Prevalence, cumulative incidence, monotherapy and combination therapy, and treatment duration of frequently prescribed psychoactive medications in the Netherlands: retrospective database analysis for the years 2000 to 2005.

BACKGROUND: Psychoactive drugs have been reported to impair daily activities (eg, driving), but data regarding the use of such drugs in the Netherlands are lacking.
OBJECTIVE: The aim of this work was to examine the prevalence, cumulative incidence, use of monotherapy and combination therapy, and treatment duration of frequently prescribed psychoactive drug classes in the Netherlands.
METHODS: Data for the years 2000 through 2005 were derived from IADB.nl, a database with pharmacy dispensing data from a population of ∼500,000 people in the northern region of the Netherlands. The following prescription psychotropic drug classes were considered: antidepressants (as a total group and the 2 subgroups of nonselective monoamine reuptake inhibitors and selective serotonin reuptake inhibitors), antipsychotics, anxiolytics, and hypnotics and sedatives. Patients aged 18 to 89 years who received ≥ 1 prescription for a psychoactive medication of interest were selected, and prevalence and cumulative incidence were calculated per 1000 patients per year. The treatment duration was analyzed by means of Kaplan-Meier survival analysis. Age, sex, and drug class stratifications were performed.
RESULTS: There was a slight increase in the prevalence of antipsychotics (final median [95% CI] prevalence in 2000 vs 2005: 16.9 [16.5-17.3] vs 18.7 [18.3-19.1]) and antidepressants (60.4 [59.7-61.2] vs 67.1 [66.4-67.9]), with selective serotonin reuptake inhibitors being the most frequently prescribed drugs in these classes (35.2 [34.6-35.7] vs 37.5 [36.9-38.1] in 2000 and 2005, respectively). At the same time, there was a slight decrease in the prevalence of anxiolytics (95.1 [94.2-96.0] vs 83.2 [82.3-84.0]), hypnotics and sedatives (68.1 [67.3-68.9] vs 60.9 [60.1-61.6]), and nonselective monoamine reuptake inhibitors (20.3 [19.8-20.7] vs 19.2 [18.8-19.7]). The data also suggested that women had more prescriptions for the psychoactive medications of interest than did men, although these observations were not assessed for statistical significance. The only increase from 2000 to 2005 in median (95% CI) incidence per 1000 people in prescriptions was for antipsychotics (4.1 [3.9-4.3] vs 4.9 [4.6-5.0]); a decrease was noted in the incidence of antidepressants (18.6 [18.2-19.1] vs 16.2 [15.8-16.6]), nonselective monoamine reuptake inhibitors (7.1 [6.9-7.4] vs 6.8 [6.6-7.1]), selective serotonin reuptake inhibitors (12.0 [11.6-12.3] vs 8.6 [8.3-8.9]), anxiolytics (34.6 [34.1-35.2] vs 30.2 [29.7-30.7]), and hypnotics and sedatives (21.2 [20.8-21.7] vs 18.4 [18.0-18.9]). Combination therapy was most common among those aged 30 to 44 years (6.5%) and those aged 45 to 59 years (6.1%). The longest median (95% CI) treatment duration was noted for antipsychotic use (1781.8 days [1755.2-1808.4]); the shortest was observed for anxiolytic use (617.4 days [608.9-625.9]).
CONCLUSIONS: From 2000 to 2005 in the Netherlands, the yearly prevalence and cumulative incidence of prescriptions for psychoactive drugs were relatively stable, although there were some changes within specific drug classes. Monotherapy was more prevalent than combination therapy. Antipsychotics had the longest median duration of use; anxiolytics had the shortest duration.