Prepandemic psychotropic drug status in Portugal: a nationwide pharmacoepidemiological profile

Abstract

The prescription of psychotropic drugs has been rising in Europe over the last decade. This study provides a comprehensive profile of prepandemic consumption patterns of antidepressant, antipsychotic, and anxiolytic drugs in Portugal considering full nationwide psychotropic drug prescription and dispensing records (2016–2019) against several criteria, including active ingredient, sociodemographics, medical specialty, and incurred costs. An increase of 29.6% and 34.7% in the consumption of antipsychotics and antidepressants between 2016 and 2019 is highlighted, accompanied by an increase of 37M Eur in total expenditure (> 20M Eur in public copay) for these classes of drugs. Disparities in sociodemographic and geographical incidence are identified. Amongst other pivotal results, 64% of psychotropic drug prescriptions are undertaken by general practitioners, while only 21% undertaken by neurological and psychiatric specialties. Nationwide patterns of psychotropic drug prescription further reveal notable trends and determinants, establishing a reference point for cross-regional studies and being currently assessed at a national level to establish psychosocial initiatives and guidelines for medical practice and training.

Use and misuse of psychoactive medicines: a descriptive cross-sectional study in a densely populated region of Portugal

“…This gender gap in Portugal is reported to be the widest across the EU in what concerns depression (OECD European Observatory on Health Systems and Policies, 2023 ). In our study, this was reflected in the striking difference in AD consumption (triple in women compared to men), in line with previous research (Madeira et al, 2023 ). It is also acknowledged that women, as well as the elderly, have an increased risk of misusing medicines (Araújo et al, 2023 ; Casati et al, 2012 ), resulting in a higher probability of adverse consequences in older females.…”

“…Our study results have shown that psychoactive medicine users are more likely to be females, confirming previously published data (Carmona Araújo et al, 2023 ; Conselho Nacional de Saúde, 2019 ; Coordenação Nacional da Estratégia do Medicamento e dos Produtos de Saúde, 2017 ; INFARMED, 2017 , 2020 ; Faria Vaz et al, 2017a ). Existing evidence points to a higher prevalence of pain (Campbell et al, 2010 ; United Nations Office on Drug and Crime, 2017a ), depression (European Medicines Agency, 2023 ) and anxiety in females (Conselho Nacional de Saúde, 2019 ), which combined with a greater general medicine consumption in the female gender (Boyd et al, 2015 ; Campbell et al, 2010 ; Carmona Araújo et al, 2023 ; Cartagena et al, 2017 ; Delaš Aždajić et al, 2019 ; Hedenmalm et al, 2019 ; Hockenhull et al, 2021 ; Madeira et al, 2023 ; Muller et al, 2019 ; Schjerning et al, 2016 ), contributes to the clear female predominance in psychoactive medicine consumption. This gender gap in Portugal is reported to be the widest across the EU in what concerns depression (OECD European Observatory on Health Systems and Policies, 2023 ).…”

“…Lorazepam, mainly prescribed in primary care, is an intermediate-acting, high potency BZD reported to be a significant predictor of long-term BZD use, dose escalation or heavy use (Kurko et al, 2015 ). Considering that lorazepam is included in the EU(7)-PIM list adapted to Portugal, and also in the most recent updates of both Beers and STOPP and START criteria (2023 American Geriatrics Society Beers Criteria® Update Expert Panel, 2023 ; O’Mahony et al, 2023 ), identifying potentially inappropriate medicines in older patients (Rodrigues et al, 2020 ) who are more susceptible to suffer from BZDR adverse effects (Gomes et al, 2023 ; Madeira et al, 2023 ; Prazeres, 2023 ), and that most ARSLVT lorazepam users are older patients – 53.7% of our chronic lorazepam users were aged 65 or more – the lorazepam chronic use found in our study is a cause for concern. Besides lorazepam, our results have also shown that analgesic buprenorphine and tramadol + paracetamol users are the oldest PMed users (mean 73.6 and 71.5 years, respectively).…”