Pattern evolution of antidepressants and benzodiazepines use in a cohort

Alcantara, Geisy de Carvalho; Coutinho, Evandro Silva Freire; Faerstein, Eduardo

doi:10.11606/s1518-8787.2020054001887

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054001887 copy

Pattern evolution of antidepressants and benzodiazepines use in a cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article.

METHODS

Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates.

RESULTS

In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1–1.8) and 4.7% (95%CI: 4.1–5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5–6.2) and 6.8% (95%CI: 6.0–7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2–5.7) for AD and 8.3% (95%CI: 7.3–9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire.

CONCLUSION

In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.

Benzodiazepines, administration & dosage; Antidepressive Agents, administration & dosage; Drug Utilization, trends; Cohort Studies

	Baseline (4,030) N (%)	Prevalence of AD % (95%CI)	p-value	Prevalence of BDZ % (95%CI)	p-value
Total		1.4 (1.1–1.8)		4.7 (4.0–5.4)

Sex
Men	1,792 (44.5)	0.5 (0.2–0.9)	< 0.001	2.8 (2.1–3.6)	< 0.001
Women	2,238 (55.5)	2.1 (1.5–2.7)	< 0.001	6.2 (5.2–7.2)	< 0.001
Age
22–34	1,124 (27.9)	1.3 (0.7–2.0)	0.922	2.2 (1.4–3.1)	< 0.001
35–44	1,740 (43.1)	1.4 (0.8–1.9)		5.0 (4.0–6.1)
45–54	885 (22.0)	1.6 (0.7–2.4)		7.0 (5.3–8.7)
55 or more	281 (7.0)	1.8 (0.2–3.3)		5.3 (2.7–8.0)
Marital status
Married or living together	2,397 (59.5)	1.0 (0.6–1.4)	0.06	4.1 (3.3–4.9)	< 0.001
Separated or divorced	611 (15.0)	2.1 (1.0–3.3)		8.3 (6.1–10.5)
Widower	116 (3.0)	2.6 (0.0–5.5)		6.9 (2.3–11.5)
Single	805 (20.0)	2.0 (1.0–2.9)		3.5 (2.2–4.7)
No information	101 (2.5)	–		–
Race
Black	626 (15.5)	1.4 (0.5–2.4)	0.811	4.9 (3.2–6.6)	0.576
Brown	1,171 (29.1)	1.4 (0.8–2.1)		4.4 (3.2–5.6)
White	2,082 (51.7)	1.5 (1.0–2.1)		5.0 (4.0–5.9)
Asian	60 (1.5)	–		3.3 (–1.2–7.9)
Indigenous	41 (1.0)	–		–
No information	50 (1.2)	–		–
Education level
Some elementary school	276 (6.8)	1.1 (–0.1–2.3)	0.951	5.1 (2.5–7.7)	0.609
Elementary school	305 (7.6)	1.6 (0.2–3.1)		3.9 (1.7–6.1)
Some high school	365 (9.0)	1.4 (0.2–2.6)		6.6 (4.0–9.1)
High school	870 (21.6)	1.6 (0.8–2.4)		4.8 (3.4–6.2)
Some college	560 (14.0)	1.2 (0.3–2.2)		3.7 (2.2–5.3)
College	1,084 (27.0)	1.3 (0.6–2.0)		4.7 (3.4–6.0)
Graduate	523 (13.0)	1.9 (0.7–3.1)		4.6 (2.8–6.4)
No information	47 (1.0)	–		–
Workplace
UERJ¹ Campus	2,053 (51.0)	1.2 (0.7–1.7)	0.229	4.0 (3.2–4.9)	0.04
HUPE² Hospital	1,977 (49.0)	1.7 (1.1–2.2)	0.229	5.4 (4.4–6.4)	0.04
Income (equal to number of minimum wages)
Up to 3	329 (8.7)	1.2 (0.02–2.4)	0.6	5.7 (3.2–8.3)	0.619
3 to 6	967 (25.5)	1.1 (0.5–1.8)		4.4 (3.1–5.7)
