UK becoming nation of ‘happy pill poppers’ fears

First published in Health News by

“The rise in antidepressant prescriptions does not necessarily mean that GPs are diagnosing more people with depression, but … reflect a greater willingness of people to seek help when concerned about their mental health”

The UK is in the grip of a ‘happy pill boom’ according to the Daily Mail, with ‘almost 50 million’ antidepressants prescribed in 2011.

The reports are based on figures released today for prescriptions dispensed by GPs, pharmacists and other health professionals in the community during 2011.

It shows that antidepressants such as Prozac and Seroxat account for the largest annual rise in prescriptions since 2010. Just under 46.7 million prescriptions for antidepressants were dispensed in 2011, a rise of 3.9 million on 2010.

Some newspapers raise concerns that this rise may be the results of GPs looking for a ‘quick fix’ for mood disorders such as depression and OCD, when ‘talking therapy’ treatments such as cognitive behavioural therapy (CBT) may be a more appropriate treatment. But this represents an editorial opinion rather any interpretation of evidence provided in the report.

The report found that while prescription numbers overall are rising  the total cost to the NHS is falling. Probably because more drugs are now ‘out of patent’ and are being prescribed in cheaper generic forms.

 

What data are the stories based on?

The stories are based on a new report, Prescriptions dispensed in the Community, England 2011. The report is a summary of prescriptions for drugs, dressings and medical appliances dispensed in England by doctors, nurses, dentists, pharmacists and other health professionals (the majority of prescriptions are written by GPs). It has information on the number of prescription items for different therapeutic areas (for example, diabetes, heart failure or ADHD), the number of prescriptions for individual drugs, and their cost.

 

Who released the data?

The report was released by the Health and Social Care Information Centre (HSCIC), which was previously known as the NHS Information Centre. Its role is to collect and analyse data on health and social care to help the NHS and social services run more effectively. It publishes a wide range of statistics each year across a number of areas.

 

How reliable is the data?

The statistics are very reliable. They are derived from the system for reimbursing professionals who dispense medicines, dressings and appliances, run by NHS Prescription Services. The specific source for these statistics is the Prescription Cost Analysis system (PCA), figures for which are published annually as a national statistic, by the Health and Social Care Information Centre, in April.

 

What trends are found in the data in terms of AD prescribing?

The report found that just under 46.7 million prescriptions for antidepressants were dispensed in England in 2011, a 9.1% increase on 2010. This was the largest increase in the number of prescription items within all 200 therapeutic areas covered in the report.  However, the report points out that the rise is similar to that seen the previous year.

Antidepressant prescribing also saw the largest increase in cost of any area. Costs for antidepressant prescribing were £49.8 million, a rise of 22.6% on 2010. In the previous two years costs for antidepressants had fallen.

The report also lists the individual changes in the number of prescriptions and costs for different antidepressants. Costs of some drugs to the NHS is determined by a scheme agreed between the NHS and drugs manufacturers (called category M) that can result in both price increases and reductions. Below are some examples of prescription data for individual antidepressants:

  • Prescriptions items for sertraline, a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) not available as a generic and sold under the brand name Lustral, rose by 0.7m (23.2%) in 2011. Costs rose by £39.2 m (over 500%).
  • Prescriptions for fluoxetine, another SSRI available as a generic and sold under the brand name Prozac, increased by 0.1 m (15.9%). Costs to the NHS fell by £6.4m (30.4%)
  • Prescriptions for duloxetine, a newer type of antidepressant available as a generic and sold under the brand name Cymbalta, increased by 28.3% and costs rose by £4.8m (28.3%)
  • Prescriptions for nortriptyline, available as a generic and under the brand name Allegron an older type of antidepressant called a tricyclic, rose by 21.6% and costs by £2.1m (59.9%).

 

Is this increase a direct result of more people becoming depressed, or could the picture be more complex than that?

It’s not certain why antidepressant prescriptions have risen.

Some experts argue that the long-term rise is linked to the economic downturn that begun in 2007. Factors such as job insecurity, rising levels of debt and reduced living standards are known to lead to a rise in feelings of depression and/or anxiety..

However, the rise may partly be down to the fact that mental health conditions such as depression and anxiety are no longer seen as taboo and are more widely recognised. So more people are prepared than in the past to go to their GP for help.

Another factor is while several non-drug treatments such as talking treatments are recommended for mild depression, access to these types of treatment can be limited depending on where you live.

 

Are antidepressants used for anything other than treating depression?

Antidepressants are also used for other mental health problems such as:

  • anxiety
  • obsessive-compulsive disorder
  • post-traumatic stress disorder
  • panic disorder 
  • serious phobias, such as agoraphobia and social phobia

An older class of antidepressants known as tricyclic antidepressants (such as amitriptyline) is sometimes prescribed to treat nerve pain as well as conditions known to cause chronic pain, such as fibromyalgia and multiple sclerosis. Duloxetine is sometimes used for stress incontinence in women. But the main use for antidepressants is in treating depression.

 

What alternative treatments are there for depression? 

There are several treatments that can be used as alternatives to antidepressants, particularly in the case of mild depression.

They include:

  • talking treatments such as cognitive behavioural therapy (CBT) (online CBT is also available)
  • interpersonal therapy and counselling
  • exercise programmes
  • self-help groups

In some cases a combination of treatments, such as combining antidepressants with a course of CBT, can be effective.

Read more about the treatment of depression.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on twitter.

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