 130.4 in 2011, equating to a 58.2% increase in dispensing over this interval. Figure 1 shows the contribution of each psycho- tropic drug class to total psychotropic dispensing in 2000 and 2011. As shown in Figure 2A, antidepressants were largely responsible for the major increase in dispensing across the study period, with DDDs/1000/day increasing at an aver- age rate of 5.7% (cumulative) per year (95.3% over the study period). By 2011, antidepressants were the most commonly dispensed class, representing 66.9% of total psychotropic DDDs/1000/day and 57.9% of psychotropic prescriptions dispensed ( Figure ...
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Citations
... Amongst the varying approaches to quantify drug consumption incidence, the DID is frequently suggested as a reference proxy for incidence [5,24], providing a uniform, drug-independent perspective on a population's consumption patterns. Notwithstanding its relevance for precise nation-wide assessments, most studies are constrained by observability limitations such as the restriction to subpopulations [20,34], the reliance on self-reported data [5], or outpatient prescriptions [24,34]. ...
... Amongst the varying approaches to quantify drug consumption incidence, the DID is frequently suggested as a reference proxy for incidence [5,24], providing a uniform, drug-independent perspective on a population's consumption patterns. Notwithstanding its relevance for precise nation-wide assessments, most studies are constrained by observability limitations such as the restriction to subpopulations [20,34], the reliance on self-reported data [5], or outpatient prescriptions [24,34]. ...
The increasing prevalence of mental health disorders has been matched with growing psychotropic drug consumption rates around the world. Assessing psychopharmacoepidemiological trends and their determinants is essential to guide medical care delivery and public health policies. However, nation-wide studies on up-to-date consumption patterns are scarce and generally disregard important pharmacological, medical, sociodemographic, and economic covariates. Previous studies on the Portuguese case, a case known for critically high consumption rates of benzodiazepines and antidepressants, are limited to the COVID-19 pre-pandemic period. This study uses the full (electronic) dispensation registry of antidepressants, benzodiazepines and zolpidem, antipsychotics and mood stabilisers in Portugal during the years of 2019 to 2022 with the goal of identifying relevant prescription and consumption patterns prior to, during and after the COVID-19 pandemic. Our findings show a consumption growth trend in antidepressants (7.41% yearly DIDs, P = 0.0215) accelerated since 2020, confirmed by the growing number of users (+15% of the population), overtaking benzodiazepines and zolpidem as the class with most active users. The total annual expenditure has increased 14M Euros between 2020 and 2022 (nearly 2M Euros in public copayment), notwithstanding price drops in diverse antipsychotic drugs.
... Psychopharmaceutical medications are noted for being the most commonly prescribed drugs worldwide, making the issue of overprescription a heated topic in medicine and psychiatry (Britt et al., 2012). As clear evidence of their overuse, the past decade or so has witnessed significant growth in the dispensing of psychotropic drugs in Australia, with an over 58% increase from 2000 to 2011 (Stephenson et al., 2013). Additionally, the use of psychopharmaceutical drugs is ballooning in almost all industrialised nations of the world (Alduhishy, 2018). ...
Purpose
Despite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental health services, there is a lack of in-depth studies specifically focusing on Bosnian refugees in Australia – one of the largest ethnic groups of displaced peoples. This qualitative investigation seeks to convey the experiences of mental health services by five Bosnian refugees in Melbourne, highlighting perceived pathways and barriers to service utilisation. This study aims to address two primary research questions: firstly, what characterises the experiences of Bosnian refugees in Australia when accessing mental health services? Secondly, what are the main barriers encountered by this population when seeking mental health services?
Design/methodology/approach
This study used qualitative inquiry and in-depth interviews to investigate the experiences of Bosnian refugees with mental health services in Australia. Data was collected through face-to-face interviews with five Melbourne-based Bosnian refugees who had previously accessed mental health services. Participants were recruited from community groups or associations using purposive sampling. Thematic analysis was used.