> 6	2,490 (65.8)	1.6 (1.1–2.0)		4.7 (3.9–5.6)
Health insurance users
Yes	2,266 (56.2)	1.5 (0.9–2.0)	0.638	4.9 (4.0–5.9)	0.446
No	1,739 (43.1)	1.3 (0.8–1.8)		4.4 (3.4–5.4)
No information	25 (0.6)	–		–
Alcohol consumption
Yes	2,148 (53.3)	1.1 (0.6–1.5)	0.03	3.9 (3.1–4.8)	0.01
No	1,751 (43.5)	1.9 (1.2–2.5)	0.03	5.7 (4.6–6.8)	0.01
No information	131 (3.2)	–		–
Frequency of alcohol consumption (2 weeks)
Every day	84 (2.1)	1.2 (0.0–3.5)	0.73	5.9 (0.8–11.0)	0.76
10 to 13 days	77 (1.9)	–		2.6 (0.0–6.2)
6 to 9 days	172 (4.3)	0.6 (0.0–1.7)		3.5 (0.7–6.2)
2 to 5 days	1.098 (27.2)	1.0 (0.4–1.6)		4.2 (3.0–5.4)
1 single day	708 (17.6)	1.4 (0.5–2.3)		3.5 (2.2–4.9)
Amount of alcohol consumed per day (2 weeks)
1 standard unit	631 (15.7)	1.1 (0.3–1.9)	0.98	3.2 (1.8–4.5)	0.3
2 to 4 standard unit	902 (22.4)	1.1 (0.4–1.8)		4.1 (2.8–5.4)
5 to 7 standard unit	311 (7.7)	1.0 (0.0–2.0)		3.2 (1.2–5.2)
8 a 10 standard unit	141 (3.5)	1.4 (0.0–3.4)		5.0 (1.4–8.6)
More than 10 standard unit	131 (3.2)	0.8 (0.0–2.3)		6.9 (2.5–11.2)
Health condition
Very good	1,132 (28.1)	0.4 (0.05–0.8)	< 0.001	1.8 (1.0–2.5)	< 0.001
Good	2,131 (52.9)	1.2 (0.7–1.6)		4.3 (3.4–5.1)
Regular	683 (16.9)	3.2 (2.0–4.5)		9.9 (7.7–12.2)
Bad	63 (1.6)	9.5 (2.2–16.8)		14.3 (5.6–23.0)
No information	21 (0.5)	–		–
Current health condition
Better than 12 months ago	784 (19.5)	2.4 (1.3–3.5)	< 0.001	5.3 (3.8–6.9)	< 0.001
Same as 12 months ago	2,721 (67.5)	0.9 (0.5–1.2)		3.3 (2.6–4.0)
Worse than 12 months ago	501 (12.4)	3.0 (1.5–4.5)		11.4 (8.6–14.2)
No information	24 (0.6)	–		–
GHQ-12 (positive ≥ 3)
Negative	2,740 (68.0)	0.7 (0.4–1.0)	< 0.001	2.3 (1.8–2.9)	< 0.001
Positive	1,233 (30.6)	3.1 (2.1–4.0)	< 0.001	10.1 (8.4–11.8)
No information	57 (1.4)	–		–
Difficulty falling asleep
Always	178 (4.4)	5.0 (1.8–8.3)	< 0.001	23.6 (17.3–29.8)	< 0.001
Almost Always	297 (7.4)	5.5 (2.5–7.5)		14.5 (10.5–18.5)
Sometimes	933 (23.1)	1.7 (0.9–2.5)		5.5 (4.0–7.0)
Rarely	887 (22.0)	0.8 (0.2–1.4)		2.7 (1.6–3.8)
Never	1,699 (42.2)	0.6 (0.2–1.0)		1.5 (0.9–2.1)
No information	36 (0.9)	–		–
Wake up during sleep cycle
Always	139 (3.5)	4.3 (0.9–7.7)	< 0.001	23.7 (16.6–30.8)	< 0.001
Almost always	320 (7.9)	3.7 (1.7–5.8)		11.2 (7.8–14.7)
Sometimes	902 (22.4)	2.0 (1.1–2.9)		6.8 (5.1–8.4)
Rarely	915 (22.7)	1.5 (0.7–2.3)		3.7 (2.5–4.9)
Never	1,723 (42.7)	0.5 (0.1–0.8)		1.4 (0.8–1.9)
No information	31 (0.8)	–		–
Tiredness for no apparent reason
Always	191 (4.7)	4.2 (1.3–7.0)	< 0.001	16.2 (11.0–21.5)	< 0.001
Almost always	423 (10.5)	4.5 (2.5–6.5)		10.2 (7.3–13.0)
Sometimes	1,107 (27.5)	1.5 (0.8–2.3)		5.5 (4.2–6.8)
Rarely	765 (19.0)	1.0 (0.3–1.8)		2.9 (1.7–4.1)
Never	1,504 (37.3)	0.3 (0.0–0.6)		1.9 (1.2–2.6)
No information	40 (1.0)	–		–

