An Economic analysis of antidepressant use

Depression, which includes troubles related to anxiety and affective disorders, represents the most frequent psychological problem during an individual’s life. In 2010 the estimated social costs of mental health disorders in Switzerland were approximately 11 billion of Swiss francs. Effective depression treatments may reduce mortality, by decreasing the risk of suicide and other depression-related causes of death – such as accidents, heart diseases or strokes. The use of antidepressants in Europe doubled between 1990 and 2000 and in 2008/2009 around 60% of people with mild depression were treated with antidepressants. Although the time trend can be partially explained by the need to offset the increasing incidence of depression in society, researchers have questioned the benefits of antidepressants, particularly in the case of mild episodes of depression. This explains the recent attention from health insurers and policy makers. Since antidepressants represent the largest share of mental health expenditure in many developed economies, there is a raising interest in assessing their cost effectiveness. However, there are no studies that undertake a comprehensive analysis of the determinants of antidepressant use and the literature on the socio-economic effects of antidepressants use is mixed and incomplete. In this research project, we have two main goals that are meant to fill the aforementioned gap in the literature. First, we investigate the main socioeconomic determinants of antidepressants use. Second, we estimate the impact of antidepressants on hospitalization costs due to mental health problems and suicides that represent two of the most important costs associated with depression. To achieve these goals, we aim to build up an unprecedented dataset merging data from various and unique sources. This will allow us to exploit the time and geographical variation in antidepressants sales, socio-economic conditions, hospitalizations (by cause) and suicides across very small Swiss areas. An important focus of our analysis is the relationship between antidepressant consumption and local economic conditions. In times of turbulent macro-economic conditions, it is also of great interest to evaluate whether the use of antidepressants can buffer the increase in hospitalizations for mental health problems and suicides. We also aim to exploit variations across cantons and over-time in mental health treatment practice and legislation to investigate whether and to what extent these factors affect antidepressants use and their effectiveness. Finally, given the focus on small geographic areas, we can also investigate the presence of spatial effects in the use of antidepressants.