Findings
Key themes were revealed, such as the crucial role of social and community services, preferences for individual vs group therapy, potential re-traumatisation from therapeutic engagement, distrust of government-run mental health services and concerns regarding psychopharmaceutical prescription practices. Addressing barriers to mental health service access necessitates a multifaceted approach, including flexible social and community service support, an increased number of co-ethnic professionals and a recognition of cultural variations for effective service provision. Implementing these strategies can enhance help-seeking behaviours, provide culturally appropriate mental health services and improve the experiences of Bosnian refugees in Australia.
Originality/value
To the best of the authors’ knowledge, this study is the first to qualitatively explore how Bosnian refugees in Melbourne perceived the adequacy and availability of mental health services upon arrival to Australia. They are a large and potentially vulnerable community, due to experiences of war trauma and dislocation from country of origin. A lack of understanding regarding how this cohort engage with mental health services can lead to persistent inequities and ineffective service provision. This study identifies unique experiences and perspectives of Bosnian refugee participants, including distrust of government-run mental health services, and concerns regarding psychopharmaceutical prescription practices. This research is expected to contribute positively to the discourse on mental health service provision for Bosnian refugees and wider refugee communities in Australia.
... SGAs were perceived to have a better adverse effect profile with regard to neurological manifestations and are now the most commonly prescribed antipsychotics (Chokhawala and Stevens, 2022). There has been a steady increase in antipsychotic utilisation over the years, both globally and in Australia, mainly attributed to the SGAs (Hálfdánarson et al., 2017;Harrison and Britt, 2003;Karanges et al., 2014;Stephenson et al., 2013;Su et al., 2020). In contrast, the global burden of schizophrenia, measured in terms of agestandardised incidence rates, decreased slightly from 1990 to 2017, while the age-standardised rate of DALYs (disability-adjusted life years) remained stable (He et al., 2020). ...
Objective
To determine antipsychotic utilisation patterns in Australian adults from 2005 to 2021, with a focus on on-label and off-label prescriptions.
Methods
We examined antipsychotic dispensing trends in adults from 2005 to 2021 using a 10% sample of the Pharmaceutical Benefits Scheme (PBS) dataset, which contains patient-level information on medicines dispensed throughout Australia. The lack of diagnostic information in PBS was substituted by analysing BEACH (Bettering the Evaluation And Care of Health) dataset, a cross-sectional national survey from 2000 to 2016, consisting of data from general practitioner–patient encounters.
Results
There were 5.6 million dispensings for 164,993 patients in PBS throughout this period; 69% patients had >1 dispensing, with a median of 6 per patient. Calculating the estimated period of exposure gave a total of 693,562 treatment episodes, with a median duration of 80 days. There were steady increases in both the incidence and prevalence of antipsychotic dispensings, mainly due to oral second-generation antipsychotics. The most commonly prescribed antipsychotics were quetiapine, olanzapine and risperidone, with a significant portion of patients receiving low-dose quetiapine without dose titration. Analysis of diagnostic indications from BEACH indicated that 27% of antipsychotic prescriptions were off-label for indications such as depression, dementia, anxiety and insomnia, at much lower prescribed daily dosages.
Conclusion
The increasing prescribing and off-label use highlights concerns about chronic adverse effects caused by antipsychotics. The combined analysis of medication dispensings and the diagnostic indications for which they are prescribed is a novel approach and throws a spotlight on the need for additional monitoring of antipsychotics.
... Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants around the world, accounting for more than 50% of all antidepressant prescriptions. [1][2][3][4] Most SSRIs are prescribed for the treatment of depression. 5 6 Over recent years, use of higher than standard licensed SSRI doses for depression treatment has increased in UK primary care and elsewhere. ...
... There has been ample discussion about the effective treatment of anxiety over the last two decades and updated clinical practice guidelines have been published in Australia and internationally [2,3,15]. In particular, as the overuse and limitations of benzodiazepines for anxiety are well documented (e.g., [16]), practice guidelines emphasise a move away from these medications. Formal monitoring and restrictions on benzodiazepines have also been introduced, and the use of these medications generally has been declining [17]. ...
