Mental health in Europe in the data: which country is the most depressed?

Mental health in Europe in the data: which country is the most depressed?

Global consumption of antidepressants (ADs) has increased dramatically over the past two decades, with Europeans being the largest consumers.

The use of antidepressants increased nearly two and a half times between 2000 and 2020 in 18 European countries, according to data from the Organization for Economic Co-operation and Development (OECD).

OECD data also shows a dramatic increase in anxiety and depression during the COVID-19 pandemic. Are the happiest countries using fewer AD drugs? How do researchers explain the sharp increase in the consumption of antidepressants?

OECD datasets demonstrate defined daily dose (DDD) consumption of “N06A-Antidepressants”. This group “includes preparations used in the treatment of endogenous and exogenous depressions”, according to the World Health Organization (WHO).

The average consumption of antidepressants in 18 European countries was 30.5 DDD per 1,000 people per day in 2000, rising to 75.3 DDD in 2020, an increase of 147%.

But this global average hides very different departures from consumption of antidepressants in 2000 depending on the country, ranging from 6.4 DDD in Estonia to 70.5 DDD in Iceland.

The Czech Republic recorded the highest increase with 577% while it only increased by 38% in France, making it the smallest variation in these countries between 2000 and 2020, but from a level relatively high.

It increased by 304% in Portugal, 256% in the United Kingdom, 208% in Spain and 200% in Germany during the same period.

A closer look at five selected countries – France, Germany, Portugal, Spain and Sweden – over 20 years shows how widely the use of pharmaceutical antidepressants varies.

While the increase is very small in France, especially over the past 15 years, it has exploded in Portugal over the past two decades.

The bar graph also shows how consumption of antidepressants has increased year over year in European countries. In 14 out of 18 countries, AD drug consumption more than doubled.

Which countries have the highest consumption of antidepressants?

Looking at changes over the past decade, we have data for 24 European countries.

In 2020, AD drug consumption per 1,000 people per day ranged from 20 DDD in Latvia to 153 DDD in Iceland. It is followed by Portugal (131 DDD), the United Kingdom (108 DDD in 2017), Sweden (105 DDD) and Spain (87 DDD).

In 2020, the average usage in these 24 countries was 68 DDDs. The three most populous countries, namely Turkey (49 DDD), France (55 DDD) and Germany (62 DDD), all recorded below-average consumption.

A correlation between happiness and the use of antidepressants?

The short answer is no. Data from European countries does not suggest that the happier people are, the fewer antidepressants they use.

Iceland, which was the second happiest country in the world in 2020 according to the World Happiness Report, has the highest consumption of antidepressants in Europe.

Sweden, which ranked sixth in the Happiness Report, has the fourth highest use of antidepressants with 105 DDDs.

Finns, who were the happiest nation according to the report, used 82 DDD antidepressants, putting Finland seventh out of 24 countries.

Latvia, which has the lowest consumption with 20 daily doses, is ranked 34th in the World Happiness Report. Hungary, which trails Latvia with 30 DDDs, was in 43rd place on the happiness list.

Consumption of antidepressants has only decreased in Denmark over the past 10 years

AD drug consumption increased by 36.5% between 2010 and 2020 in 24 European countries with average daily consumption increasing from 49.8 DDD to 68 DDD. Denmark is the only country to have seen a decline in the use of antidepressants over the past decade with a 4% drop.

Estonia recorded the highest increase with 133% while consumption only increased by 2% in France.

It doubled in the UK and increased by 50% in Turkey. The change was less than 25% in 10 countries.

What about spending on antidepressants?

The cost of spending on antidepressant drugs is a burden on citizens and their countries.

In 2020, Germany spent 812 million dollars (783 million euros) on antidepressants. Spain ($649 million or €626 million) and Italy ($456 million or €440 million) are the other top countries for spending on antidepressants.

The ratio of spending on antidepressants to total pharmaceutical sales suggests that this is a significant cost in some countries.

In 2020, antidepressants accounted for 4% of pharmaceutical sales in Portugal, compared to 2.7% in Spain, 2.2% in Austria, 1.9% in Turkey and 1.4% in Germany.

The prevalence of chronic depression in Europe

There are no comparable official data on the proportion of people who reported suffering from chronic depression or consulting a psychologist, psychotherapist or psychiatrist.

However, the results of the survey published by Eurostat provide some information. In 2019, Eurostat found that 7.2% of EU citizens reported suffering from chronic depression, which was only a slight increase compared to 2014 (+0.3 percentage points).

In 2019, among EU countries, Portugal (12.2%) had the highest share of the population reporting chronic depression, followed by Sweden (11.7%), Germany and Croatia (11.6% each).

The proportion of people reporting chronic depression was lowest in Romania (1.0%), Bulgaria (2.7%) and Malta (3.5%).

Interestingly, the top two countries, Iceland (15.6%) and Portugal (12.2%), reporting chronic depression also had the highest consumption of antidepressants with 153 DDDs and 131 DDD in 2020 respectively.

The impact of COVID on mental health

Recent surveys published by the OECD have revealed that mental health has deteriorated significantly since the start of the COVID-19 pandemic.

As of March 2020, the prevalence of anxiety and depression increased in 15 selected OECD countries, including several European ones.

The prevalence of anxiety at the start of 2020 was double or more than double that seen in previous years in Belgium, France, Italy, Mexico, New Zealand, the United Kingdom and the United States.

The prevalence of depression at the start of 2020 was also double or more than double that seen in previous years in Mexico, Australia, Belgium, Canada, France, Czech Republic, Mexico, Sweden, United Kingdom UK and USA.

However, since the survey methods differ from one study to another, it is not possible to offer robust comparisons between countries.

Has consumption of antidepressants increased during COVID?

As the prevalence of anxiety and depression has increased dramatically during the COVID-19 pandemic, has the consumption of antidepressants also increased?

There is a 10% or more increase in consumption between 2019 and 2021 in the 14 OECD countries for which data is available. For example, usage increased by 22 percent in Latvia over those two years, but only by 1 percent in Hungary.

However, this comes against the backdrop of a steady trend of increasing use of antidepressants over the past 20 years. Therefore, further research is needed to understand any possible impact of the pandemic on these recent increases.

Why is the consumption of antidepressants increasing?

There are a number of potential explanations for this increase over the past two decades.

Researchers who studied influences on antidepressant prescribing trends in the UK between 1995 and 2011 suggested that the increase can be attributed to improved recognition of depression, the availability of new drugs for AD, changes in attitude of patients/GPs, availability of therapies, clinical course guidelines and a broadening of the range of indications treated with ADs.

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