Serbia - the country without depression?

M Stojancevic1, M Paut Kusturica1, N Pavlovic1, B Stanimirov1, K Stankov1,2, A Sabo1, M Mikov1. 1Faculty of Medicine Novi Sad, Department of Pharmacology, Toxicology and Clinical Pharmacology, 21000, Serbia, 2Clinical center of Vojvodina, 21000, Serbia

INTRODUCTION: Depressive disorder is one of the most prevalent forms of mental illness and is of major public health importance. The aim of the study was to to determine the total utilization and pattern of use of antidepressants in Serbia in correlation with Croatia and Finland and to propose appropriate interventions in Serbia on the basis of the results obtained. Scandinavian country was chosen for its long tradition of drug utilization monitoring by use of ATC/DDD methodology and rational and conservative prescription practice.

METHODS: The data on utilization of antidepressant drugs (ATC group N06) in 2010 were retrieved from the annual reports of medicines agencies in Serbia, Croatia, and Finland. The ATC/DDD methodology was applied and the results were expressed in defined daily doses per 1000 inhabitants per day (DID). As an indicator of the quality of drug prescribing, the Drug Utilization 90% (DU90%) method was used.

RESULTS: In 2010, the consumption of antidepressants in Serbia (11.67 DID) was approximately 6 times lower than in Finland (68.83 DID) and around 2 times lower than in Croatia (23.24 DID). The selective serotonine reuptake inhibitors (SSRIs) were the most commonly used subgroup of antidepressant drugs in all three countres (63.88%, 77.84%, 73.76% in Finland, Croatia and Serbia, respectively) which is in accordance with a current clinical practice guidelines that recommend SSRIs as the first-line treatment for panic and generalized anxiety disorders. Eight drugs fell under DU90% segment in all obderved countries, with a notable difference in overall utilization distribution of antidepressant drugs. Citalopram and escitalopram accounted for the highest share of total antidepressant utilization in Finland (25.43% and 17.11%, respectively). On the contrary, sertraline was the most commonly used in Croatia (25.04%) and Serbia (47.73%). The differences are partly consequential to different socioeconomic and health policy factors among the selected countries.

CONCLUSION: This study shows that the overall utilization of antidepressant drugs in Serbia is lower than in some of the most developed European countries, which implies possible underdiagnosing of affective disorders in general practice. To reduce the serious consequences that may be caused on that way, the early diagnosis and timely, adequate and effective management and treatment of depression is essential.

Acknowledgement: This work is supported by Ministry of Education and Science, Republic of Se rbia, project No. 41012.