Background
Anxiety disorders are highly prevalent mental health conditions managed predominantly by general practitioners (GPs). This study aimed to examine the management of anxiety by Australian GPs since the introduction of the Better Access to Psychiatrists, Psychologists and General Practitioners initiative in 2006.
Methods
We conducted secondary analysis of Bettering the Evaluation and Care of Health data on GP encounters for anxiety from 2006 to 2016 (N = 28,784). We calculated point estimates and used multivariate logistic regression to explore the effect of GP and patient characteristics on rates and types of management.
Results
The management rate of anxiety increased from 2.3% of GP encounters in 2006 to 3.2% in 2016. Over the 10-year period, increases were seen in referrals to psychologists (AOR = 1.09, 95%CI = 1.07–1.11, p < .0001) and selective serotonin / serotonin-noradrenalin reuptake inhibitors (AOR = 1.05, 95%CI = 1.03–1.06, p < .0001), and benzodiazepines decreased (AOR = 0.94, 95%CI = 0.92–0.95, p < .0001). Systematic differences in management were found for patient and GP characteristics, including high rates of benzodiazepines in certain groups.
Conclusions
Anxiety is accounting for more of the GP workload, year on year. GP management of anxiety has become more closely aligned with practice guidelines since 2006. However, high rates of benzodiazepine prescribing in certain groups remains a concern. Further research is needed into GP treatment decision making for anxiety.
... psychotherapeutic and psychotropic interventions over the past few decades (Olfson et al., 2015;Stephenson et al., 2012), anxiety and depression continue to be highly prevalent and burdensome disorders (Ciobanu et al., 2018;Jorm et al., 2017). Identifying modifiable risk factors that could inform treatment strategies is therefore increasingly important. ...
Background
Emerging evidence suggests that a healthier diet is associated with a reduced risk for depressive symptoms. However, the relationships between diet quality and clinical depression and anxiety have not been established. This systematic review is the first to examine whole-of-diet associations in cohorts with diagnosed depression and/or anxiety disorders.
Methods
Literature searches captured 44 studies reporting on diet quality (22 cross-sectional, 12 prospective, seven combining cross-sectional/longitudinal data) OR using a dietary intervention in adults with depression and/or anxiety diagnoses (3 RCTs). A best-evidence synthesis of 25 observational studies of higher methodological quality was conducted.
Results
There was strong evidence that adherence to a Mediterranean diet was associated with lower depression incidence in prospective studies. Level of adherence to national dietary guidelines was not consistently associated with anxiety and depression. Studies which examined other dietary quality measures reported conflicting or limited evidence in relation to both anxiety and depression, with considerably fewer studies reported in anxiety. Some dietary interventions showed promising findings in relation to improvements in depression/anxiety outcomes, however, a range of methodological limitations warrant further consideration.
Limitations
Heterogeneity across studies was high which limited the ability to compare findings and precluded meta-analysis.
Conclusions
High-quality prospective studies generally support evidence that increased adherence to a Mediterranean diet may be a cost-effective and safe adjunct to existing therapies for clinical depression, which is supported by the findings of several dietary interventions.
... Finally, depression is a highly prevalent condition, with recent figures that more than 10% of Australians are prescribed antidepressant medications (Stephenson et al., 2013;Brett et al., 2017). Medicinal cannabis prescribing for depressive disorders is low relative to other psychiatric indications, but is on the rise. ...
Objective: Evidence is accumulating that components of the Cannabis sativa plant may have therapeutic potential in treating psychiatric disorders. Medicinal cannabis (MC) products are legally available for prescription in Australia, primarily through the Therapeutic Goods Administration (TGA) Special Access Scheme B (SAS-B). Here we investigated recent prescribing practices for psychiatric indications under SAS-B by Australian doctors.
