Antidepressant utilization patterns and mortality in Swedish men and women aged 20-34 years

Purpose To compare antidepressant utilization patterns and mortality in relation to antidepressant use in men and women aged 20-34 years. Methods We used data from the Swedish Prescribed Drug Register to identify adults aged 20-34 years who purchased at least one antidepressant in 2006. Information on death and migration was obtained from the Total Population Register by record linkage. One-year prevalence and proportion of new users, amount of purchased antidepressants, concurrent use of other antidepressants, mood stabilizers and antipsychotics and mortality were assessed. Results The one-year prevalence of antidepressant use was 5.6% among all Swedes aged 20-34 years (n=94,239) and was higher among women than men (7.2 vs. 4.0%, p<0.001). Selective serotonin reuptake inhibitors were the most dominant class of antidepressants at baseline and were more common among women than men (78.7 vs. 71.7%, p<0.001). Of the new users, 22.3% filled only one prescription during the study period, men more often than women (24.1 vs. 21.4%, p<0.001). The mortality rate was higher in men than in women (24 vs. 14 per 10,000, p=0.009). Concurrent use of mood stabilizers (48 vs. 16 per 10,000, p<0.001) and antipsychotics (50 vs. 14 per 10,000, p<0.001) was associated with increased mortality in men and women. Conclusions Almost twice as many Swedish women than men aged 20-34 years purchased antidepressants in 2006. Differences in utilization patterns between sexes were rather small. Discontinuation rates were high, indicating that health care providers need to acquire an increased awareness on attitudes to treatment. In both sexes, mortality rates were elevated among those concurrently using mood stabilizers and antipsychotics, which needs further investigation.