Trends in use of antipsychotics in Germany 2014–2024: a nationwide population-based study

Antipsychotic medication (APM) use in children and adolescents in Germany increased over decades. However, contemporary data across all age groups is lacking. We aimed to analyze outpatient APM use across all age groups in Germany between 2014 and 2024. We analyzed anonymized Statutory Health (SH) Insurance claims data (approximately 87% of the German population) from the German Institute for Drug Use Evaluation (DAPI), selected the Anatomical Therapeutic Chemical (ATC) code N05A (antipsychotics) except lithium, analyzed defined daily doses per 1,000 SH-insured persons per day (DID), stratified by age group, type of APM [first-generation antipsychotic (FGA) vs. second-generation antipsychotic (SGA)] and performed linear regression analyses. Overall APM use increased from 2014 to 2024 by 2% (11.44 to 11.71 DID, p = 0.304). While the FGA use fell by 29% (3.96 to 2.82, p < 0.001), SGA use rose by 19% (7.48 to 8.89, p < 0.001). The largest increases occurred in the age groups 15–19 (+ 32%), 20–24 (+ 29%), 60–64 (+ 20%), 65–69 (+ 34%) and 70–74 years (+ 22%). During the study period, use of aripiprazole (+ 106%), olanzapine (+ 25%), and quetiapine (+ 19%) rose. However, risperidone and clozapine decreased (-2% and − 11%, respectively). In 2024, APM use peaked at age 60–64, dropped in 65–74 and rose again from 75, reaching a maximum in those 90 + years, while the general practitioners (GPs) APM prescriptions proportion rose with patient´s age Antipsychotic medication use in Germany stayed mainly stable during the study period but showed considerable age-specific shifts, including increasing APM use in ages 15 to 24, 60 to 74, and a very high use of APM in patients 90+. Clozapine use has declined in most age groups, which may indicate continued underutilization despite strong evidence supporting its effectiveness in treatment resistant schizophrenia. These findings highlight the need for age-specific monitoring of prescribing behaviour.