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

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