{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T16:04:26Z","timestamp":1784649866167,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background\/Objectives: Antipsychotic drug utilization has changed substantially over recent decades, reflecting evolving prescribing practices, drug availability, and treatment guidelines. Methods: This study analyzed national antipsychotic consumption in Serbia from 2006 to 2024 using official data from the Medicines and Medical Devices Agency of Serbia. Utilization was expressed as defined daily doses per 1000 inhabitants per day, and trends were assessed using linear and joinpoint regression analyses. Results: Total antipsychotic utilization increased from 4.35 to 14.42 DDD\/1000 inhabitants\/day, representing a 231.5% increase. This growth was predominantly driven by atypical antipsychotics, whose utilization increased from 1.16 to 10.91 DDD\/1000 inhabitants\/day (+840.2%). In contrast, typical antipsychotic utilization remained relatively stable in absolute terms. The share of atypical antipsychotics increased from 26.7% in 2006 to 75.6% in 2024, while the atypical: typical utilization ratio increased from 0.36 to 3.10. Atypical antipsychotics surpassed typical agents in 2013. Marked increases were observed for olanzapine, quetiapine, aripiprazole, paliperidone, risperidone, and clozapine, while chlorpromazine and fluphenazine declined. Conclusions: These findings demonstrate a substantial increase in overall antipsychotic utilization in Serbia and a pronounced structural shift toward atypical agents, highlighting the need for continued monitoring of prescribing trends, safety outcomes, and population-level treatment patterns.<\/jats:p>","DOI":"10.3390\/ph19071128","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:17:52Z","timestamp":1784647072000},"page":"1128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Twenty-Year Trends in Antipsychotic Utilization in Serbia: A Nationwide Drug Utilization Study"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7636-306X","authenticated-orcid":false,"given":"Zorana","family":"Pavlovic","sequence":"first","affiliation":[{"name":"Clinic for Psychiatry, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9372-2728","authenticated-orcid":false,"given":"Milena","family":"Stevanovic","sequence":"additional","affiliation":[{"name":"Clinic for Psychiatry, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5575-0587","authenticated-orcid":false,"given":"Marija","family":"Milic","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2161-2394","authenticated-orcid":false,"given":"Jelena","family":"Filimonovic","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bojana","family":"Mateji\u0107","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mladen","family":"Bogdanovic","sequence":"additional","affiliation":[{"name":"National Center for Drug and Medical Information, Medicines and Medical Devices Agency of Serbia, 11221 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Vukajlovic","sequence":"additional","affiliation":[{"name":"National Center for Drug and Medical Information, Medicines and Medical Devices Agency of Serbia, 11221 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandar","family":"Krsti\u0107","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4062-3002","authenticated-orcid":false,"given":"Miodrag","family":"Milenovi\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Emergency Center, Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bojana","family":"Dunji\u0107 Kosti\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Psychiatry, University Clinical Center of Serbia, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","unstructured":"Taylor, D.M., Barnes, T.R.E., and Young, A.H. (2018). The Maudsley Prescribing Guidelines in Psychiatry, John Wiley & Sons. [13th ed.]."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1755-5949.2010.00222.x","article-title":"Antipsychotic occupancy of dopamine receptors in schizophrenia","volume":"17","author":"Nord","year":"2011","journal-title":"CNS Neurosci. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S0140-6736(19)31135-3","article-title":"Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: A systematic review and network meta-analysis","volume":"394","author":"Huhn","year":"2019","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/pds.2213","article-title":"National changes in oral antipsychotic treatment for people with schizophrenia in primary care between 1998 and 2007 in the United Kingdom","volume":"21","author":"Prah","year":"2012","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_5","unstructured":"National Institute for Health and Care Excellence (NICE) (2026, April 26). Guidance on the Use of Newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia. NICE. Available online: https:\/\/www.crd.york.ac.uk\/crdweb\/ShowRecord.asp?ID=32002000858#."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1016\/j.euroneuro.2017.07.001","article-title":"International trends in antipsychotic use: A study in 16 countries, 2005\u20132014","volume":"27","author":"Aagaard","year":"2017","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1176\/appi.ajp.2011.10081224","article-title":"A nationwide cohort study of oral and depot antipsychotics after first hospitalization for schizophrenia","volume":"168","author":"Tiihonen","year":"2011","journal-title":"Am. J. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/acps.12742","article-title":"International trends in clozapine use: A study in 17 countries","volume":"136","author":"Bachmann","year":"2017","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1017\/S2045796022000117","article-title":"Covid-19-related stressors, mental disorders, depressive and anxiety symptoms: A cross-sectional, nationally-representative, face-to-face survey in Serbia","volume":"31","author":"Priebe","year":"2022","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1192\/bjo.2025.10073","article-title":"Twenty-five year trend in antipsychotic medication prescribing in England: Challenges and opportunities","volume":"16","author":"Newman","year":"2025","journal-title":"BJPsych Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S2215-0366(21)00292-3","article-title":"Psychotropic medicine consumption in 65 countries and regions, 2008\u201319: A longitudinal study","volume":"8","author":"Brauer","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1111\/bcp.13945","article-title":"Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016","volume":"85","author":"Johnsen","year":"2019","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"BJGPO.2024.0219","DOI":"10.3399\/BJGPO.2024.0219","article-title":"Patterns and indications for quetiapine prescribing in Dutch primary care: A retrospective database study","volume":"9","author":"Cinar","year":"2025","journal-title":"BJGP Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/pds.2082","article-title":"Increasing off-label use of antipsychotic medications in the United States, 1995\u20132008","volume":"20","author":"Alexander","year":"2011","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1017\/S2045796021000159","article-title":"Use of antipsychotics in Denmark 1997-2018: A nation-wide drug utilisation study with focus on off-label use and associated diagnoses","volume":"30","author":"Andersen","year":"2021","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e180","DOI":"10.1192\/bjo.2025.10815","article-title":"An overview of antipsychotic drug prescribing trends (initiation\/prevalence) in UK primary care from 1995 to 2018: Analysis of electronic health records from over 790 general practices","volume":"5","author":"Samsuddin","year":"2025","journal-title":"BJPsych Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/wps.20699","article-title":"20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20)","volume":"19","author":"Taipale","year":"2020","journal-title":"World Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"921","DOI":"10.2147\/NDT.S390482","article-title":"Prescribing Trends for the Same Patients with Schizophrenia Over 20 Years","volume":"19","author":"Kawamata","year":"2023","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/wps.20252","article-title":"Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: A systematic review and meta-analysis","volume":"14","author":"Vancampfort","year":"2015","journal-title":"World Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e006135","DOI":"10.1136\/bmjopen-2014-006135","article-title":"Prescribing of antipsychotics in UK primary care: A cohort study","volume":"4","author":"Marston","year":"2014","journal-title":"BMJ Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3280","DOI":"10.2174\/1381612821666150619092903","article-title":"Off-label prescribing of antipsychotics in adults, children and elderly individuals: A systematic review of recent prescription trends","volume":"21","author":"Carton","year":"2015","journal-title":"Curr. Pharm. Des."},{"key":"ref_22","unstructured":"Stahl, S.M. (2018). Stahl\u2019s Essential Psychopharmacology: Prescriber\u2019s Guide, Cambridge University Press. [6th ed.]."},{"key":"ref_23","first-page":"269","article-title":"Prescribing of antipsychotics for people diagnosed with severe mental illness in UK primary care 2000-2019: 20-year investigation of who receives treatment, with which agents and at what doses","volume":"226","author":"Launders","year":"2024","journal-title":"Br. J. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/wps.21089","article-title":"Long-term efficacy of antipsychotic drugs in initially acutely ill adults with schizophrenia: Systematic review and network meta-analysis","volume":"22","author":"Leucht","year":"2023","journal-title":"World Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1007\/s00228-018-2498-1","article-title":"Efficacy and safety of aripiprazole for the treatment of schizophrenia: An overview of systematic reviews","volume":"74","author":"Ribeiro","year":"2018","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1440-1819.2004.01194.x","article-title":"Antipsychotic drug prescription for schizophrenia in East Asia: Rationale for change","volume":"58","author":"Chong","year":"2004","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"112271","DOI":"10.1016\/j.psychres.2019.02.056","article-title":"Clozapine prescription pattern in patients with schizophrenia in Asia: The REAP survey (2016)","volume":"287","author":"Xu","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1017\/S2045796015000694","article-title":"Trends in the access to and the use of antipsychotic medications and psychotropic co-treatments in Asian patients with schizophrenia","volume":"25","author":"Xiang","year":"2016","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jpsychires.2020.05.012","article-title":"The 12-year trend report of antipsychotic usage in a nationwide claims database derived from four million people in Japan","volume":"127","author":"Hata","year":"2020","journal-title":"J. Psychiatr. