Psychotropic Drug Use in São Paulo, Brazil – An Epidemiological Survey

Abstract

ObjectiveTo estimate the prevalence of one month psychotropic drug use in São Paulo, Brazil, and to assess the gap treatment between the presence of mental disorders and psychotropic drug users.MethodA probabilistic sample of non-institutionalized individuals from the general population of São Paulo (n = 2336; turnout: 84.5%) who were 15 years or older were interviewed by a trained research staff, applying the Composite International Diagnostic Interview 2.1 (CIDI WHO) (depression, anxiety-phobia, OCD\PTSD, alcoholism sections), and an inventory investigating psychotropic drug use during the 12-month and one-month periods immediately preceding the interview. Logistic models were fitted to investigate associations between psychotropic drug use as well as socio-demographic and clinical variables.ResultsThe one month prevalence of psychotropic drug use in São Paulo was 5.89%, the most commonly used drugs were antidepressants (3.15%) and tranquilizers (2.67%). A higher consumption of psychotropic drugs (overall, antidepressants and tranquilizers) was observed among women (OR:2.42), older individuals (OR:1.04), individuals with higher levels of formal education (1.06), and individuals with a family (OR:2.29) or personal history of mental illness (OR:3.27). The main psychotropic drug prescribers were psychiatrists (41%), followed by general practitioners (30%); 60% of psychotropic drugs were obtained through a government-run dispensing program. Most individuals who obtained a positive diagnosis on the CIDI 2.1 during the previous month were not using psychotropic medication (85%). Among individuals with a diagnosis of moderate to severe depression, 67.5% were not on any pharmacological treatment.ConclusionThere is a change in the type of psychotropic more often used in São Paulo, from benzodiazepines to antidepressants, this event is observed in different cultures. The prevalence of use is similar to other developing countries. Most of the patients presenting a psychiatric illness in the month prior to testing were not receiving any sort of psychiatric medication. This may be explained by a failure to identify cases in primary care, which could be improved (and access to treatment could be facilitated) if professionals received more specialized training in managing cases with mental health problems.

Long-term benzodiazepine use in patients taking antidepressants in a public health setting in Brazil: a cross-sectional study

“…Women commonly show higher consumption of psychotropic drugs and greater use of health services than men. 24 29 …”

“…We considered the following variables as risk factors possibly associated with prolonged use of antidepressants and benzodiazepines. For each factor, we previously postulated the direction of the possible effects: (1) age (older vs younger, with a higher risk of prolonged use of benzodiazepines for adults over 35), 14 (2) gender (women have higher risk than men), 24 (3) marital status (single vs married, with a higher risk for single individuals; we merged single participants, divorced participants and widows/widowers into the same group), 7 (4) the time since diagnosis (longer vs shorter, with a higher risk for longer times), 1 (5) the presence of comorbidities (none vs one or more, with a higher risk for one or more illnesses), 10 (6) concomitant use of other prescribed drugs (none vs one or more, with a higher risk for those using one or more medications), (7) prescription by physician (psychiatrists vs other, with a higher risk when prescribed by psychiatrists), 18 24 (8) the type of prescription (continuous or intermittent, with a higher risk for intermittent), (9) the type of diagnosis (major depression vs others, including generalised anxiety, pain and bipolar disease, with a higher risk for major depression), 10 16 and (10) the type of antidepressant (tricyclic vs selective serotonin reuptake inhibitors (SSRIs), with a higher risk for SSRIs; SSRIs cause more agitation, insomnia and anxiety, so it is more common to associate them with benzodiazepines at the beginning of a treatment). 25 …”

Psychotropic use patterns: Are there differences between men and women?

“…On the other hand, a large number of individuals with mental disorders remain without medicinal treatment in particular segments of the population. The gap between the demand and use of these medications is important, as this difference can be as high as 80 to 85%, depending on the location of the study [ 9 , 10 ].…”

The use of benzodiazepines by women cared for at a Family Health Unit

“…Furthermore, we understand that the sociodemographic characteristics specific to each study's population may also contribute to the variability. Thus, the prevalence described in previous studies (5,6,16,(18)(19)(20) varies between 2.5% and 16.8%. Among the studies carried out in primary care, one of them (19) reports the prevalence of 2.5% of women who were BZD users; however, for data collection, the authors used only people who were BZD users in the previous six months from data obtained by the city's information system.…”