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Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student The Nordic Cochrane Centre Conflicts of interests: None

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Page 1: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Increasing sales of selective serotonin reuptake inhibitors are closely related to

increasing number of products on the market Margrethe Nielsen

PhD student

The Nordic Cochrane CentreConflicts of interests: None

Page 2: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student
Page 3: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Sales of all psychoactive drugs in DenmarkDDD: defined daily doses per 1,000 inhabitants

0

20

40

60

80

100

120

140

160

year

DD

D

antipsychotics, anxiolytics andhypnotics

antidepressants, psychostimulants,antidementia

total

Page 4: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Influence of benzos and neurotransmitter reuptake inhibitors on total usage

0

20

40

60

80

100

120

140

160

year

DD

D all psychoactive drugs - total

benzos and neurotransmitter reuptake inhibitors

Page 5: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

The total sales of benzodiazepines and benzodiazepine-like drugs and neurotransmitter

reuptake inhibitors

0

20

40

60

80

100

120

year

DD

D

Total benzodiazepines

Total neurotransmitter reuptakeinhibitors

Page 6: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Possible explanations

Page 7: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Sales of all psychoactive drugs in Denmark – changes in disease classification systems

0

20

40

60

80

100

120

140

160

year

DD

D

antipsychotics, anxiolytics andhypnotics

antidepressants, psychostimulants,antidementia

total

Symptoms

and increasing

number of diagnoses

Increasing number of symptoms for the diagnosis of depression

implementing and harmonising

Page 8: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

SSRI DDD, number of products and indications

0

10

20

30

40

50

60

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005/ 06

2007 2008

year

nu

mb

er o

f D

DD

an

d n

um

ber

of

pro

du

cts

number of indications

Number of SSRI products

SSRI DDD

Page 9: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Benzo DDD, number of indications and products

0

20

40

60

80

100

120

year

indications

number of benzodiazepine product

benzo DDD

Page 10: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

Recommendation of screening from referenceprogram from the National Board of Health

• ”In the literature there is conflicting information about the efficacy of systematic screening for depression, in order to ensure that more people are treated. A newer Cochrane review is thus showing minimal influence of systematic screening on the degree of diagnostics, treatment and outcome. There is on the other hand a generel agreement that screening for depression in risk groups can improve outcome, for example for patients with stroke or heart disease.”(my translation)(IIb)

Page 11: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student
Page 12: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

The Commission’s proposal on information to patients (1)

• Enable citizens to get high-quality informa-tion about prescription only-medicines

• Pharmaceutical companies should disseminate informa-tion about drugs

• Certain information in a new presentation

Page 13: Increasing sales of selective serotonin reuptake inhibitors are closely related to increasing number of products on the market Margrethe Nielsen PhD student

The Commission’s proposal on information to patients (2)

• Allowing the pharma-ceutical industry to promote their products to the public

• No clear distinction between advertising and information

• Comparisons between medicinal products are not allowed