Classes/medications	Phase 1 N (%)	Phase 2 N (%)	Phase 3 N (%)	Phase 4 N (%)
Antidepressants

Non-selective monoamine inhibitors	35 (60.3)	26 (36.7)	31 (22.2)	24 (15.2)
Amitriptyline	17 (29.3)	12 (17.0)	14 (10.0)	12 (7.6)
Amitriptyline + chlordiazepoxide	4 (6.9)	6 (8.5)	5 (3.6)	0.0
Clomipramine	2 (3.4)	3 (4.2)	6 (4.3)	3 (1.9)
Imipramine	9 (15.5)	4 (5.6)	1 (0.7)	4 (2.5)
Nortriptyline	3 (5.2)	1 (1.4)	5 (3.6)	5 (3.2)
Selective Serotonin Reuptake Inhibitors	17 (29.31)	32 (45.1)	87 (62.7)	106 (67.6)
Citalopram	1 (1.7)	0.0	3 (2.2)	10 (6.4)
Escitalopram	0.0	0.0	4 (2.9)	12 (7.6)
Fluoxetine	10 (17.2)	17 (24.0)	51 (36.7)	47 (30.0)
Paroxetine	3 (5.2)	11 (15.5)	13 (9.4)	16 (10.2)
Sertraline	3 (5.2)	4 (5.6)	16 (11.5)	21 (13.4)
Others	3 (5.1)	3 (4.2)	16 (11.5)	22 (13.9)
Bupropion	0.0	3 (4.2)	4 (2.9)	3 (1.9)
Desvenlafaxine	0.0	0.0	0.0	1 (0.6)
Duloxetine	0.0	0.0	2 (1.4)	6 (3.8)
Mirtazapine	1 (1.7)	0.0	1 (0.7)	0.0
Trazodone	1 (1.7)	0.0	4 (2.9)	4 (2.5)
Venlafaxine	1 (1.7)	0.0	5 (3.6)	8 (5.1)
Only the class declared	4 (6.9)	10 (14.1)	7 (5.0)	6 (3.8)

Benzodiazepines

Alprazolam	8 (4.2)	24 (12.4)	28 (12.2)	21 (10.5)
Bromazepam	83 (43.7)	66 (34.0)	43 (18.8)	24 (12.0)
Clobazam	2 (1.0)	0.0	2 (0.9)	3 (1.5)
Clonazepam	9 (4.7)	21 (10.8)	82 (36.0)	101 (50.5)
Clorazepate dipotassium	1 (0.5)	0.0	0.0	0.0
Cloxazolam	16 (8.4)	23 (11.9)	15 (6.5)	15 (7.5)
Diazepam	41(21.6)	38 (19.6)	44 (19.2)	24 (12.0)
Flunitrazepam	0.0	10 (0.5)	5 (2.2)	2 (1.0)
Flurazepam	3 (1.6)	2 (1.0)	1 (0.4)	2 (1.0)
Lorazepam	4 (2.1)	6 (3.1)	2 (0.9)	2 (1.0)
Midazolam	3 (1.6)	4 (2.1)	3 (1.3)	2 (1.0)
Nitrazepam	0.0	1 (0.5)	0.0	0.0
Only the class declared	23 (12.1)	13 (6.7)	10 (4.4)	8 (4.0)

	Incidence of AD (%) (95%CI)	p-value	Incidence of BDZ (%) (95%CI)	p-value
Total	4.9 (4.2–5.7)		8.3 (7.3–9.3)

