1 Selective serotonin reuptake inhibitors (SSRI) â sales, withdrawal ...

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Paper 1 An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products. International Journal of Risk & Safety in Medicine, 2011; 23 (2): 125-32. Correction to paper 1: page 128: Sales figures for the specific neurotransmitter reuptake inhibitors (N06AB and N06AX) separately were available form 1992. This is incomplete expressed, because N06AX also includes Mianserin, which is a receptor blocking agent and not a specific neurotransmitter reuptake inhibitor. Paper 2 What is the difference between dependence and withdrawal reactions A comparison of benzodiazepines and selective serotonin re-uptake inhibitors. Nielsen M, Hansen EH, Gøtzsche PC. Addiction. 2012 May;107(5):900-8. doi: 10.1111/j.1360-0443.2011.03686.x. Epub 2012 Jan 23. Review. Paper 3 Dependence and withdrawal reactions to benzodiazepines and selective serotonin reuptake inhibitors. How did the health authorities react Authors: Margrethe Nielsen, Ebba Holme Hansen, Peter C. Gøtzsche 52
International Journal of Risk & Safety in Medicine 23 (2011) 125–132 DOI 10.3233/JRS-2011-0526 IOS Press 125 An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products Margrethe Nielsen a, * and Peter Gøtzsche b a The Nordic Cochrane Centre, Rigs hospitalet, Copenhagen, Denmark b Nordic Cochrane Centre, Copenhagen, Denmark Abstract. Background: Prescribing of selective serotonin reuptake inhibitors (SSRIs) has increased dramatically. Objective: To compare the sales of benzodiazepines and SSRIs within the primary care sector in Denmark and relate changes in usage to number of indications and products on the market. Methods: We used data from various sources to establish the sales curves of psychotropic drugs in the period 1970 to 2007, based on the Anatomic Therapeutic Classification system and Defined Daily Doses. Results: Fluctuations in sales of psychotropic drugs that cannot be explained by disease prevalence were caused by changes in sales of the benzodiazepines and SSRIs. We found a decline in the sales of benzodiazepines after a peak in 1986, likely due to the recognition that they cause dependence. From a low level in 1992, we found that the sales of SSRIs increased almost linearly by a factor of 18, up to 44 DDD per 1000 inhabitants, which was closely related to the number of products on the market that increased by a factor of 16. Conclusions: Sales of antidepressant drugs are mainly determined by market availability of products indicating that marketing pressures are playing an important role. Thus the current level of use of SSRIs may not be evidence-based, which is supported by studies showing that the effect of SSRIs has been overestimated. Keywords: Benzodiazepines, SSRIs, DDD, sales, indications 1. Introduction Psychotropic medicines have been available since the middle of the 1800s. Some of the active ingredients have changed over time and they have been associated with dependency [1, 2]. Barbiturates were introduced on the market in 1903 for treatment of insomnia and anxiety, but because of the risk of intoxication, dependency and drug abuse, they were slowly replaced by benzodiazepines, which have now been available for 50 years [1, 2]. At the peak of their use, the sales corresponded to a usage in about 10% of the Danish population [1], and they are still widely used, although the risk of dependency has been known for more than 25 years [1]. In 1988, selective serotonin reuptake inhibitors (SSRI) were ∗ Address for correspondence: Margrethe Nielsen, The Nordic Cochrane Centre, Rigs hospitalet, Department 3343, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. Tel.: +45 35 45 71 12; Fax: +45 35 45 70 07; E-mail: marn@phmetropol.dk. 0924-6479/11/$27.50 © 2011 – IOS Press and the authors. All rights reserved
Page 1 and 2: Selective serotonin reuptake inhibi
Page 3 and 4: 1. Preface and acknowledgement 1.1
Page 5 and 6: 2. Abstract Psychotropic drug use h
Page 7 and 8: 3. Danish summary Brugen af psykotr
Page 9 and 10: 4. Introduction Psychotropic medici
Page 11 and 12: It is pretty clear that the inclusi
Page 13 and 14: The first two studies led to the th
Page 15 and 16: 4.1. List of abbreviations ATC CPMP
Page 17 and 18: to accept withdrawal reactions as a
Page 19 and 20: than in the former DSM-III were des
Page 21 and 22: 5. Objectives In the light of this
Page 23 and 24: including gifts, drug samples and i
Page 25 and 26: The data in the register represent
Page 27 and 28: DDD/1000 inhabitants/day Figure 1:
Page 29 and 30: general, a motivated GP in an urban
Page 31 and 32: of Diseases (ICD) is organized by t
Page 33 and 34: palpitations skin rash, itching abd
Page 35 and 36: which withdrawal reaction is one cr
Page 37 and 38: It was not possible to use a system
Page 39 and 40: http://www.mhra.gov.uk/home/groups/
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Page 45 and 46: 8. Perspectives Patient safety is a
Page 47 and 48: 9. References 1. Hansen EH, Gyldmar
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Page 71 and 72: Abstract Aim: Our objective was to
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Page 75 and 76: Results We identified 6 documents r
Page 77 and 78: In 1998, it was stated that SSRIs d
Page 79 and 80: having both medical and abuse poten
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Page 85 and 86: Table 1: Search strategy Source Sea
Page 87 and 88: 1988 Medicines Control Agency, Comm
Page 89 and 90: 2000 Medicines Control Agency, Comm
Page 91 and 92: 2003 Meeting 16 September CSM and E

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