pha maceu icals
A icle
T ends in An idep essan s Use in Spain be ween 2015
and 2018: Analyses om a Popula ion-Based Regis y
S udy wi h Re e ence o D i ing
Edua do Gu ié ez-Abejón1,2 , F ancisco He e a-Gómez 1,3,* , Paloma C iado-Espegel 4and
F. Ja ie Ál a ez 1,5
1Pha macological Big Da a Labo a o y, Pha macology and The apeu ics, Facul y o Medicine, Uni e si y o
Valladolid, 47005 Valladolid, Spain; egu ie [email p o ec ed] (E.G.-A.), al a [email p o ec ed] (F.J.
Á
.)
2Technical Di ec ion o Pha maceu ical Assis ance, Ge encia Regional de Salud de Cas illa y León,
47007 Valladolid, Spain
3Neph ology, Hospi al Vi gen de la Concha—Sanidad de Cas illa y León, 49022 Zamo a, Spain
4Ge encia de Asis encia Sani a ia-Sanidad de Cas illa y León, 34001 Palencia, Spain;
[email p o ec ed]
5CEIm, Hospi al Clínico Uni e si a io de Valladolid—Sanidad de Cas illa y León, 47003 Valladolid, Spain
*Co espondence: [email p o ec ed]; Tel.: +34-983423077
Recei ed: 9 Ma ch 2020; Accep ed: 1 Ap il 2020; Published: 3 Ap il 2020


Abs ac :
An idep essan s a e conside ed d i ing-impai ing medicines (DIM). This is a
popula ion-based egis y s udy ha shows he end in he use o an idep essan s in Cas ile
and Le
ó
n, Spain, om 2015 o 2018. Da a on an idep essan dispensa ions a pha macies and he
adjus ed use o hese medicines by he d i e popula ion a e p esen ed. Fo he pu poses o analysis,
popula ion dis ibu ion by age and gende has been aken in o accoun , as well as he h ee D i ing
Unde he In luence o D ugs, alcohol, and medicines (DRUID) ca ego ies. An idep essan s we e
used by 8.56% o he gene al popula ion and 5.66% o d i e s. An idep essan s we e used mo e
commonly by emales han by males (12.12% s. 4.87%,
χ2
=1325.124, p =0.001), and use s inc eased
as he age inc eased, e en i women who d i e used less an idep essan s a e u ning 60 yea s o age.
Ch onic use o an idep essan s was ele an (8.28%) in he same way as daily use (3.15%). Mos o
he consump ion included SSRIs (4.99%), which a e also known as “o he an idep essan s” (3.71%).
Rega dless o an idep essan s consumed, use s ook 2.75
±
1.19 DIMs, which a e mainly anxioly ics
(58.80%) and opioids (26.43%). Las ly, ega ding consump ion o an idep essan s acco ding o he
DRUID classi ica ion, ca ego y I p edomina ed o e ca ego ies II and III. Ou indings should se e
as a s a ing poin o heal h and a ic au ho i ies o aise awa eness o he isk o a ic acciden s,
especially in ol ing SSRIs.
Keywo ds:
an idep essan s; d i ing impai ing medicines; au omobile d i ing; d ug u iliza ion;
a ic acciden s
1. In oduc ion
Dep ession causes se e e disabili ies in he occupa ional and social li e o pa ien s [
1
] and i is
cu en ly ecognized as a global public heal h conce n [
2
]. Acco ding o he Wo ld Heal h O ganiza ion
(WHO), majo dep essi e diso de will become he second leading cause o disabili y a ound he
wo ld in 2030 [
2
]. Dep ession a ec s nea ly 10% o he adul popula ion, and has a li e ime p e alence
o app oxima ely 13% [
3
]. In addi ion, dep ession is he nin h mos equen ch onic disease among
people o e 14 yea s o age, which is mo e equen in women han in men [4].
Pha maceu icals 2020,13, 61; doi:10.3390/ph13040061 www.mdpi.com/jou nal/pha maceu icals
Pha maceu icals 2020,13, 61 2 o 14
Dep ession is cha ac e ized by loss o ene gy and cogni i e impai men o he pa ien [
5
], and
i is associa ed wi h le ha gy and sleep dis u bances, which a ec daily unc ions [
6
], including he
i ness o d i e [
7
]. Mobili y is undamen al o he independence o he indi idual in socie y oday [
8
],
and di e en s udies indica e ha 80% o pa ien s wi h dep ession ha e a alid d i e ’s license and
70% d i e egula ly [
9
]. Al hough he objec i e o pha macological ea men wi h an idep essan s
is long- e m emission o symp oms and imp o ed daily ac i i y o pa ien s [
8
], an idep essan s can
a ec he sa e y o d i ing [9,10].
