Abstract
Antidepressant prescribing patterns have changed globally over the past few years, with conventional drugs including tricyclic antidepressants and monoamine oxidase inhibitors being replaced by selective serotonin reuptake inhibitors (SSRIs) and novel antidepressants. The objective of this study was to assess antidepressant utilization in Iran from 2006 to 2013 and to show Iran’s situation in antidepressant consumption compared with other countries. A cross-sectional study was undertaken using prescription claims data from Iranian insurance agencies. In addition, total antidepressant sales data were obtained from the databank of the national regulatory authority. Medicines were classified according to the Anatomic Therapeutic Chemical (ATC-2012 edition) System. The Organisation for Economic Co-operation and Development data were used to compare national results from Iran with other countries. Antidepressant sales were four-fold higher than those of prescribed antidepressants [24 defined daily doses (DDD)/1000 inhabitants/day were sold whereas 6 DDD/1000 inhabitants/day were prescribed in 2013]. The trend in antidepressant prescriptions and consumption showed increasing use of SSRIs (N06AB). Nortriptyline, fluoxetine, and citalopram accounted for more than 60% of all prescriptions each year. The type of adverse reactions with new expensive antidepressants may seem convincing for the growing tendency toward using these medicines, but considering their high costs, health policymakers have to be aware of the risk of overprescription of newer antidepressant. Drivers of over-the-counter purchase of antidepressants need to be explored.
Highlights
Depression is a widespread disorder, with the World Health Organization (WHO) estimating that more than 350 million people are affected worldwide [1]
The number of defined daily doses (DDD)/1000 inhabitants/day of antidepressant medications obtained on prescription was 3 in 2006 and rose to 6 in 2013
When examining sales data, which include both prescriptions and self-medication, the antidepressant medication sales rose from 16 DDD/1000 inhabitants/day in 2006 to 24 DDD/1000 inhabitants/day in 2013
Summary
Depression is a widespread disorder, with the World Health Organization (WHO) estimating that more than 350 million people are affected worldwide [1]. A variety of health conditions such as depressed mood, loss of interest and enjoyment, and increased fatigability may be some of the different manifestations of depression [1,2]. In Iran, the prevalence of psychiatric disorders is not high compared to those recorded in international studies [3]. It is estimated that 7 million Iranians experience at least one psychiatric disorder, demonstrating Iran’s mental health burden [4]. Based on the burden of diseases calculation, major depressive disorder is ranked as the most predominant mental health disorder in Iran [5].
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