Trends in sales of antidepressants in Brazil from 2014 to 2020: A time trend analysis with joinpoint regression

Antidepressant drugs are used for the treatment of several psychiatric conditions, including depression, anxiety, posttraumatic stress, obsessive-compulsive, and binge-eating disorders (Dragioti et al., 2019). Although widely used in clinical practice, their efficacy appears to vary significantly between patients (Cipriani et al., 2018), and their associated benefits may be marginal (Jakobsen et al., 2020). There is limited real-world evidence on antidepressants' long-term effectiveness while their potential harms may have been underestimated in clinical trials (Moncrieff, 2016). In clinical practice, the choice of the antidepressant drug relies on factors that may not reflect higher effectiveness, but mainly the novelty of products driven by patent protection (Gotzsche, 2018). For instance, in China the use of serotonin reuptake inhibitors has increased from 2013 to 2018, while prescriptions of tricyclics have decreased (Yu et al., 2020), even though direct comparisons of tricyclics and serotonin reuptake inhibitors did not differ in patients' improvement and response in terms of efficacy (Undurraga and Baldessarini, 2017). As similar effects were observed between older and newer antidepressants, these changes in market share potentially are triggered by reasons other than efficacy.

In 2015, depressive disorders resulted in >50 million years lived with disability, and >80 % of this burden occurred in low- and middle-income countries (Rathod et al., 2017). Despite possible inflation of these estimates due the quality of the source databases (Brhlikova et al., 2011), social factors, such as poverty, urbanization, internal migration, lifestyle changes, unemployment, armed conflicts, and cultural and institutional influences may explain the higher burden of mental illness in these settings. In this vicious cycle, the poorest and most vulnerable individuals are at the highest risk of developing mental health disorders, which in turn leads to lower income-generating opportunities and unemployment (Rathod et al., 2017). Although the burden in mental health may be higher, lower availability of data for drug utilization monitoring is observed in these settings; even drug utilization administrative databases lack public accessibility and transparency (Canas et al., 2021).

In Brazil, the increase of individuals living in peripheral areas underserved by the government and prone to urban violence, successive economic crises, precarious work conditions, and exposure to hostile environments is a factor that increases mental suffering (Lopes, 2020; Tiguman et al., 2022). Drug utilization data in this country are mainly obtained from population-based surveys or available exclusively in subscribed databases, which limit the access and the analysis of drug-related information. The Brazilian National Controlled Products Management System (Sistema Nacional de Gerenciamento de Produtos Controlados, SNGPC) was created in 2007 with the aim of supporting the Brazilian National Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) in monitoring the prescriptions of medicines under special control from private drugstores and pharmacies. In 2020, data from the SNGPC since 2014 were made publicly available, allowing the investigation of drug utilization patterns in the Brazilian population using an official and reliable source. Particularly for antidepressants, these data could provide relevant information about the use of specific drugs and therapeutic groups, as well as the changes in their market shares over the years. The aim of this study was to assess the trends in sales of antidepressants in Brazil from 2014 to 2020.

留言 (0)

沒有登入
gif