An idep essan s ha hold he Ana omical The apeu ic Chemical (ATC) code N06 a e classi ied in
ou subg oups [
11
]: (1) non-selec i e monoamine eup ake inhibi o s (o icyclic an idep essan s,
TCAs) (N06A), (2) selec i e se o onin eup ake inhibi o s (SSRIs) (N06B), (3) non-selec i e monoamine
oxidase A inhibi o s (N06AF), (4) monoamine oxidase A inhibi o s (N06AG), and (5) “o he
an idep essan s” (N06AX). Each o hese an idep essan ypes has a pa icula side-e ec s p o ile.
Fo ins ance, TCAs can cause seda ion, dizziness, double and blu ed ision, achyca dia, and a
emo [
12
]. SSRIs a e associa ed wi h nausea, dia hea, insomnia, ne ousness, agi a ion, and
anxie y [
13
]. Seda ion and he impai men o d i e ’s abili ies a e impo an wi h TCAs (e.g.,
ami ip yline, no ip yline) and he no ad ene gic and speci ic se o one gic an idep essan s (NaSSAs)
(e.g., mianse ine, mi azapine) belonging o he N06AX subg oup. On he con a y, SSRIs (e.g.,
as pa oxe ine, luoxe ine, esci alop am), he o he se o onin ecep o an agonis and eup ake
inhibi o s (SARIs) (e.g., azodone), and he se o onin no epineph ine eup ake inhibi o s (SNRIs) (e.g.,
enla axine, duloxe ine) a e well ole a ed conside ing hei lowe seda i e e ec .
Cu en ly, SSRIs ha e p ac ically eplaced TCAs due o hei g ea e ole abili y and sa e y [
13
].
S udies epo on Odds Ra ios (OR) om 1.10 o 3.10 o he isk o a a ic acciden when being unde
an idep essan ea men [
14
], which highligh s he isk o inc easing doses o TCAs [
15
–
18
] as a clea
ela ion in ol ing exclusi ely he use o TCAs ha is no con i med [
19
]. On he o he hand, among
s udies ha assessed he in luence o non-seda i e an idep essan s, such as SSRIs and enla axine, a
sligh o no inc ease in he isk o a ic acciden s was ound [18,19].
Impo an ly, an idep essan s a e p esen in he h ee D i ing Unde he In luence o D ugs, alcohol
and medicines (DRUID) ca ego ies: SSRIs and monoamine oxidase A inhibi o s belong o ca ego y I
(mino in luence on i ness o d i e), TCAs belong o ca ego ies II (mode a e in luence on i ness o
d i e), and III (se e e in luence on i ness o d i e), and he so-called “o he an idep essan s” (ATC
subg oup N06AX) may be encoun e ed in o ca ego y III (e.g., mianse in, azodone), o ca ego ies I
and II (e.g., enla axine, duloxe ine) (Table S1) [20].
T ends in an idep essan s use by he popula ion is a opic o g ea in e es . Since comme cializa ion
o SSRIs, an inc ease in hei use o wo o h ee imes may be obse ed in wes e n coun ies [
21
,
22
].
Fo ins ance, in Spain, he use o an idep essan s inc eased by 200% be ween 2000 and 2013, and,
in a simila way as in Eu opean Union (EU) coun ies, SSRIs we e he mos consumed (70.4%) [
23
].
Howe e , he e is s ill li le in o ma ion ega ding he use o SSRIs and d i ing isks. In Spain, a speci ic
pic og am on “medicines and d i ing” was in oduced in 2011 on he packaging o all d i ing-impai ing
medicines (DIM), including all an idep essan s. The main objec i e o his pic og am was o imp o e
pa ien and physician knowledge abou he e ec s o hese medicines on he abili y o d i e sa ely [
24
].
This s udy p esen s he da a on an idep essan s consump ion om 2015 o 2018 in Cas ile and
Le
ó
n, Spain, based on dispensa ion o such DIMs a pha macies. The adjus ed use o an idep essan s
by he d i e popula ion is also p esen ed in o de o assess di e ences in pa e ns o use wi h espec o
he gene al popula ion [
24
–
27
]. In addi ion, he du a ion and hei concomi an use o an idep essan s
wi h o he d i ing impai ing medicines we e also assessed. Dis ibu ions by age and gende , and he
use o an idep essan s in o he h ee DRUID ca ego ies we e conside ed [20].
