More than four million people in England are long-term users of antidepressants, new figures obtained by the Guardian show.
Data released under the Freedom of Information Act shows that more than 7.3 million people were prescribed antidepressants in 2017-18, 4.4 million of whom also received a prescription for such drugs in both of the two previous years.
1.6 million people prescribed antidepressants in the past year were “new” users, meaning they were not being prescribed such drugs in either 2015-16 or 2016-17.The figures also show the number of such “new” users of antidepressants is falling. Month-by-month figures show an overall decline from just over 179,000 “new” starters in April 2016 to just over 132,000 in March 2018.
Experts say it is not clear what is behind the trend and that there could be a number of factors at play.
Scott Weich, a professor of mental health at the University of Sheffield, said the tendency to prescribe antidepressants seems to have gone in phases over recent decades.
“Professionals may be becoming slightly less certain about the benefits of antidepressants [for mild depression], and patients themselves may be declining medication,” he said. Weich noted other reasons might be that individuals are finding it increasingly difficult to access GP services to discuss mental health issues, or that the issues are not discussed due to time constraints or other pressures. On the other hand, he said, it could in part reflect the rise in so-called “talking therapies” like CBT.
“There might be a good news story here that more people are getting psychological treatments and not needing antidepressants,” said Weich, adding that there has also been a rise in awareness of the benefits of exercise and other social measures for tackling depression.
“I think the less likely explanation would be that somehow depression is going away,” Weich added, noting that there has also been no guidance that GPs should reduce prescriptions of antidepressants.
But Christopher Dowrick, professor of primary medical care at the University of Liverpool was cautious, telling the Guardian data would need to be collected for far longer to be sure the trend was not merely a blip.
According to the figures obtained from the NHS Business Services Authority, one in six 18 to 64-year-olds were prescribed antidepressants at some point last year, rising to one in five among those aged 65 and over.
Rates of antidepressant use across all age groups rose 5% between 2015-16 and 2017-18.
Twice as many women as men are being prescribed antidepressants in all age groups.
The figures include antidepressants prescribed for conditions other than mental health problems, including migraine and diabetic neuropathy. “Some of these products can be used for a variety of clinical indications and therefore the drugs prescribed may have been prescribed for a different condition,” the NHS Business Services Authority (NHSBSA) said.
Previous research has shown that people are staying on antidepressants for increasingly lengthy periods, boosting the numbers of prescriptions, while the number of first time prescriptions has remained fairly stable or even shown a slight drop.
Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said antidepressants are an effective treatment for many people with mental health conditions including depression and anxiety.
“It’s important that data showing increased prescribing of antidepressants aren’t always automatically seen as negative as it is likely that more patients are now willing to discuss their mental health problems with a healthcare professional, which is ultimately a good thing and a step towards parity of esteem with physical health issues,” she said.
“Nevertheless, people don’t often want to be on long-term medication, and GPs don’t want their patients to be reliant on medication either.
“These figures showing rises in antidepressants prescribing slowing down could be an indication of things stabilising, and it will be interesting to see whether this is a long-term trend.”Mind’s head of information, Stephen Buckley, said it was important that people are being offered a choice of treatments.
“It’s important that those prescribing treatment don’t take a one-size-fits-all approach and offer people a choice of treatment options that may include medication, talking therapies, alternatives such as arts therapy or exercise, or a combination of some or all of these.”
He added: “While around 40% of GP appointments involve mental health we also know that around two-thirds of people with mental health problems aren’t accessing any kind of help at all.”
Since April 2015 the NHSBSA has collected the number of individuals receiving prescriptions by counting the NHS numbers captured on prescription forms. Each patient is counted just once regardless of how many different antidepressant drugs were prescribed in the cited time period.
The figures provided to the Guardian cover prescriptions dispensed through NHS Prescription Services in England and exclude those prescribed and dispensed in prisons, hospitals and private prescriptions.