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Harro J, Aadamsoo K, Rootslane L, Laius O, O'Leary A, Adomaitiene V, Kupca B, Lehtmets A, Navickas A, Rancans E, Taube M, Terauds E, Pops K. Comparison of psychotropic medication use in the Baltic countries. Nord J Psychiatry 2020; 74:301-306. [PMID: 31889460 DOI: 10.1080/08039488.2019.1707283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: While the pivotal role of pharmacotherapy in psychiatry is universal, significant regional differences exist in drug use patterns. Herewith we compare the use of ATC psychotropic drugs (N05, psycholeptics and N06A, antidepressants) in 2010-2015 in the three Baltic Countries with reference to the Nordic Countries.Methods: Data were obtained from the national authorities on medicines as expressed in DDD per 1000 inhabitants per day. A semi-structured questionnaire was used for expert statements on the rationale of current use of medicines.Results: During the observation period the use of antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants steadily increased, while the growth in use of anxiolytics stagnated in the more recent years. Antipsychotic use was the largest in Lithuania and the lowest in Estonia. The use on anxiolytics in Lithuania was more than twice of that in Estonia and Latvia. Conversely, the use of hypnotics and sedatives was about three times higher in Estonia than in Latvia or Lithuania. Antidepressant use was dominated by the selective serotonin reuptake inhibitors in all three countries, but overall was much lower in Latvia as compared to Lithuania and Estonia. As compared to the Nordic Countries in 2015, antidepressants are used at much lower level throughout Baltics, probably reflecting underdiagnostics of depression and anxiety disorders.Conclusion: While the health-care expenditures in Estonia, Latvia and Lithuania are largely similar, as is the cultural and recent political background of these EU member countries, the extent and the pattern of psychotropic drug use is remarkably variable.
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Affiliation(s)
- Jaanus Harro
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia.,Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Tartu, Estonia
| | - Kaire Aadamsoo
- North Estonia Medical Centre, Psychiatry Clinic, Tallinn, Estonia
| | - Ly Rootslane
- Estonian State Agency of Medicines, Tartu, Estonia
| | - Ott Laius
- Estonian State Agency of Medicines, Tartu, Estonia.,Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Aet O'Leary
- Division of Neuropsychopharmacology, Department of Psychology, University of Tartu, Tartu, Estonia.,Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Laboratory of Translational Psychiatry, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Biruta Kupca
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | | | - Alvydas Navickas
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Maris Taube
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | - Elmars Terauds
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
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Horton DB, Gerhard T, Davidow A, Strom BL. Impact of the black triangle label on prescribing of new drugs in the United Kingdom: lessons for the United States at a time of deregulation. Pharmacoepidemiol Drug Saf 2017; 26:1307-1313. [PMID: 28857309 DOI: 10.1002/pds.4304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Newly approved novel drugs in Europe receive a black triangle label to promote pharmacovigilance. With growing momentum for earlier drug approvals and reliance on real-world evidence, we studied if the black triangle label promotes more judicious prescribing. METHODS We examined whether general practitioners prescribed escitalopram, tadalafil, and vardenafil with a black triangle more cautiously than the same or similar drugs without a black triangle in The Health Improvement Network (UK). We performed interrupted time-series analyses to estimate changes in new prescription rates and nested case-control studies to compare characteristics of new users before and after removal of a black triangle. RESULTS Prescribing rates to the 33 441 new users of these new drugs were highest shortly after initial approval and declined subsequently; there were no increases in rates of new prescriptions after a black triangle's removal (new prescriptions/million/month postlabel: escitalopram -1.5 [95% CI, -1.9 to -1.2]; tadalafil and vardenafil: -0.1 [95% CI, -0.6 to 0.4]). Among drugs in the same class, loss of a patent had more impact on prescribing rates than loss of a black triangle. People who began taking black triangle drugs were less likely to be young or to have multiple comorbidities or recent hospitalization compared with those starting the same drugs after the label's removal. However, these differences generally reflected secular trends seen also in similar, unlabeled medicines. CONCLUSIONS Accelerated drug approvals could cause more uncertainty about drug effectiveness and safety, but specific labeling of newly approved medicines is unlikely to promote more judicious prescribing.
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Affiliation(s)
- Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Tobias Gerhard
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.,Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.,Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Amy Davidow
- Department of Biostatistics, Rutgers School of Public Health, Newark, NJ, USA
| | - Brian L Strom
- Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.,Rutgers Biomedical and Health Sciences, Newark, NJ, USA.,Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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