The overall consumption of psychotropic drugs in children and adolescents has increased in the studied period (2008–2017) in all the Nordic countries (Denmark 58,2%, Norway 43,9% and Sweden 152,8%) but not in Catalonia (-15,6%). To see total psychotropic consumption by year and country please see Table and Fig. 1 of the Supplementary material.
In all countries anxiolytics (containing hypnotic and sedatives) are the ones showing the highest consumption followed by the stimulants, being the antipsychotics the group with the lowest consumption.
Consumption by groups.
Antipsychotics (N05A)
This group is the one with the lowest consumption in all studied countries. The highest prevalence in 2017 is observed in Catalonia (7.41‰) and the lowest in Denmark (2.40‰).
During the studied decade Sweden, Norway and Catalonia increased their consumption (57.6%, 45.1% and 35.7%, respectively) while in Denmark it remained stable (-2.8%).
Anxiolytics, hypnotics and sedatives (N05B and N05C)
For all the studied period, this group shows the highest prevalence of use in all countries except in Denmark where psychostimulants prevalence was 13.54‰ whereas for anxiolytics was 12.15‰. All Nordic countries show an increase in their consumption but Catalonia is the country with the highest consumption every year although there are two peaks of decrease in 2009 (25.18‰) and 2013 (34.24‰) and a trend to decrease from 2015 to 2017 (18% of decreasing rate). In 2017, Catalonia and Sweden are the countries with highest consumption (35.33‰ and 33.36‰ respectively), although the trends are opposite, while in Catalonia the use of these groups have shown a decrease (-32.1%) in Sweden an increase during the last decade can be observed (190.8%).
Antidepressants (N06A)
Sweden shows the highest consumption on this group through all the studied period, as well as the highest increase, almost double (from 7.18‰ in 2008 to 13.68‰ in 2017). Denmark is the only country that shows a decrease (-30.9%).
Psychostimulants (N06BA)
Although all countries show an increase in the psychostimulants consumption during this decade, Sweden shows the highest increase (189,4%) achieving a total of 22.17‰. After 2012 the consumption of this group stabilizes for Catalonia, Denmark and Norway, showing in 2017 a consumption of 16,73‰, 13,54‰ and 15,72‰ respectively.
Consumption by sex.
There is no important difference between both sexes regarding antipsychotic consumption except in Catalonia, were the prevalence of use in boys in 2017 doubled that in girls (10.33‰ vs 4.32‰). In the Nordic countries this consumption is almost the same in the last four years of study in both, boys and girls (between 2,09‰ to 3,29‰).
In the case of the anxiolytics, hypnotics and sedatives there is no difference in consumption between both sexes in any of the four countries for all the study years.
Antidepressants consumption shows differences between sexes, being twice in girls than in boys, except for Catalonia where the consumption is similar in both groups, being higher for girls (in 2017, boys 4.12‰ and girls 5.79‰).
Psychostimulants show the highest difference of consumption between boys and girls in all countries, being in Catalonia and Denmark around 3-fold (2017, Catalonia 24.35‰ vs 8.66‰, boys and girls respectively and Denmark 19.10‰ vs 7.70‰) and in Norway and Sweden around 2-fold (2017, Norway 21,59‰ vs 9,51‰, boys and girls respectively and Sweden 29,31‰ vs 14,55‰). Despite these differences, the increase rate in the psychostimulants consumption between 2008 and 2017 is twice as high in girls as in boys.
Consumption by sex and age in 2017. Figure 3.
For both sexes the use of psychotropic drugs increases with age, except for the anxiolytics, hypnotics and sedatives group in Catalonia.
Antipsychotics
In all countries the consumption at least doubles when age group increases. This increase is up to 5-fold in girls in the Nordic countries between 10–14 years and 15–17/19 years. In Catalonia there is no difference in the increasing rates by sex.
Anxiolytics, hypnotics and sedatives
Catalonia is the only country with a higher consumption for the 0–4 years age group as they have the highest drug consumption of all ages in both sexes (64.48‰ for boys and 61.98‰ for girls vs 16.01‰ and 30.01‰ respectively in the 15–17 years group). The Nordic countries consumption of anxiolytics is the lowest in this age group (0–4 years).
Girls’ anxiolytics, hypnotics and sedatives consumption is lower until 15–17/19 years than boys’. Catalonia and Denmark show a lower consumption for this age group, but it has to be taken into account that data for this age group is only for 15–17 years in this two countries whereas it is 15–19 for Norway and Sweden. Sweden girls of 15–19 years have the highest consumption in this group, with 92.73‰ vs 55.56‰ in boys of this age.
Antidepressants
The antidepressant consumption is similar in boys and girls in the age groups 0–4, 5–9 and 10–14, being less than 1‰ in the first two age groups in all countries. The consumption increases up to 3 times from 10–14 years to 15–17/9 years in boys and up to 5–6 times in girls. In Norway the consumption rises in the group of 10–14 from 1.74‰ and 1.8‰, boys and girls, to 11.68‰ and 30.54‰ respectively. Sweden shows the highest prevalence in the 15–19 age group: 69.35‰ girls and 29.35‰ boys.
Psychostimulants
The highest consumption in psychostimulants is showed for boys between 10–14 years with a decrease in the next age group (15–17/9 years) in the Nordic countries. In Catalonia the consumption remains stable from 10–17 years (50.42‰ in 10–14 years and 50.80‰ in 15–17 years) for boys and an increase in girls from 10–14 to 15–17 (17.61‰ to 19.39‰ respectively).
In the case of the girls, the use of psychostimulants increases with age, reaching its highest consumption in the 15–17/9 group. The increments in Sweden (69.3%) and Denmark (64.8%) are the highest being in Norway (13.7%) and Catalonia (10.1%) lower, from 10–14 to 15–17/9 years.
Active substances most used in 2017.
Antipsychotics
In Denmark and Norway the most used is quetiapine (33% and 38% respectively) followed by risperidone (24% and 28% respectively). In Catalonia the most used antipsychotic is risperidone (43%), followed by aripiprazole (28%), the same as in Sweden (31% and 26% respectively). Lithium accounts for the fifth position in Sweden (4.3%) but is no more than 1% in the rest of the countries (Catalonia 0.9%, Denmark 0.1% and Norway 1.2%).
Anxiolytics, hypnotics and sedatives
Hydroxyzine is by far the most used active substance of this group in Catalonia (80%), meanwhile in the Nordic countries is melatonin (Denmark 66.5%, Norway 63.5% and Sweden 52.4%). Diazepam is also among the five most used active substances in all the countries.
Antidepressants
Sertraline is the most used active substance in all countries. Denmark sertraline’s consumption is 62% from the total of antidepressants, in Norway is 30% and in Sweden is 43%. In Catalonia sertraline’s consumption is 34%, behind fluoxetine (36%).
Psychostimulants
All countries show methylphenidate as the most active substance consumed in this group (Catalonia 80‰, Denmark 65‰, Norway 77‰ and Sweden 61‰) followed by lixdesamfetamine and atomoxetine.