Pharmaceuticalisation of Mental Health: Trends in Psychotropic Prescription in Primary Care in Spain

Background

Psychotropic drug use has steadily increased in recent years. Beyond a rise in psychiatric disorders, explanations point to a potential increase in psychotropic treatment of distress and mental health. This study aims to analyse temporal changes in prescriptions following a psychiatric diagnoses in primary care, as a measure of the potential pharmacologization of mental health.

Methods

A longitudinal study was conducted using Spanish primary care data (BDCAP) from individuals aged ≥14 years with consecutive yearly records between 2018 and 2024 (n = 28,260,548). Incident anxiety, depression, and nonspecific or adjustment distress diagnoses were defined as new diagnoses relative to the previous year. The outcome was the dispensing of anxiolytics/antidepressants within 30 days post-diagnosis. Poisson regression models with robust variance were fitted using year as a categorical variable, adjusting for sex, income, age, and diagnoses. Sex-year and age-year interactions were assessed, and models were stratified by sex, diagnoses, and age.

Results

Incidence of mental health diagnoses increased, particularly anxiety and distress among women aged 31–45 years. Post-diagnosis prescription remained broadly stable (64.8% to 66.8%), while it increased markedly among individuals aged 14–30 years (40.8% to 45.8%). The adjusted model showed a 3.8% higher prescription probability in 2024 compared to 2019. The 14-30 group had the largest probability increase (PR = 1.13 [1.10–1.15]). Females had higher prescriptions, but the temporal increase was greater among males. Depression-related prescriptions showed the greatest increase, especially in the 14–30 group (PR = 1.18 [1.12–1.25]).

Conclussions

The prescription probability for a mental health disorder increased from 2018 to 2024 particularly among young individuals diagnosed with depression. This trend suggests a more pharmacologised approach to mental health care in recent years, presenting significant public health challenges.

Key messages

• The increased probability of a pharmacological response to mental health diagnoses may explain part of the rise in psychotropic drug use in Spain.

• The rise in pharmaceuticalisation of mental health primarily affects younger and older populations, with no significant trend differences between men and women.