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Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report

Published online by Cambridge University Press:  23 September 2021

Alan E. Kazdin
Department of Psychology, Yale University, New Haven, CT, USA
Chi-Shin Wu
Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
Irving Hwang
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Victor Puac-Polanco
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Nancy A. Sampson
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ali Al-Hamzawi
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, Iraq
Jordi Alonso
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Laura Helena Andrade
Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
Corina Benjet
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
José-Miguel Caldas-de-Almeida
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Giovanni de Girolamo
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Peter de Jonge
Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
Silvia Florescu
National School of Public Health, Management and Development, Bucharest, Romania
Oye Gureje
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Josep M. Haro
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Meredith G. Harris
School of Public Health, The University of Queensland, Herston, QLD 4006, Australia Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol QLD 4072, Australia
Elie G. Karam
Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Georges Karam
Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Viviane Kovess-Masfety
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Sing Lee
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
John J. McGrath
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol QLD 4072, Australia Queensland Brain Institute, The University of Queensland, St Lucia QLD 4065, Australia National Centre for Register-based Research, Aarhus University, Aarhus V 8000, Denmark
Fernando Navarro-Mateu
UDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Spain
Daisuke Nishi
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan National Center of Neurology and Psychiatry, Tokyo, Japan
Bibilola D. Oladeji
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
José Posada-Villa
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
Dan J. Stein
Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa Groote Schuur Hospital, Cape Town, South Africa
T. Bedirhan Üstün
Department of Psychiatry, Koç University, Istanbul, Turkey
Daniel V. Vigo
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Zahari Zarkov
Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
Alan M. Zaslavsky
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ronald C. Kessler
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA



The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.


Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.


3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.


ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.

Original Article
Copyright © The Author(s), 2021. Published by Cambridge University Press

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