Antidepressant Use Rises Sharply Among Greek Youth as Sedative Prescribing Declines

A sweeping analysis of Greece’s national e-prescription records has revealed a quiet but consequential shift in the mental health treatment of the country’s youngest citizens. Between 2020 and 2024, the proportion of children, adolescents and young adults receiving psychotropic medications climbed steadily, driven almost entirely by a surge in antidepressant dispensing, while older sedative classes faded from favor. The study, published in Frontiers in Drug Safety and Regulation, offers one of the most detailed population-based pictures yet of how psychiatric medication use is evolving in a Southern European health system, and it arrives amid mounting international evidence that the pandemic era reshaped prescribing patterns for an entire generation.

The research team, led by Konstantinos Kassandros of Democritus University of Thrace, mined nationwide administrative e-prescription dispensing data from EOPYY, Greece’s national health services organization. Their repeated cross-sectional design covered two age bands: children and adolescents aged 0 to 17, and young adults aged 18 to 29. Population denominators were drawn from the 2021 national census of the Hellenic Statistical Authority, broken down by age, sex and regional unit, allowing the researchers to calculate dispensing prevalence per 1,000 inhabitants and dispensing intensity, defined as the number of packs dispensed per patient receiving at least one medication. Because the data capture dispensing rather than consumption, the figures serve as a proxy for medication exposure rather than a direct measure of adherence or intake.

The headline numbers are striking. Overall psychotropic dispensing prevalence rose from 64.5 per 1,000 inhabitants in 2020 to 71.8 per 1,000 in 2024, translating into an annual population of recipients that grew from 81,201 individuals to 98,269. Total dispensing volume climbed from just under 1.08 million packs in 2020 to roughly 1.27 million in 2024, peaking at 1.298 million packs in 2023. Yet the crucial nuance lies in what did not change: dispensing intensity remained broadly stable, hovering between roughly 12.9 and 13.5 packs per patient across the study window. That stability tells the researchers that the growth was not a matter of existing patients receiving more medication, but of more people entering treatment.

Drug-class decomposition sharpens that story considerably. Selective serotonin reuptake inhibitors, the SSRIs that dominate first-line pharmacotherapy for depression and anxiety, saw their dispensing prevalence rise from 6.65 to 9.09 per 1,000 inhabitants, with pack volume jumping from 241,323 to 342,340. Serotonin-norepinephrine reuptake inhibitors, or SNRIs, grew even faster in relative terms, from 1.32 to 2.08 per 1,000. Among antipsychotics, second-generation agents expanded from 7.20 to 8.08 per 1,000 while first-generation antipsychotics contracted from 0.91 to 0.78, marking a compositional shift away from older molecules with heavier extrapyramidal side-effect burdens. In contrast, hypnotic benzodiazepine prevalence slipped from 1.01 to 0.94 per 1,000 and Z-drugs such as zolpidem and zopiclone fell from 0.20 to 0.15, suggesting a degree of prescribing restraint in the sedative-hypnotic space even as antidepressant use accelerated.

Sex and age produced sharply differentiated patterns. Females showed higher odds of receiving SSRIs (odds ratio 1.150), SNRIs (1.064), anxiolytic benzodiazepines (1.029) and certain other antipsychotics, while males had higher odds of second-generation antipsychotic dispensing (female OR 0.588), first-generation antipsychotics (0.435) and hypnotic benzodiazepines (0.736). The age gradient was far steeper: across every class, children and adolescents aged 0 to 17 had dramatically lower odds of dispensing than young adults, with odds ratios as low as 0.009 for SNRIs and 0.012 for Z-drugs. Notably, benzodiazepine hypnotics were the exception, with comparatively smaller age differences, a finding that echoes earlier Swedish and Irish registry work documenting benzodiazepine exposure in very young populations and the persistent off-label dispensing that surrounds these agents.

Linking dispensing records to diagnostic categories through ICD-10 macro-groups revealed where these medications are being deployed. The highest diagnosis-specific dispensing prevalence belonged to SSRIs in anxiety disorders, at 5.06 per 1,000 inhabitants, followed by anxiolytic benzodiazepines in the same diagnostic group at 4.25 per 1,000 and second-generation antipsychotics in the psychosis-spectrum F20-F29 category at 3.91 per 1,000. Dispensing intensity told a different tale: first-generation antipsychotics reached extraordinary per-patient volumes in neurological indications, including 104.67 packs per patient in multiple sclerosis and 77.01 in parkinsonism, reflecting maintenance-oriented long-term use rather than acute treatment. Antipsychotic dispensing also appeared in sleep-disorder categories, consistent with well-documented off-label sedative use, and in obsessive-compulsive and related conditions where antipsychotics are prescribed to augment primary treatments.