Methods: The dataset, obtained from the TGA, included information on MC applications made by doctors through the SAS-B process between 1st November 2016 and 30th September 2022 inclusive. Details included the primary conditions treated, patient demographics, prescriber location, product type (e.g., oil, flower or capsule) and the general cannabinoid content of products. The conditions treated were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR). Trends in prescribing for conditions over time were analyzed via polynomial regression, and relationships between categorical variables determined via correspondence analyses.
Results: Approximately 300,000 SAS-B approvals to prescribe MC had been issued in the time period under investigation. This included approvals for 38 different DSM-5-TR defined psychiatric conditions (33.9% of total approvals). The majority of approvals were for anxiety disorders (66.7% of psychiatry-related prescribing), sleep-wake disorders (18.2%), trauma- and stressor-related disorders (5.8%), and neurodevelopmental disorders (4.4%). Oil products were most prescribed (53.0%), followed by flower (31.2%) and other inhaled products (12.4%). CBD-dominant products comprised around 20% of total prescribing and were particularly prevalent in the treatment of autism spectrum disorder. The largest proportion of approvals was for patients aged 25–39 years (46.2% of approvals). Recent dramatic increases in prescribing for attention deficit hyperactivity disorder were identified.
Conclusion: A significant proportion of MC prescribing in Australia is for psychiatry-related indications. This prescribing often appears somewhat “experimental”, given it involves conditions (e.g., ADHD, depression) for which definitive clinical evidence of MC efficacy is lacking. The high prevalence of THC-containing products being prescribed is of possible concern given the psychiatric problems associated with this drug. Evidence-based clinical guidance around the use of MC products in psychiatry is lacking and would clearly be of benefit to prescribers.
... The outcome of this battle appears to be the 'cancelling out' of each position, most clearly articulated in the standoff between the 'International Consensus Statement on ADHD' (Barkley 2002) and the 'Critique of the International Consensus Statement on ADHD' (Timimi 2004). Despite this, diagnosis and treatment with stimulant medication continues apace: in Scotland, between 2002 and 2011, the increase in prescriptions was 105% (General Register Office for Scotland 2013) with Australia seeing an increase of 73% between 2000 and 2011 (Stephenson, Karanges, and McGregor 2012). ...
The article elaborates the theoretical and methodological foundations of a Foucauldian-inspired critical ethnographic investigation of Attention Deficit Hyperactivity Disorder (ADHD). The aim was to consider ADHD from outside its dominant biomedical explanation as a means of problematizing the increasing usage within schools and health services. The investigation targeted the conditions that made it possible to say and do ADHD, for it to be enacted by various professionals. Thus, the investigation does not to engage with ADHD as a 'real' condition, but reconnects wider historic, social, political, institutional and discursive events within and across apparatuses of health and education that were influential in the emergence of a 'treatment' approach to ADHD. The approach, instead of 'treating' a 'real' condition, legitimated inscription of the biomedical explanation, individualized an array of difficulties as 'symptoms', and allowed for the governance of young people through psychostimulant medication. ARTICLE HISTORY
... The increasing prevalence, recognition and public awareness of depression and anxiety disorders, and generally of mental disorders, and the improved diagnosis of these conditions might contribute to this increase. Additionally, the number of therapeutic indications changed over time, at present ADs being also used as first-line treatment in anxiety disorders, panic attacks, agoraphobia and post-traumatic stress disorder (Stephenson et al., 2013;Estrela et al., 2020). The prominent increase of ADs utilization in the present study was largely driven by rises in the utilization of SSRIs, but also of other ADs, such as SNRIs and NaSSAs. ...
... The financial support from national health insurance and the possibility of the FM physicians to initiate the therapy for some ADs highly influence the prescription choice. Even if the efficacy of ADs cannot be clearly differentiated among the available classes, the better tolerability of SSRIs, the once-daily administration, and the less dose-titration needed as compared to TCAs explain their increasing uptake over time (Stephenson et al., 2013). ...