Sex
Men	2.1 (1.3–2.9)	< 0.001	5.3 (4.1–6.6)	< 0.001
Women	7.2 (6.0–8.4)	< 0.001	10.6 (9.1–12.2)	< 0.001
Age
22–34	4.9 (3.4–6.4)	0.20	6.0 (4.4–7.7)	< 0.001
35–44	5.0 (3.9–6.2)		8.2 (6.7–9.7)
45–54	5.7 (3.9–7.5)		10.0 (7.6–12.3)
55 or more	1.7 (0.0–3.7)		13.3 (8.4–18.7)
Marital status
Married or living together	4.2 (3.3–5.1)	0.08	7.2 (6.2–8.4)	< 0.001
Separated or divorced	6.8 (4.5–9.2)		10.8 (7.8–13.8)
Widower	7.4 (1.7–13.1)		22.2 (13.1–31.3)
Single	5.5 (3.7–7.3)		8.2 (6.0–10.5)
Race/color
Black	4.1 (2.3–5.9)	0.27	11.3 (8.4–14.2)	0.02
Brown	4.2 (2.9–5.4)		7.2 (5.5–8.8)
White	5.9 (4.7–7.1)		8.0 (6.6–9.4)
Asian	3.8 (0.0–8.9)		7.8 (0.4–15.3)
Indigenous	3.1 (0.0–9.2)		18.7 (5.0–32.5)
Education level
Some elementary school	2.8 (0.6–5.1)	0.03	9.9 (5.8–14.0)	0.50
Elementary school	2.5 (0.5–4.6)		6.5 (3.3–9.7)
Some high school	2.8 (0.9–4.7)		8.1 (4.8–11.4)
High school	4.5 (2.9–6.0)		9.0 (6.9–11.2)
Some college	6.7 (4.3–9.1)		7.4 (4.8–9.9)
College	6.1 (4.5–7.8)		7.3 (5.5–9.1)
Graduate	6.2 (3.5-8.8)		10.3 (7.0-13.7)
Workplace
UERJ Campus¹	4.1 (3.1–5.1)	0.04	6.9 (5.6–8.2)	0.01
HUPE Hospital²	5.7 (4.6–6.9)	0.04	9.6 (8.1–11.1)	0.01
Income equivalence (minimum wages)
Up to 3	3.5 (1.3–5.8)	0.45	8.7 (5.1–12.3)	0.96
3 to 6	4.8 (3.3–6.3)		8.1 (6.2–10.1)
>6	5.3 (4.3–6.3)		8.2 (7.0–9.5)
Health insurance users
Yes	5.6 (4.5–6.7)	0.10	8.7 (7.4–10.1)	0.32
No	4.2 (3.2–5.3)	0.10	7.7 (6.3–9.2)	0.32
Alcohol consumption
Yes	4.2 (3.2–5.2)	0.07	7.3 (6.0–8.6)	0.07
No	5.7 (4.4–6.9)	0.07	9.2 (7.6–10.8)	0.07
Frequency of alcohol consumption (2 weeks)
Every day	1.7 (0.0–5.0)	0.41	3.6 (0.0–8.6)	0.67
10 to 13 days	5.3 (0.0–11.3)		9.2 (1.4–17.0)
6 to 9 days	7.2 (2.6–11.7)		8.1 (3.3–13.0)
2 to 5 days	3.9 (2.6–5.2)		6.9 (5.2–8.7)
1 single day	4.2 (2.5–6.0)		8.3 (5.9–10.7)
Amount of alcohol consumed per day (2 weeks)
1 standard unit	4.6 (2.7–6.5)	0.98	7.2 (4.8–9.5)	0.009
2 to 4 standard unit	4.1 (2.6–5.6)		5.8 (4.0–7.6)
5 to 7 standard unit	4.1 (1.6–6.6)		13.0 (8.7–17.3)
8 a 10 standard unit	3.8 (0.1–7.4)		7.9 (2.6–13.2)
More than 10 standard unit	5.0 (0.7–9.4)		6.5 (1.4–11.6)
Health condition
Very good	3.6 (2.3–4.8)	< 0.001	5.1 (3.6–6.5)	< 0.001
Good	4.7 (3.7–5.7)		7.9 (6.6–9.2)
Regular	8.0 (5.6–10.5)		14.2 (11.1–17.5)
Bad	8.3 (0.0–17.5)		22.8 (8.7–37.0)
Current health condition
Better than 12 months ago	5.1 (3.3–6.9)	0.004	12.1 (9.4–14.9)	< 0.001
Same as 12 months ago	4.3 (3.5–5.2)		6.7 (5.6–7.8)
Worse than 12 months ago	8.4 (5.6–11.2)		11.5 (8.1–14.9)
GHQ-12 (Positive ≥ 3)
Negative	3.7 (2.9–4.5)	< 0.001	6.3 (5.3–7.4)	< 0.001
Positive	8.0 (6.2–9.7)	< 0.001	12.7 (10.5–15.0)	< 0.001
Difficulty falling asleep
Always	10.6 (5.3–15.9)	< 0.001	21.7 (13.8–29.6)	< 0.001
Almost Always	4.6 (1.8–7.3)		21.8 (16.1–27.5)
Sometimes	6.2 (4.4–8.0)		9.4 (7.2–11.2)
Rarely	4.6 (3.0–6.2)		6.9 (5.0–8.9)
Never	3.9 (2.8–5.0)		5.0 (3.8–6.2)
Wake up during sleep cycle
Always	11.5 (5.4–17.7)	< 0.001	19.5 (11.1–27.9)	< 0.001
Almost Always	3.4 (1.1–5.7)		19.2 (14.0–24.4)
Sometimes	7.5 (5.5–9.5)		9.9 (7.6–12.3)
Rarely	3.8 (2.4–5.3)		7.5 (5.5–9.5)
Never	4.0 (2.9–5.0)		5.1 (3.5–6.4)
Tiredness for no apparent reason
Always	13.9 (8.0–19.7)	< 0.001	20.0 (12.8–27.2)	< 0.001
Almost Always	9.0 (5.8–12.2)		17.0 (12.7–21.3)
Sometimes	6.2 (4.6–7.9)		9.8 (7.7–11.8)
Rarely	2.8 (14.5–4.2)		4.8 (3.0–6.6)
Never	3.0 (2.0–4.0)		5.2 (3.9–6.4)

