28 May 2014

The financial crisis and subsequent recession saw a significant acceleration in the numbers of antidepressants prescribed by GPs, new research published by the Nuffield Trust and Health Foundation reveals today.

The study shows that between 1998 and 2012, the amount of antidepressants dispensed in the community each year rose by 25 million – from 15 million items in 1998, to 40 million in 2012. Almost half of that increase occurred in the four years between the 2008 financial crisis and 2012, the last year for which data are available. This means that the annual rise in prescriptions has risen to 8.5% per year since the banking crash, compared to 6.7% before.

This striking increase is despite the incidence of depression having risen much more slowly over the same time period, meaning that either antidepressants were heavily under-prescribed in 1998, or they are heavily overprescribed now. Some GP practices also prescribed far more antidepressant medicine than others even where their patients were similar – suggesting over-use or under-use in many parts of England.

That acceleration in the use of these drugs raises some difficult questions

The research is published as part of the Nuffield Trust and Health Foundation’s QualityWatch programme, which is tracking the quality of health and social care in England.

Examining the number of tablets dispensed on NHS prescriptions across the country, Nuffield Trust researchers found that:

  • Areas with more white people, more women, and more people over the age of 65, had the heaviest use of antidepressants. Areas with more men and more people from ethnic minorities, on the other hand, had significantly lighter use.
  • Even when regional characteristics are taken into account, there is significant variation in the rates of antidepressant prescription across the country. For example, per 1000 people, residents of Blackpool collected more than four times as many of these tablets each month as those of the London Borough of Brent.
  • An analysis of changes over time found that increases in unemployment were associated with significant increases in the number of antidepressant tablets dispensed. A 1% rise in unemployment typically meant one and a half more tablets were given out per person on a GP list, per year.
  • An analysis comparing practices in different geographical areas, meanwhile, did not show clear links to unemployment – but areas with worse housing tended to see significantly higher antidepressant use.
  • GPs who prescribe more antibiotics also tend to prescribe more antidepressants, suggesting doctors vary across the board in how likely they are to use drugs to deal with their patients’ conditions.
  • Adjusting for all these factors, younger, female GPs who qualified in the UK tend to prescribe more anti-depressants to their patients.

Adam Roberts , Senior Research Analyst at the Nuffield Trust, said:

“It's striking that GPs were prescribing an extra 2.7 million antidepressants in 2012, compared to the trend we saw during the years of economic growth. That acceleration in the use of these drugs raises some difficult questions about the impact that poverty and unemployment can have on people’s health.

“Our research shows stark variation in antidepressant prescription rates between regions, ethnicities and age groups. While some variation is to be expected, the differences between regions suggest that there could be particular underlying problems in mental health for people in areas suffering from unemployment and poor housing.

“What we don’t know from the research is what level of prescribing is objectively the ‘right’ level. But the fact that the rise over time outstrips the incidence of depression suggests either that we were dispensing far too few of these drugs in 1998, or that we are dispensing far too many now.”

Professor Nick Barber, Director of Research at the Health Foundation, said:

“The report clearly shows a significant increase in antidepressant prescriptions in recent years. A crucial finding for doctors and patients to consider is that there is real variation in prescription rates across GP practices.

“These differences imply that certain practices have a propensity to over or under prescribe. This could suggest that not enough attention has been given to individual patients’ needs, including the need to avoid possible side effects of these medicines.”


Notes to Editors

  • Focus on: Antidepressant prescribing, is the fifth in the Focus On series of reports, published as part of the Nuffield Trust and Health Foundation’s QualityWatch programme.
  • The report’s findings on national trends in the use of antidepressants are based on analysis of publicly available figures. These show how many times each drug is dispensed in the community from prescription forms each year. The analysis of different factors which are linked to antidepressant use at a local or GP practice level is based on two regression analysis models put together by Nuffield Trust researchers.
  • Antidepressant prescribing at the GP or practice level is counted in terms of individual capsules or pills, which we refer to as “tablets” for convenience. At a national level it is counted in terms of the numbers of ‘items’ (prescription forms).
  • The Nuffield Trust is an authoritative and independent source of evidence-based research and policy analysis for improving health care in the UK. It conducts cutting edge research and influential analysis, informs and generates debate, supports leaders, and examines international best practice.
  • The Health Foundation is an independent charity working to improve the quality of healthcare in the UK. It is here to support people working in healthcare practice and policy to make lasting improvements to health services. The Health Foundation carries out research and in-depth policy analysis, runs improvement programmes to put ideas into practice in the NHS, support and develop leaders and share evidence to encourage wider change. The Health Foundation wants the UK to have a healthcare system of the highest possible quality – safe, effective, person-centred, timely, efficient and equitable.

Comments

They don't even claim to cure depression, so are massively over-prescribed. IAPT was launced in 2006 with the fanfare: 'The end of the Prozac nation' since when prescribing has nearly doubled. The answer is to empower GPs to prescribe Mindfulness Based Cognitive Therapy (MBCT) as easily as Prozac, by mass-commissioning it on vouchers, see papers on section 9 of www.reginaldkapp.org, and www.sectco.org.
John Kapp (not verified)
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Dear John We appreciate your interest in our work. Our analysis focussed on antidepressant prescribing rather than depression explicitly. However, we would echo your sentiment that a variety of treatment approaches may be beneficial depending on the particular individual. Best wishes, Con
Cono Ariti
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