2. Expe imen al Sec ion
This manusc ip p esen s indings om a popula ion-based egis y s udy ca ied ou acco ding
o he Repo ing o s udies Conduc ed using Obse a ional Rou inely-collec ed Da a (RECORD)
Pha maceu icals 2020,13, 61 3 o 14
ecommenda ions in o de o adequa ely p o ide eal-wo ld e idence in o he opic add essed [
28
].
Ou indings co e dispensa ion o all comme cialized an idep essan s in Cas ile and Le
ó
n, Spain (ATC
subg oups N06AA, N06AB, N06AG, and N06AX) om 2015 o 2018.
Fo a be e unde s anding o ou esul s, sepa a ely, an idep essan s in o each o DRUID
ca ego ies we e s udied (Table S1). The da a on dispensa ion o an idep essan s and o he DIMs we e
accessible om CONCYLIA (h p://www.saludcas illayleon.es/po almedicamen o/es/indicado es-
in o mes/concylia), whe e he en i e in o ma ion on pha maceu icals ca e in Cas ile and Le
ó
n is
ou inely collec ed. The d i e s’ license census da a o he yea s 2015 o 2018 we e also accessible
(h p://www.dg .es/es/segu idad- ial/es adis icas-e-indicado es/pe misos-conduccion/) o calcula e
he adjus ed use o an idep essan s by d i e s (Table S2), as p e iously made [24–27].
Fo he pu poses o an analysis in a eal-wo ld se ing, all dispensa ions we e conside ed as
equi alen o consump ion. Al hough consump ion o an idep essan s in hospi als and p i a e clinics
was no conside ed, ou indings co e mo e han 95% o uses since he en i e Spanish popula ion is
included in he public heal h sys em and an idep essan s a e manda o y p esc ip ion d ugs.
The ollowing a iables we e conside ed: (1) yea ly equency o an idep essan s consump ion,
(2) acu e (1–7 days), sub-acu e (8–29 days), and ch onic use (
≥
30 days) o an idep essan s each yea , (3)
yea ly equency o daily use o an idep essan s, (4) yea ly equency o an idep essan s consump ion
by DRUID ca ego ies, and (5) concomi an use o an idep essan s wi h o he DIMs du ing each yea .
All analyses we e done conside ing age and gende dis ibu ions. This s udy was app o ed by ou
local e hics commi ee on 17 Ma ch 2016 ( e e ence numbe PI 16-387).
Resul s a e exp essed as equencies (pe cen age) wi h hei co esponding 95% con idence
in e al (95% CI) o as means accompanied by hei s anda d de ia ions (SD). Di e ences be ween
con inuous a iables we e calcula ed using S uden ’s - es , and hose be ween ca ego ical a iables
we e calcula ed using Pea son’s chi-squa ed es . The Coch an-A mi age end es was used o
e alua e he consump ion end by yea s. The le el o signi icance was se a p
≤
0.05. All s a is ical
analyses we e pe o med by using he S a is ical Package o he Social Sciences (SPSS e sion 24.0.,
SPSS Inc, Chicago, IL). Las ly, Mic oso Wo d and Excel (Mic oso O ice e sion 365, Mic oso ,
Redmon, WA, USA) we e used o p epa ing his manusc ip .
3. Resul s
F om 2015 o 2018, 8.56% o he gene al popula ion ook a leas one an idep essan . Thei use
was h ee imes g ea e in women han in men (12.12% s. 4.87%,
χ2
=1325.124, p =0.001, Table 1),
and, in bo h sexes, he consump ion inc eased as he age inc eased (Figu e 1), which in ol ed he ou
ATC subg oups (Figu e 2). O e all, yea ly an idep essan consump ion inc eased 21.18% (
Z=57.216
,
p<0.0001) om 2015 (7.64%) o 2018 (9.26%), and his inc ease in ol ed pa icula ly ch onic use
(21.80%, Z =57.607, p <0.0001) (7.38% in 2015 s. 8.98 in 2018) and daily use (25.80%, Z =43.183,
p<0.0001
) (2.76% in 2015 s 3.48 in 2018). Rega ding he inc ease in he s udy pe iod, no di e ences
we e obse ed be ween men and women (Figu e 3). Ch onic use (
≥
30 days) was he mos equen
(97.73%), bu 3.15% o he popula ion ook a leas one an idep essan daily (Table 1). In addi ion,
concomi an use o an idep essan s wi h o he DIMs was common. Rega dless o an idep essan s
consumed (Table 2), yea ly use s ook 2.75
±
1.19 DIMs (anxioly ics, 58.80%, opioids, 26.43%) and daily
use s ook 2.91 ±1.21 DIMs (anxioly ics, 67.18%, opioids, 28.89%).
