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Denmark—unexpected trends in use of psychotropic medicines

Psychotropic medicines are drugs that affect the chemical signals used by brain cells to communicate. These drugs can have an effect on behaviour and mood. Commonly prescribed classes of psychotropic meds include the following:

  • anti-anxiety drugs
  • antidepressants
  • antipsychotics
  • hypnotics
  • mood stabilizers
  • sedatives

As part of a study, researchers at major clinics in Denmark reviewed health-related information collected from more than 3,000 HIV-positive people in several databases. The researchers had access to data on the filling of prescriptions for psychotropic medicines in pharmacies by both HIV-positive and HIV-negative Danes.

The researchers’ analysis found that 55% of these HIV-positive people filled prescriptions for a wide range of psychotropic medicines. Among HIV-negative people of the same age and gender, only 30% filled prescriptions for psychotropic medicines. Prescription patterns varied among the populations studied, affected by factors such as age and co-existing health conditions. The filling of prescriptions revealed that there are mental health and emotional issues among some HIV-positive people that need to be addressed.

Study details

Researchers reviewed and analysed information held in several databases dealing with HIV-positive people and their use of prescribed medications.

Data on 3,615 HIV-positive participants who were not co-infected with hepatitis C virus were analysed. Data from each HIV-positive person were compared to data from nine HIV-negative Danish people of the same age and gender.

At the time they entered the study, between 1995 and 2009, participants were on average about 38 years old and were mostly male (83% men, 17% women). The majority of men were gay or bisexual. No participants in this study injected street drugs.

Participants were in the study for between two and four years.

Results

Psychotropic drugs were used at least once by the following populations:

  • HIV-positive people – 55%
  • HIV-negative people – 30%

The most commonly used classes of psychotropic drugs were either hypnotics or sedatives. These drugs are generally used to help people fall asleep or stay asleep. Sedatives are also used to relieve temporary distress from anxiety.

The researchers found that the following categories of medicines were distributed as follows:

  • antipsychotics were more likely to be prescribed to women and people of colour
  • antidepressants were more likely to be prescribed to men who had sex with men (MSM)

Changes over time

Over the course of the study, the use of antipsychotics rose in both HIV-positive and HIV-negative people.

The pattern over time was different with antidepressants, as follows:

  • HIV-positive people – use of antidepressants increased rapidly
  • HIV-negative people – use of antidepressants increased slowly

The use of anti-anxiety medicines decreased then stabilized among HIV-positive people. However, rates of use were still greater than among HIV-negative people. The use of this category of medicines was stable among HIV-negative people.

The use of hypnotics and sedatives decreased then stabilized among HIV-positive people but still remained greater than among HIV-negative people. Among the latter group, rates of use of hypnotics and sedatives were stable throughout the study.

Putting it all together

The Danish team found that HIV-positive people had an overall greater use of psychotropic medicines than HIV-negative people of the same gender.

As the Danish national databases are comprehensive, the researchers were able to monitor prescription patterns before and after HIV infection occurred in some participants. In this sub-group of participants, they found that that there was a greater rate of use of hypnotics and sedatives both before and after HIV infection compared to people who did not become HIV positive.

In general, the researchers found that the longer a person had HIV, the more likely they were to be prescribed psychotropic medicines. In other words, as HIV-positive people grew older, they were more likely to use antidepressants than HIV-negative people.

More than one use

The rise in the prescribing and use of antipsychotics is not likely due to a large increase in psychosis. Rather, researchers point out that this class of medicines has been found to be useful by both doctors and patients for helping to treat a broad range of mental health issues including depression, anxiety, bipolar disorders and so on. Therefore, the increased prescribing of this class of medicines is likely because doctors are using them to treat several conditions.

Focus on hypnotics and sedatives

As mentioned earlier, hypnotics and sedatives are used to treat sleeping problems and anxiety. Although their use declined over time among HIV-positive people, rates of using these classes of drugs were between two- and four-fold greater in people with HIV than in their HIV-negative counterparts. Furthermore, as HIV-positive participants grew older, their use of these drugs increased.

Ideally these drugs should only be used for short periods of time. One of the reasons for this is that some sedatives related to Valium (known as benzodiazepines), as well as others, can become addictive. As a result, in many high-income countries health authorities discourage the routine prescribing of this class of drugs for prolonged use. The relatively high rate of hypnotic and sedative use by HIV-positive people caused concern among the researchers.

Due to their overall findings, the Danish researchers encourage doctors everywhere who are caring for HIV-positive people to “focus on the diagnosis and treatment of [mental health and emotional issues] among their HIV-positive patients, including MSM.”

—Sean R. Hosein

REFERENCE:

Rasmussen L, Obel D, Kronborg G, et al. Utilization of psychotropic drugs prescribed to persons with and without HIV infection: a Danish nationwide population-based cohort study. HIV Medicine. 2014 Sep;15(8):458-69.