Variable	Antidepressants		Benzodiazepines

	RR (95%CI)	p-value	RR (95%CI)	p-value
Sex
Men	1	< 0.001	1	0.001
Women	2.66 (1.75–4.04)	< 0.001	1.58 (1.3–2.1)	0.001
Age
22–34	1		NI	NI
35–44	1.15 (0.78–1.70)	0.47	NI	NI
45–54	1.54 (1.0–2.44)	0.062	NI	NI
55 or more	0.53 (0.16–1.77)	0.305	NI	NI
Marital status
Married or living together	NI	NI	1
Separated or divorced	NI	NI	1.20 (0.86–1.68)	0.28
Widower	NI	NI	2.15 (1.34–3.47)	0.002
Single	NI	NI	1.03 (0.82–1.55)	0.46
Race/Color
Brown	NI	NI	1
Black	NI	NI	1.47 (1.03–2.09)	0.03
White	NI	NI	1.26 (0.93–1.71)	0.14
Asian	NI	NI	1.25 (0.47–3.27)	0.65
Indigenous	NI	NI	3.15 (1.42–6.97)	0.005
Education level
Some elementary school	1		NI	NI
Elementary school	0.99 (0.32–3.03)	0.98	NI	NI
Some high school	0.99 (0.34–2.84)	0.98	NI	NI
High school	1.7 (0.69–4.18)	0.25	NI	NI
Some college/ graduate	2.35 (0.98–5.62)	0.05	NI	NI
Health condition
Very good	NI	NI	1
Good	NI	NI	1.4 (0.98–2.00)	0.06
Regular/Bad	NI	NI	1.81 (1.2–2.72)	0.005
GHQ-12 (Positive ≥ 3)
Negative	1	0.08	1
Positive	1.34 (0.96–1.88)	0.08	1.34 (1.05–1.79)	0.03
Wake up during sleep cycle
Never	NI	NI	1
Rarely	NI	NI	1.23 (0.85–1.77)	0.27
Sometimes	NI	NI	1.45 (1.01–2.07)	0.04
Almost Always/Always	NI	NI	2.71 (1.86–3.94)	< 0.001
Tiredness for no apparent reason
Never	1		NI	NI
Rarely	0.84 (0.47–1.50)	0.56	NI	NI
Sometimes	1.73 (1.11–2.70)	0.015	NI	NI
Almost Always	2.02 (1.20–3.42)	0.008	NI	NI
Always	3.2 (1.82–5.66)	< 0.001	NI	NI

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Geisy de Carvalho Alcantara Rua São Francisco Xavier, 524 – Maracanã, Bloco D, 7º andar – UERJ E-mail: geisycarvalho2011@gmail.com