Mental health policy and practice across Europe: an overview

Psychopharmaceuticals in Europe 151
effectiveness of their drug for specific psychiatric conditions, each now linked to
a particular kind of anomaly in a particular aspect of a neurotransmitter system.
The new age of smart psychiatric drugs had arrived.
The market for drugs
Accurate comparative and historical data on psychiatric drug prescribing since
the 1950s is not readily available. The World Health Organization (WHO) has
adopted one particular unit as a measure of the intensity of use of pharmaceuticals.
This is the defined daily dose or DDD, and a comparative standard is
emerging based on the DDD per 1000 inhabitants per day. 7 However, the compilation
and publication of detailed DDD figures for psychopharmaceutical use
across Europe is at an early stage and coverage is patchy. Other data is available
from commercial organizations that monitor the pharmaceutical industry, notably
from the leading organization, IMS Health. In this chapter, we largely draw
upon studies specially commissioned from IMS Health to illustrate some general
trends and patterns. The IMS measure used to assess these trends is the standard
dosage unit, or SU (see Note 1 for an explanation of this measure) which is not
directly convertible into DDDs. 8 While the interpretation of the detailed figures
is subject to many qualifications, and actual numbers should be regarded simply
as indicative, they are sufficiently robust for these purposes.
Let us begin by considering some broad regional differences. An initial overview
(see Table 7.1) reveals a marked rising trend in prescription of psychiatric
medication in all regions from 1990 to 2000 as measured in standard dosage
units. In the more developed regions, the United States shows a growth of about
70 per cent, Europe of around 44 per cent and Japan of about 30 per cent. In the
less developed regions, South America remains remarkably constant with a
growth of only 1.6 per cent, South Africa shows a growth of about 13 per cent,
but the use of prescription drugs in Pakistan has grown by over 33 per cent
(although from a low base). 9
This variation in the quantity of drug prescriptions is instructive, but we see a
rather different pattern when we relate the number of standard doses prescribed
Table 7.1 Psychiatric drug prescribing 1990–2000 in selected regions (standard dosage
units, thousands)
1990 1992 1994 1996 1998 2000
EU 30,612,851 32,975,134 34,026,814 38,169,030 40,443,452 42,464,477
USA 9,965,639 11,540,978 13,830,291 16,074,244 19,001,486 18,953,979
Japan 7,817,352 8,144,026 8,398,988 8,974,334 9,243,612 10,049,994
Latin America 3,696,757 3,695,284 3,515,827 3,483,267 3,521,456 3,723,646
Pakistan 631,172 680,378 874,607 927,253 868,876 825,437
South Africa 277,579 303,834 314,972 383,234 345,159 378,434
Source: IMS Health Second Study. See Note 1.