Trends in antipsychotic use in Portugal: a retrospective study 2015–2025

Abstract

Introduction: Portugal has the second highest prevalence of psychiatric disorders in the European population, with high morbidity and significant socioeconomic impact. Among these, schizophrenia, bipolar disorder, and mood disorders are among the most prevalent, affecting quality of life and representing a growing challenge for healthcare systems. Antipsychotics are first-line medications for treating these conditions, acting on the central nervous system to reduce psychotic symptoms such as hallucinations, delusions, and disorganized thinking. Understanding the patterns of use of these medications is essential to describe prescribing trends and support health policy planning.

Objectives: To analyze the evolution of antipsychotic use in Portugal between 2015 and 2025, providing relevant data for monitoring medication use in mental health.

Methodology: A retrospective, observational, descriptive study was conducted using data from the Health Market Research database on antipsychotic packages dispensed in community pharmacies across Portugal between January 1, 2015, and December 31, 2025. Dispensed packages were used as the primary unit of analysis as they provide a pragmatic measure of real-world dispensing patterns and allow robust assessment of temporal trends in medication use. The analysis is restricted to community pharmacy dispensing and does not include hospital or inpatient data. Data were analyzed by antipsychotic class (typical and atypical) and by active substance.

Results: Between 2015 and 2025, the total number of dispensed antipsychotic packages increased by 82.3%, with atypical antipsychotics rising by 111.4% and typical antipsychotics decreasing by 37.6%. Among atypicals, the most dispensed were quetiapine (42.0%), olanzapine (14.3%), and risperidone (11.9%), with quetiapine showing a remarkable 261.6% increase over the study period. Among typical antipsychotics, the most frequently dispensed were haloperidol (4.7%) and cyamemazine (3.0%). Overall, atypical antipsychotics accounted for 88.3% of all dispensed packages.

Conclusion: Antipsychotic dispensing in Portugal has increased significantly between 2015 and 2025, with a clear predominance of atypical agents. These trends reinforce the need for ongoing surveillance of antipsychotic prescribing trends to inform mental health policy.