... However, they can be prescribed in the case of various other psychiatric disorders, including major depressive disorder, substance abuse, anxiety disorders, sleep disorders, autism spectrum disorders or aggression and behavioral symptoms of dementia in elderly. These expanded approved indications and even the increasing off-label use of APs could also explain their rise in utilization (Stephenson et al., 2013;Forns et al., 2019). On the other side, for some compounds, such as thioridazine, severe side effects supported the withdrawal of the marketing authorization in 2005 (severe cardiac arrhythmias) (McNaughton et al., 2014). ...
Background: Mental disorders can have a significant impact on patients' life, including economic, social and individual consequences, and psychotropic medication is essential to treat these conditions. Psychotropic drug utilization studies contribute to a clearer picture of the management of these conditions. Data published from Romania on this topic is limited. The present study aims to characterize the utilization patterns of anxiolytics, antidepressants (ADs), and antipsychotics (APs) in Romania during 1998-2018. Methods: Drug utilization data were provided by Management Center for Documentation, Information and Marketing (CEGEDIM) Romania and quantitative data for each psychotropic medicine were converted to total defined daily doses (DDDs) and to DDD/1000inhabitants/day (DDD/TID). The total use of medicines in DDD/TID was computed in order to obtain the drug utilization 90% (DU90%) segment. Results: An increasing trend in total utilization of psychotropic medicines in Romania started in 2004. Anxiolytics use was predominant until 2013 and the yearly anxiolytic use over the entire study period remained between 10 and 15 DDD/TID. Diazepam lost popularity over time in detriment of the utilization of other anxiolytic benzodiazepines, such as alprazolam and lorazepam. ADs utilization markedly increased during the study period (the average annual growth rate was 13.66% starting 1999). Selective serotonin reuptake inhibitors (SSRIs) became present on the 2008 DU90% and was the dominant class of ADs, with sertraline being the most prescribed, followed by escitalopram and paroxetine. APs utilization showed an increasing trend from 2003 until 2018. Atypical APs became present on the 2008 DU90%, while typical APs were no longer included in the 2018 DU90%. Among atypical APs, olanzapine was the main agent prescribed, and starting 2010 was followed by quetiapine and risperidone. The uptake of APs long-acting formulations became more evident during the last analyzed years (2015-2018). Conclusion: We observed an increasing utilization of APs and a more prominent increase in ADs utilization in Romania during 1998-2018. The anxiolytic prescribing remained nearly stable during this time. Further research can bring more information on the various factors influencing psychotropic utilization in Romania.
... Even though rendezvous with psychotherapeutic and psychotropic handlings have enlarged over several decades (Olfson et al., 2015;Stephenson et al., 2013), the predominance of depressive disorders remains uncontrollable (Jorm et al., 2017). Consequently, there is an urgent need to gain new insight into the underlying pattern of depressive disorder to develop more effective treatment targets. ...
In recent decades, the primary intention of neuroscientists and psychiatrists been to evaluate the connectivity between brain regions and psychiatric disorders. The amygdala has central immersion in memory alliance, stress response, emotional perception, and automatic responses to emotional stimuli. This paper uses a meta-analysis approach to establish the relationship between structural resting state and functional amygdala connectivity with depression and suicide ideation with suicide behavior. In addition, this study explores the moderating effect of patients' demographic characteristics (gender and age) based on an effect meta-analysis of 30 studies. The results show that structural amygdala connectivity is positively related to the instability of depression, while for resting and task functional connectivity amygdala shows a significant negative connection with depression. Furthermore, the amygdala showed partial activation for non-suicide self-injuries and suicide ideation. From structural and functional magnetic imaging, the findings also support the moderating effect of the age of the participants on amygdala connectivity with psychiatric conditions. Generally, amygdala connectivity with psychiatric disorders was not significantly moderate with the role of gender, besides, this study enhances existing hypothetical review articles and further confirms the connectivity of the psychological condition with the amygdala region. It concludes that the amygdala plays a vital role in regulating and responding to emotions.