Pha maceu icals 2020,13, 61 4 o 14
Table 1. An idep essan s consump ion acco ding o he CONCYLIA da abase and he Cas ile and León d i e s’ license census da a.
Type o
An idep essan
Popula ion Using An idep essan s % (95CI) D i e s Using An idep essan s % (95CI)
Yea ly Use Daily Use Type o Use Yea ly Use Daily Use Type o Use
Acu e Subacu e Ch onic Acu e Subacu e Ch onic
To al An idep essan s
TOTAL 8.56 (8.52–8.59) 3.15 (3.13–3.17) 0.05 (0.04–0.06) 0.23 (0.22–0.24) 8.28 (8.25–8.32) 5.66 (5.62–5.70) 1.93 (1.91–1.95) 0.04 (0.03–0.05) 0.21 (0.20–0.21) 5.41 (5.37–5.44)
Male 4.87 (4.83–4.91) 1.68 (1.65–1.70) 0.03 (0.02–0.04) 0.15 (0.14–0.15) 4.70 (4.66–4.74) 4.83 (4.78–4.87) 1.68 (1.65–1.70) 0.03 (0.02–0.04) 0.16 (0.15–0.16) 4.64 (4.60–4.69)
Female
12.12 (12.06–12.17)
4.57 (4.54–4.61) 0.07 (0.06–0.08) 0.31 (0.30–0.32)
11.74 (11.68–11.80)
6.90 (6.83–6.96) 2.31 (2.27–2.35) 0.07 (0.06–0.08) 0.16 (0.15–0.17) 4.64 (4.59–4.70)
X2=1325.124;
p=0.001
X2=4531.330;
p=0.001
X2=32.612;
p=0.013
X2=76.08;
p=0.001
X2=7024.208;
p=0.001
X2=14360.161;
p=0.001
X2=14615.499;
p=0.001
X2=1160.409;
p=0.001
X2=6083.759;
p=0.001
X2=43897.32;
p=0.001
Non-selec i e monoamine eup ake inhibi o s
TOTAL 1.11 (1.10–1.13) 0.05 (0.04–0.05) 0.17 (0.16–0.17) 0.30 (0.29–0.31) 0.64 (0.63–0.65) 0.80 (0.70–0.90) 0.04 (0.03–0.05) 0.14 (0.13–0.15) 0.24 (0.24–0.25) 0.42 (0.41–0.43)
Male 0.58 (0.57–0.59) 0.03 (0.03–0.04) 0.08 (0.08–0.09) 0.16 (0.15–0.17) 0.34 (0.32–0.35) 0.61 (0.59–0.63) 0.04 (0.03–0.05) 0.09 (0.08–0.10) 0.17 (0.16–0.18) 0.35 (0.34–0.36)
Female 1.63 (1.61–1.65) 0.06 (0.05–0.06) 0.25 (0.24–0.26) 0.44 (0.43–0.45) 0.94 (0.92–0.96) 1.10 (0.99–1.12) 0.03 (0.02–0.04) 0.21 (0.2–0.22) 0.35 (0.34–0.37) 0.53 (0.51–0.55)
X2=48.521;
p=0.001
X2=306.885;
p=0.001
X2=36.373;
p=0.004
X2=51.54;
p=0.001
X2=392.684;
p=0.001
X2=1837.676;
p=0.001
X2=113.888;
p=0.023
X2=1149.338;
p=0.013
X2=2029.683;
p=0.001
X2=3326.979;
p=0.001
Selec i e se o onin eup ake inhibi o s
TOTAL 4.99 (4.96–5.02) 2.22 (2.20–2.24) - 0.23 (0.22–0.24) 4.76 (4.73–4.79) 3.32 (3.29–3.35) 1.33 (1.31–1.35) - 0.19 (0.18–0.20) 3.13 (3.10–3.16)
Male 2.69 (2.66–2.72) 1.16 (1.14–1.18) - 0.30 (0.29–0.31) 0.64 (0.63–0.66) 2.69 (2.65–2.72) 1.14 (1.12–1.16) - 0.14 (0.13–0.15) 2.55 (2.51–2.58)
Female 7.22 (7.17–7.26) 3.24 (3.21–3.27) - 0.32 (0.31–0.33) 6.90 (6.85–6.94) 4.26 (4.21–4.32) 1.62 (1.59–1.65) - 0.26 (0.25–0.27) 4.00 (3.95–4.05)
X2=1009.602;
p=0.001
X2=2947.450;
p=0.001 -X2=114.15;
p=0.001
X2=4329.346;
p=0.001
X2=6700.641;
p=0.001
X2=10488.675;
p=0.001 -X2=1231.407;
p=0.001
X2=23530.089;
p=0.001
O he an idep essan s
