Attitudes to mental health could explain variable antidepressant use across Europe

Research suggests economic factors and stigma associated with mental health could affect use of and adherence to antidepressants.

Researchers found that people living in EU countries were more likely to take antidepressants if the country had high levels of healthcare spending. In the image, stressed businessman about to take an antidepressant

Levels of healthcare spending and the attitude of a country’s population to mental health could explain the variation in the use of antidepressants across the European Union (EU), say the authors of research published in The
British Journal of Psychiatry
on 9 July 2015.

Researchers found that people living in EU countries were more likely to take antidepressants if the country had high levels of healthcare spending, and if the population believed people who are mentally ill are dangerous.

Antidepressant use was lower and less regular in countries where the population believed people never recover from mental illness or that mental illness is a person’s own fault.

The researchers, led by Sara Evans-Lacko from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, also discovered that patients are more likely to take their antidepressants regularly in countries with a high per capita health spend, and if the society is more likely to think that people with mental illness are unpredictable.

“These findings provide further evidence for the relationship between stigma and treatment for mental illness,” say the researchers.

The study charted antidepressant prescribing rates by individual country and whether those people taking antidepressants took them regularly.

Across 27 EU member states, an average of 7.2% of adults had taken antidepressants in the previous 12 months.

Individual country rates varied widely — Portugal had the highest rate at 15.7% and Greece had the lowest rate at 2.7%. The UK came fourth in the table (rate not stated).

Sweden had the highest percentage of antidepressant users who took their medication regularly (89%), closely followed by the UK. Bulgaria was at the bottom of the table with 19%.

The researchers found no correlation at a country level between the prevalence of antidepressant use and the proportion of antidepressant users reporting regular use.

Caroline Parker, adult mental health consultant pharmacist at Central & North West London NHS Foundation Trust, says having high rates of antidepressant prescribing is not necessarily desirable.

“Talking therapies are recommended as first-line treatment (before antidepressants) for most cases of depression,” she says, adding that rates of prescribing do not necessarily correlate with adherence.

“There is little purpose in countries spending significant monies on prescribing lots of antidepressants that are then not taken regularly or for long enough to be effective,” she says. “This study is an important reminder that if an antidepressant is required, and is prescribed, it needs to be taken regularly to be useful.”

Katherine Delargy, deputy chief pharmacist at Barnet, Enfield and Haringey Mental Health NHS Trust, and director of the College of Mental Health Pharmacy, says the fact that the UK appears high in the ranking for levels of antidepressant use should not automatically be viewed in a negative light.

“Antidepressants are a core evidence-based treatment in moderate to severe depressive disorder and the effects of stigma on people accessing services are in fact most pertinent,” she says. 


[1] Lewer D, O’Reilly C, Mojtabai R et al. Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors. The British Journal of Psychiatry 2015. doi:0.1192/bjp.bp.114.156786 .

Last updated
The Pharmaceutical Journal, PJ, 25 July/1 August 2015, Vol 295, No 7872/3;295(7872/3):DOI:10.1211/PJ.2015.20068995

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