Australia

Provocative title, no? The observed increases over the time period 2000-2003 were 49 (53%) and 21 (22%) DDD/1000 beneficiaries/day inNova Scotia and Australia, respectively.

Defined Daily Doses (DDDs)

This standard measure is set at the average maintenance dose per day of a drug when used for its major indication. It overcomes difficulties in comparing prescriptions of different price, pack size, duration and dose. Use is expressed as the number of DDDs per 1000 concession beneficiaries per day (DDD/1000 beneficiaries/day), which allows comparisons over time and place.

This may be due to prescribing antidepressants for conditions other than depression in Novia Scotia. It could also be caused by an increased exposure to direct-to-consumer-advertising. Something posted about earlier on this blog: Direct To Consumer Advertising of prescription drugs, a threat to Europe?
Why I am against direct to consumer marketing for medication?

• advertisements from drug companies are mostly limited to those drugs with the highest profit
• efficacy is often exaggerated
• risks are usually obscured
• it confuses patients when suggested another drug by their physicians
• it forces physicians to use the advertised drug
• advertisements by drug companies lack comparison with drugs from other companies or other treatments, making it hard for consumers to compare different drugs or other treatment options

There are only two countries allowing “direct-to-consumer-advertising”: USA and New Zealand. Want to know how it is received in New Zealand, read this.

The increase of prescription could also be due to an increase in consumer and/or prescriber awareness, education or training in depression and its management compared with Australia.

Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed class of drugs in both areas, constituting 60% of all antidepressants prescribed.

What is more troubling is that the ratio of benzodiazepines to antidepressants in Nova Scotia was more than double that of Australia over the study period. Moreover the ratio decreased in Nova Scotia but this decrease was largely due to to the increase of antidepressants at a faster rate than an absolute decrease in benzodiazepines use. Normally the number of benzodiazepines should decrease as antidepressants prescriptions increase as depression is better recognized and patients switched to antidepressants instead of benzodiazepines. Benzodiazepines have limited use, they pose a risk for the elderly.

Alesha J Smith, Ingrid Sketris, Charmaine Cooke, David Gardner, Steve Kisely, Susan E Tett (2008). A comparison of antidepressant use in Nova Scotia, Canada and Australia Pharmacoepidemiology and Drug Safety, 17 (7), 697-706 DOI: 10.1002/pds.1541