TOTAL 3.71 (3.69–3.74) 0.97 (0.96–0.99) - 0.43 (0.42–0.44) 3.28 (3.26–3.3) 2.36 (2.34–2.39) 0.62 (0.61–0.63) - 0.31 (0.30–0.32) 2.05 (2.03–2.07)
Male 2.31 (2.28–2.34) 0.54 (0.53–0.55) - 0.29 (0.28–0.30) 2.02 (1.99–2.04) 2.24 (2.21–2.27) 0.56 (0.54–0.57) - 0.29 (0.28–0.30) 1.95 (1.93–1.98)
Female 5.07 (5.03–5.11) 1.39 (1.37–1.41) - 0.56 (0.55–0.57) 4.51 (4.47–4.54) 2.54 (2.50–2.58) 0.71 (0.69–0.73) - 0.35 (0.33–0.36) 2.19 (2.15–2.23)
X2=661.836;
p=0.001
X2=1423.581;
p=0.001 -X2=98.22;
p=0.001
X2=3157.1;
p=0.001
X2=5506.160;
p=0.001
X2=4202.911;
p=0.001 -X2=2613.557;
p=0.001
X2=16278.972;
p=0.001
Abb e ia ions: 95CI. con idence in e al.
Pha maceu icals 2020,13, 61 5 o 14
Pha maceu icals 2019, 12, x FOR PEER REVIEW 1 o 15
Figu e 1. F equency o an idep essan s use by he gene al popula ion and he d i e popula ion.
Figu e 1. F equency o an idep essan s use by he gene al popula ion and he d i e popula ion.

Pha maceu icals 2020,13, 61 6 o 14
Pha maceu icals 2019, 12, x FOR PEER REVIEW 1 o 15
Figu e 2. F equency o use by he ype o an idep essan .
Figu e 2. F equency o use by he ype o an idep essan .
Su p isingly, among he 40 DIMs wi h he highes numbe o packages dispensed in Cas ile
and Le
ó
n du ing he co e ed pe iod, 11 we e an idep essan s, especially esci alop am, se aline,
mi azapine, and enla axine (Table S3). SSRIs we e he mos consumed ype o an idep essan s (4.99%)
ega dless o gende , which is ollowed by he “o he an idep essan s” (ATC subg oup N06AX) (3.71%)
and TCAs (1.11%) (Table 1). The inc ease in he use o new N06AX an idep essan s should also be
highligh ed (Table S4): des enla axine (56.90%), mi azapine (34.68%), and se aline (32.44%). Among
daily use s, 7 ou o 10 we e aking SSRIs. TCAs appea ed only ela ed o acu e use (<7 days) ha was
in equen (0.05%). The use o monoamine oxidase A inhibi o s (N06AG) was negligible (18 pa ien s
in o he co e ed pe iod, 8.78*10–6%).
Consump ion o an idep essan s in he DRUID ca ego y I was wice compa ed o hose in
ca ego y II and 1.5 imes highe han hose in ca ego y III. Ne e heless, he highes inc ease in he use
co esponded o an idep essan s in ca ego y III (40.84%), which is ollowed by hose in ca ego ies II
(18.84%) and I (13.44%) (Figu e 4and Table S5).
Pha maceu icals 2020,13, 61 7 o 14
Pha maceu icals 2019, 12, x FOR PEER REVIEW 1 o 15
Figu e 3. E olu ion o an idep essan s use in Cas ile and León (2015–2018).
Figu e 3. E olu ion o an idep essan s use in Cas ile and León (2015–2018).
Pha maceu icals 2020,13, 61 8 o 14
Table 2. O he d i ing-impai ing medicines (DIMs) used concomi an ly wi h an idep essan s.