Geography added yet another layer of heterogeneity. Antidepressant dispensing prevalence ranged from a high of 13.46 per 1,000 in the Ionian Islands to a low of 8.04 per 1,000 in the South Aegean, with Attica at 11.93 and Western Greece at 11.86 also above the population-weighted national mean of 11.38. Antipsychotic dispensing peaked in Western Greece at 10.39 per 1,000 and bottomed out in Epirus at 6.73, while benzodiazepine receptor agonists were most prevalent in the Ionian Islands and Peloponnese and least prevalent in the island regions of the South and North Aegean. Critically, the authors note that the regions with the highest rates were not the same across the three medication groups, indicating that no single geographic factor explains the variation. Comparable regional disparities have been reported in Ontario, Canada, where pediatric psychotropic use correlated with regional and sociodemographic characteristics.

Placed in international context, the Greek trajectory fits a broader pattern of rising psychotropic exposure among young people in high-income countries, with a strong antidepressant contribution. Global dispensing-based analyses covering 65 countries and regions documented widespread increases between 2008 and 2019, concentrated in wealthier nations. In England, primary care antidepressant prescribing to children and young people rose steadily from 1998 to 2017. In the United States, antidepressant dispensing to adolescents and young adults increased through 2022 with a more pronounced climb during the COVID-19 pandemic. Ireland recorded psychotropic use among young people rising from 6.41 to 8.46 per 1,000 between 2017 and 2021, Canada saw youth antidepressant use increase by 67.6 percent between 2014 and 2020, and interrupted time-series analyses identified post-March 2020 increases in adolescent antidepressant and anxiolytic dispensing in Norway and Sweden, though not in Italy. France documented monthly pediatric psychotropic prescriptions rising from 9.9 to 16.1 per 1,000 between 2016 and 2022, with the steepest acceleration after the pandemic’s onset.

The Greek findings carry specific clinical and policy implications. The authors argue that the combination of rising prevalence and stable intensity supports age-appropriate prescribing stewardship and targeted regional monitoring, rather than alarm about escalating doses. The concentration of SSRI and SNRI dispensing in anxiety-related diagnoses is consistent with international treatment guidelines, including the 2023 World Federation of Societies of Biological Psychiatry recommendations that identify these drug classes as first-line pharmacological options for anxiety disorders, with specific provisions for children and adolescents. At the same time, the co-occurrence of antipsychotic and antidepressant dispensing in childhood behavioral and emotional disorder categories mirrors patterns seen in UK and German cohorts and underscores the continued relevance of structured review and deprescribing programs. The shift from first-generation to second-generation antipsychotics aligns with tolerability considerations, since network meta-analytic evidence continues to document the physiological and metabolic effects of antipsychotics in young populations.

The study’s limitations temper its conclusions in important ways. Annual rather than monthly data obscures seasonality and short-term shifts; ATC-level classification without product, strength and formulation detail precludes standardized consumption metrics such as defined daily doses per 1,000 inhabitants per day; the coarse 0-17 age band prevents finer pediatric stratification; and dispensing cannot be equated with actual intake or adherence. Cell-level intensity estimates may be unstable where recipient numbers are small, and reliance on electronic prescriptions risks under-recording out-of-system dispensing. Crucially, the absence of linkage to clinical severity, adverse reactions and socioeconomic indicators means regional and sex differences cannot be interpreted as differences in need or appropriateness. Even with those caveats, the analysis establishes a national baseline from a Southern European setting that had been largely missing from the comparative literature, and it gives Greek health authorities a concrete evidence base for monitoring a generation whose relationship with psychiatric medication is visibly, and measurably, changing.

Subject of Research: National trends and regional variation in psychotropic medication dispensing among Greek children, adolescents and young adults, 2020–2024

Article Title: Psychotropic dispensing in Greek adolescents and young adults: national trends and regional variation

Article References: Kassandros, K., Samakouri, M., Panagopoulou, M., Constantinidis, T., & Kontogiorgis, C. (2026). Psychotropic dispensing in Greek adolescents and young adults: national trends and regional variation. Frontiers in Drug Safety and Regulation, 6, Article 1900494. https://doi.org/10.3389/fdsfr.2026.1900494

Image Credits: AI Generated

DOI: 10.3389/fdsfr.2026.1900494

Keywords: psychotropics, antidepressants, SSRIs, benzodiazepines, antipsychotics, Greece, pharmacoepidemiology, pediatrics, young adults, e-prescription, regional variation, COVID-19