Christopher Lane Ph.D.

Side Effects


The OECD Warns on Antidepressant Overprescribing

Antidepressant consumption not matched by an increase in global diagnoses.

Posted Nov 22, 2013

The Organisation for Economic Co-operation and Development warned yesterday that antidepressant consumption “has increased significantly in most [Western] countries since 2000,” with Iceland reporting the highest prescription rates in 2011, followed by Australia, Canada, Denmark and Sweden.

In its 2013 edition of Health at a Glance, the organization’s annual report on world health trends in developed countries, the OECD found that antidepressant consumption within those countries has risen sharply, despite a significant slowdown in health-related spending due to government cutbacks. As the Guardian newspaper noted in an excellent summary, the rate of increase in antidepressant consumption is “not matched by [an] increase in global diagnoses, prompting concern among psychiatrists about over-use of medication.”

In its attempt to explain the sharp rise, the OECD suggests that one factor may be “the insecurity created by the economic crisis.” The latter “has had a profound impact on the lives of citizens across the world," an editorial warns, "and has tested the resilience of many families as they see their wealth and incomes decline.” In Spain, for instance, “the consumption of antidepressants per capita increased by 23% between 2007 and 2011”; and, in Portugal, by “20% between 2007 and 2011.”

But as the organization later concedes, the increase in antidepressant consumption in such countries doesn’t explain a comparable or in some cases far-greater rise in countries relatively unscathed by the crisis, such as Germany, which saw “a rise of 46% between 2007 and 2011.”

While the OECD links the rise in antidiabetic and cholesterol-lowering drugs to a pronounced uptick in obesity rates, it notes that for antidepressant use “rising consumption levels can also be explained by the extension of the set of indications of some antidepressants to milder forms of depression, generalized anxiety disorders, or social phobia.” Not only do drug companies seek licenses for a single drug to treat multiple, often dissimilar disorders, but the thresholds for those disorders have often been lowered dramatically by each new edition of the DSM, making it much easier for greater numbers of people to meet their criteria. “These extensions have raised concerns about appropriateness,” the OECD warned.

In its report on the 2013 findings, the Guardian notes, “Figures show that doctors in some countries are writing prescriptions for more than one in 10 adults, with Iceland, Australia, Canada and the other European Nordic countries leading the way. Separate data from the US show that more than 10% of American adults use the medication. In China, the antidepressant market has grown by about 20% for each of the past three years, albeit from a lower base.”

Yet “global rates of depression have not risen to the same extent,” the newspaper observes, “even though more people are being diagnosed in some countries.”

With the previous post on this blog confirming that committees responsible for publishing the International Classification of Diseases are being petitioned to accept new additions from the American Psychiatric Association’s DSM-5, including Disruptive mood dysregulation disorder, Hoarding disorder, and Premenstrual dysphoric disorder—and that the DSM, more generally, is “Americanizing the world’s understanding of the mind” as it exports chiefly U.S. models of illness, the next OECD report is likely to show a still-greater escalation in the use of antidepressants as their manufacturers compete for official licenses for the treatment of those disorders, too.

The OECD report is available here. The Guardian article on it, “Antidepressant use on the rise in rich countries, OECD finds,” appears here.  Follow me on Twitter @christophlane