ATC Code Desc ip ion
Popula ion % (95CI) D i e s % (95CI)
Yea ly Use Daily Use Yea ly Use Daily Use
Male Female Male Female Male Female Male Female
N05B Ansyoli ics
53.65
(53.36–53.94)
60.80
(60.51–61.09)
61.21
(60.52–61.89) 69.3 (68.91–69.68) 55.22 (54.75–55.7) 61.89
(61.42–62.37)
62.75
(61.97–63.53)
71.85
(71.09–72.60)
X2=1026.420; p =0.001 X2=845.748; p =0.001 X2=6479.230; p =0.001 X2=2593.569; p =0.001
N02A Opioids 20.84 (20.5–21.17) 28.61
(28.38–28.84)
20.77
(20.20–21.34)
31.76
(31.37–32.15)
20.53
(20.14–20.91)
23.33
(22.92–23.74)
20.43
(19.78–21.08)
26.49
(25.75–27.23)
X2=399.964, p =0.001 X2=378.297, p =0.001 X2=3344.400, p =0.001 X2=1178.273, p =0.001
N02B O he analgesics
and an ipi e ics
16.15
(15.84–16.45) 20.59 (20.39–20.8) 15.96
(15.45–16.47)
22.53
(22.18–22.88)
15.40
(15.06–15.74) 16 (15.64–16.35) 15.08
(14.50–15.66)
17.67
(17.03–18.31)
X2=229.200, p =0.001 X2=201.621, p =0.001 X2=2612.735, p =0.001 X2=939.163, p =0.001
N05C Hypno ics and
Seda i es
17.33
(17.01–17.64)
17.16
(16.97–17.36)
18.63
(18.08–19.18)
19.81
(19.48–20.14)
16.97
(16.61–17.33)
14.64
(14.30–14.98)
18.56
(17.93–19.19)
18.85
(18.19–19.50)
X2=235.223, p =0.001 X2=188.963, p =0.001 X2=2087.480, p =0.001 X2=835.451, p =0.001
N03A An iepilep ics
19.14
(18.82–19.47)
16.28
(16.09–16.47)
24.48
(23.88–25.08)
20.93
(20.59–21.27)
20.24
(19.86–20.62)
17.67
(17.30–18.04)
26.30
(25.59–27.01)
25.58
(24.84–26.31)
X2=362.380, p =0.001 X2=359.500, p =0.001 X2=1878.187, p =0.001 X2=775.130, p =0.001
N05A An ipsycho ics
20.73
(20.40–21.06)
15.43
(15.25–15.62)
29.39
(28.75–30.03)
20.20
(19.86–20.53)
20.71
(20.32–21.09)
13.44
(13.11–13.77)
30.76
(30.02–31.51)
20.96
(20.27–21.64)
X2=1082.860, p =0.001 X2=876.871, p =0.001 X2=1435.496, p =0.001 X2=610.888, p =0.001
A e age o D i ing Impai ing
Medicines. Popula ion
An idep essan s Use
2.74 ±1.14 2.76 ±1.18 2.86 ±1.12 2.92 ±1.23 2.73 ±1.31 2.59 ±1.37 2.89 ±1.35 2.88 ±1.43
=−2.951; p =0.003 =−7.255; p =0.001 =20.608; p =0.001 =1.150; p =0.250
Abb e ia ions: 95CI. con idence in e al.
Pha maceu icals 2020,13, 61 9 o 14
Pha maceu icals 2019, 12, x FOR PEER REVIEW 1 o 15
Figu e 4. F equency o use by D i ing Unde he In luence o D ugs, alcohol, and medicines (DRUID)
classi ica ion.
4. Discussion
Ou esul s show ha he inc ease in an idep essan s consump ion be ween 2015 and 2018 in
Cas ile and León, Spain was ele an . In each yea o he s udy pe iod, women use s p edomina ed
o e men use s in bo h he gene al popula ion and he d i e popula ion. Wi h espec o he ype o
an idep essan , SSRIs we e he mos commonly used. In addi ion, an idep essan s we e mos ly
consumed ch onically, and acu e and subacu e use was p ac ically insigni ican . Mo e han hal o
Figu e 4.
F equency o use by D i ing Unde he In luence o D ugs, alcohol, and medicines
(DRUID) classi ica ion.
The esul s ob ained o d i e s we e simila : 5.66% used an idep essan s and 1.93% ook hese
medicines e e y day (Table 1). As o he gene al popula ion, ch onic use was he mos equen .
The use o an idep essan s inc eased wi h age, and, in he case o women, a peak was eached in