{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:20:57Z","timestamp":1780096857022,"version":"3.54.0"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>This study investigated regional variations in the use of sedative psychotropic medications, often prescribed for insomnia, by comparing Italy and the culturally distinct Autonomous Province of Bolzano, South Tyrol. Using daily defined dose (DDD) data per 1000 inhabitants per day, benzodiazepines, Z-drugs, sedative antidepressants, and melatonin consumption from 2019 to 2023 were examined. The findings indicate a notably lower utilization of benzodiazepines in South Tyrol compared to the national Italian average, alongside a significant increase in sedative antidepressant use, particularly mirtazapine. These disparities likely stem from regional prescribing preferences influenced by cultural, linguistic, and healthcare system factors. While Z-drug consumption remained comparable across regions, melatonin use exhibited a gradual upward trend, albeit less pronounced in South Tyrol. These insights emphasize the necessity for region-specific strategies in optimizing insomnia treatment, balancing pharmacological approaches with non-pharmacological alternatives such as cognitive behavioral therapy for insomnia. Understanding these prescribing trends can inform healthcare policies aimed at reducing long-term sedative use while enhancing patient-centered care in sleep medicine.<\/jats:p>","DOI":"10.3390\/pharmacy13020032","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:39:07Z","timestamp":1740119947000},"page":"32","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Distinct Regional Pattern of Sedative Psychotropic Drug Use in South Tyrol: A Comparison with National Trends in Italy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4639-8195","authenticated-orcid":false,"given":"Christian J.","family":"Wiedermann","sequence":"first","affiliation":[{"name":"Institute of General Practice and Public Health, College of Healthcare Professions\u2014Claudiana, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Sangermano","sequence":"additional","affiliation":[{"name":"Medical Directorate, South Tyrolean Medical Service (SABES-ASDAA), 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasqualina","family":"Marino","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Public Health, College of Healthcare Professions\u2014Claudiana, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Ausserhofer","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Public Health, College of Healthcare Professions\u2014Claudiana, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolf","family":"Engl","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Public Health, College of Healthcare Professions\u2014Claudiana, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-4184","authenticated-orcid":false,"given":"Giuliano","family":"Piccoliori","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Public Health, College of Healthcare Professions\u2014Claudiana, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e820","DOI":"10.1016\/S2468-2667(23)00182-2","article-title":"The Need to Promote Sleep Health in Public Health Agendas across the Globe","volume":"8","author":"Lim","year":"2023","journal-title":"Lancet Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/S0140-6736(22)00879-0","article-title":"Insomnia","volume":"400","author":"Perlis","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e12967","DOI":"10.1111\/jsr.12967","article-title":"The European Academy for Cognitive Behavioural Therapy for Insomnia: An Initiative of the European Insomnia Network to Promote Implementation and Dissemination of Treatment","volume":"29","author":"Baglioni","year":"2020","journal-title":"J. Sleep Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1111\/jsr.12594","article-title":"European Guideline for the Diagnosis and Treatment of Insomnia","volume":"26","author":"Riemann","year":"2017","journal-title":"J. Sleep Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.7326\/M15-2175","article-title":"Clinical Guidelines Committee of the American College of Physicians Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians","volume":"165","author":"Qaseem","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Asnis, G.M., Thomas, M., and Henderson, M.A. (2015). Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17010050"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wiedermann, C.J. (2023). Advancing Precision Medicine in South Tyrol, Italy: A Public Health Development Proposal for a Bilingual, Autonomous Province. J. Pers. Med., 13.","DOI":"10.3390\/jpm13060972"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.3390\/epidemiologia5030027","article-title":"Integrating a Strategic Framework to Improve Health Education in Schools in South Tyrol, Italy","volume":"5","author":"Wiedermann","year":"2024","journal-title":"Epidemiologia"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Barbieri, V., Wiedermann, C.J., Lombardo, S., Ausserhofer, D., Plagg, B., Piccoliori, G., G\u00e4rtner, T., Wiedermann, W., and Engl, A. (2022). Vaccine Hesitancy during the Coronavirus Pandemic in South Tyrol, Italy: Linguistic Correlates in a Representative Cross-Sectional Survey. Vaccines, 10.","DOI":"10.3390\/vaccines10101584"},{"key":"ref_10","first-page":"377","article-title":"Trust in Conventional Healthcare and the Utilization of Complementary and Alternative Medicine in South Tyrol, Italy: A Population-Based Cross-Sectional Survey","volume":"36","author":"Barbieri","year":"2024","journal-title":"Ann. Ig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1017\/S1121189X00003092","article-title":"Psychotropic Drug Use in a Sample of General Population in the Sardinia Region","volume":"12","author":"Carta","year":"2003","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6487","DOI":"10.1007\/s10072-022-06309-z","article-title":"Insomnia in Primary Care: A Survey Conducted on Italian Patients Older than 50 Years\u2014Results from the \u201cSonno e Salute\u201d Study","volume":"43","author":"Proserpio","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jad.2008.01.011","article-title":"Clinical Factors Influencing the Prescription of Antidepressants and Benzodiazepines: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)","volume":"110","author":"Demyttenaere","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1007\/s00415-023-12112-3","article-title":"Evaluation and Management of Insomnia in the Clinical Practice in Italy: A 2023 Update from the Insomnia Expert Consensus Group","volume":"271","author":"Palagini","year":"2024","journal-title":"J. Neurol."},{"key":"ref_15","unstructured":"World Health Organization (WHO) (2024, November 07). DDD Indicators. Available online: https:\/\/www.who.int\/tools\/atc-ddd-toolkit\/indicators."},{"key":"ref_16","unstructured":"World Health Organization (WHO) (2024, November 12). Anatomical Therapeutic Chemical (ATC) Classification. Available online: https:\/\/www.who.int\/tools\/atc-ddd-toolkit\/atc-classification."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"244","DOI":"10.9740\/mhc.2023.10.244","article-title":"Efficacy and Safety of Pharmacotherapy in Chronic Insomnia: A Review of Clinical Guidelines and Case Reports","volume":"13","author":"Salari","year":"2023","journal-title":"Ment. Health Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"24927","DOI":"10.52965\/001c.24927","article-title":"Zolpidem: Efficacy and Side Effects for Insomnia","volume":"9","author":"Edinoff","year":"2021","journal-title":"Health Psychol. Res."},{"key":"ref_19","first-page":"CD010753","article-title":"Antidepressants for Insomnia in Adults","volume":"5","author":"Everitt","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Marupuru, S., Arku, D., Campbell, A.M., Slack, M.K., and Lee, J.K. (2022). Use of Melatonin and\/on Ramelteon for the Treatment of Insomnia in Older Adults: A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11175138"},{"key":"ref_21","unstructured":"Institut f\u00fcr Allgemeinmedizin and Public Health Bozen (2024). So schl\u00e4ft S\u00fcdtirol: Die Schlafstudie 2024. Forschung, Available online: https:\/\/www.institut-allgemeinmedizin.bz.it\/so-schlaft-sudtirol-die-schlafstudie-2024\/."},{"key":"ref_22","first-page":"1","article-title":"Italy: Health System Review","volume":"24","author":"Valerio","year":"2022","journal-title":"Health Syst. Transit."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Guina, J., and Merrill, B.M. (2018). Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives. J. Clin. Med., 7.","DOI":"10.3390\/jcm7020017"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101208","DOI":"10.1016\/j.smrv.2019.08.002","article-title":"Cognitive Behavioral Therapy for Insomnia: A Meta-Analysis of Long-Term Effects in Controlled Studies","volume":"48","author":"Bisdounis","year":"2019","journal-title":"Sleep. Med. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.sleep.2020.08.020","article-title":"Efficacy of Digital Cognitive Behavioural Therapy for Insomnia: A Meta-Analysis of Randomised Controlled Trials","volume":"75","author":"Soh","year":"2020","journal-title":"Sleep Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/fampra\/cmx122","article-title":"Sleep Hygiene Education as a Treatment of Insomnia: A Systematic Review and Meta-Analysis","volume":"35","author":"Chung","year":"2018","journal-title":"Fam. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1080\/15563650.2023.2181092","article-title":"Association of Prescription Drug Monitoring Programs with Benzodiazepine Prescription Dispensation and Overdose in Adolescents and Young Adults","volume":"61","author":"Toce","year":"2023","journal-title":"Clin. Toxicol."},{"key":"ref_28","first-page":"278","article-title":"Pharmacist-Led Sedative-Hypnotic Deprescribing in Team-Based Primary Care Practice","volume":"154","author":"Lui","year":"2021","journal-title":"Can. Pharm. J.\/Rev. Des Pharm. 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