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Meyer, J.M., and Stahl, S.M. (2020). The Clozapine Handbook, Cambridge University Press.","DOI":"10.1017\/9781108553575"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1001\/jamapsychiatry.2017.1322","article-title":"Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29 823 patients with schizophrenia","volume":"74","author":"Tiihonen","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.2147\/NDT.S199048","article-title":"The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia","volume":"15","author":"Pietrini","year":"2019","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s40263-022-00976-4","article-title":"A 10-year observational study of the use, acceptability and effectiveness of long-acting paliperidonepalmitate:implications for clinical decision making","volume":"37","author":"Pappa","year":"2023","journal-title":"CNS Drugs"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S2215-0366(21)00039-0","article-title":"Long-acting injectable versus oral antipsychotics for the maintenance treatment of schizophrenia: A systematic review and comparative meta-analysis of randomized, cohort, and pre-post studies","volume":"8","author":"Kishimoto","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.euroneuro.2019.02.003","article-title":"Long-acting injectable antipsychotics (LAIs) for maintenance treatment of bipolar and schizoaffective disorders: A systematic review","volume":"29","author":"Pacchiarotti","year":"2019","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Liu, Y., Patterson, M.E., Sahil, S., and Stoner, S.C. (2023). Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1140969"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1192\/bjp.195.52.s7","article-title":"Historical perspective on antipsychotic long-acting injections","volume":"195","author":"Johnson","year":"2009","journal-title":"Br. J. Psychiatry"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1600-0447.2006.00757.x","article-title":"Medication decisions and clinical outcomes in the Canadian National Outcomes Measurement Study in Schizophrenia","volume":"113","author":"Williams","year":"2006","journal-title":"Acta Psychiatr. Scand. Suppl."},{"key":"ref_39","unstructured":"European Medicines Agency (2025, March 15). Invega: EPAR\u2014Product Information (Paliperidone). Available online: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/invega."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1093\/ijnp\/pyz037","article-title":"Psychopharmacological Treatment of Schizophrenia Over Time in 30 908 Inpatients: Data From the AMSP Study","volume":"22","author":"Toto","year":"2019","journal-title":"Int. J. Neuropsychopharmacol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.ajp.2019.08.010","article-title":"Prescription of antipsychotic and concomitant medications for adult Asian schizophrenia patients: Findings of the 2016 research on Asian psychotropic prescription patterns (REAP) survey","volume":"45","author":"Dong","year":"2019","journal-title":"Asian J. Psychiatry"},{"key":"ref_42","first-page":"487","article-title":"Prescribing pattern of antipsychotic drugs during the years 1996\u20132010: A population-based database study in Europe with a focus on torsadogenic drugs","volume":"82","author":"Oteri","year":"2016","journal-title":"Br. J. ClinPharmacol"},{"key":"ref_43","unstructured":"World Health Organization (2017). WHO Model List of Essential Medicines, 20th List (March 2017, Amended August 2017), World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/273826."},{"key":"ref_44","unstructured":"Medicines and Medical Devices Agency of Serbia (ALIMS) (2025, May 07). Trade and Consumption of Medicines for Human Use in Republic of Serbia, Available online: https:\/\/www.alims.gov.rs\/o-agenciji\/publikacije\/."},{"key":"ref_45","unstructured":"National Cancer Institute (2023, March 21). Joinpoint Trend Analysis Software, Available online: https:\/\/surveillance.cancer.gov\/joinpoint\/."},{"key":"ref_46","unstructured":"Centers for Disease Control and Prevention (2026, February 02). Joinpoint Trend Analysis Software. 2020\u20132021, Available online: https:\/\/www.cdc.gov\/nchs\/hus\/sources-definitions\/joinpoint.htm."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/19\/7\/1128\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:24:38Z","timestamp":1784647478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/19\/7\/1128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":46,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ph19071128"],"URL":"https:\/\/doi.org\/10.3390\/ph19071128","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]}}}