Pharmacy insights

The rise of antidepressants in UK

It has already been reported that a record number of 64.5mln prescription items  were issued in 2016 for treatment of depression, questioning whether doctors overprescribe this class of drugs or whether more people actually get help with their condition.

In 2017-2018 more than 7.3 mln people were prescribed antidepressants (The Guardian, 2018). This trend continues as we look at figures for year 2018.

70.5mln antidepressant items were prescribed in 2018. This number has been rising at average rate of 3.5mln items per year since 2014 (prescribing data available on OpenPrescribing.net), although it is known that this value has been on a rise for over 25 years (Mars, et al, 2017).

Druggist.Online (2019). Data source: OpenPrescribing.net

Why increasing number of antidepressants are prescribed?

Complexity of antidepressant prescribing and in-depth analysis across UK population is beyond the scope of this post.

At individual level number of factors can cause depression, some of which include stressful life events, personality, family history of depression, giving a birth alcohol and drugs use (NHS, 2016).

Some trends that were previously suggested as contributing factors in rise of antidepressant prescribing include increase in long term use of antidepressants rather than new cases of patients being diagnosed (Mars, et al, 2017). Some studies found increase in antidepressant prescribing after 2008 recession, specifically in younger men due to rising unemployment (Kendrick et al., 2015)

Older population (65+) is most likely to receive antidepressant (BSA, 2017). This contributes to increased antidepressant prescribing as population in UK is getting older with 18% aged 65 and over and 2.4% aged 85 and over (ONS, 2017). This trend is most likely to continue as population projections clearly indicate increased % of elderly people in coming years.

Population projections for 65+ and 85+ Source: ONS (2017)

Some antidepressants such as amitriptyline and duloxetine can be used in treatment of neuropathic pain which limits available prescribing information as this prescribing data is not solely available. Both amitriptyline and duloxetine are recommended by NICE as first line treatment in management of neuropathic pain. Between 2014 and 2018 there is no significant changes in amitriptyline prescribing standing respectively at 1.1mln and 1.2mln each year (OpenPrescribing.net, 2019). For duloxetine a significant increase in prescribing can be seen from 1.3mln in 2014 to 2.3ml items in 2018. This however can be partly explained by Cymbalta’s patent expiration and significant cost reduction in prescribing which drives this increase.

What is the most commonly prescribed antidepressant in UK?

Selective serotonin reuptake inhibitors are the most common group of antidepressants prescribed in UK. This reflect NICE recommendations for first line management of depression.

With 14.7mln prescriptions sertraline is the most commonly prescribed antidepressant in UK in 2018, closely followed by citalopram with 14.1 mln items prescribed (OpenPrescribing.net, 2019). Sertraline is one of the most commonly prescribed drugs in 2018. Both sertraline and citalopram made it into most commonly prescribed drugs in UK in 2018.

References:

BSA (2017). Antidepressant prescribing. Available at: https://www.nhsbsa.nhs.uk/prescription-data/prescribing-data/antidepressant-prescribing 01/03/2018

Kendrick T, et al. Changes in rates of recorded depression in English primary care 2003–2013: time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF). Available at: https://www.ncbi.nlm.nih.gov/pubmed/25881283 01/03/2018

Mars Becky, Jon Heron,1 David Kessler,1 Neil M. Davies,1,2 Richard M. Martin,1 Kyla H. Thomas,1 and David Gunnell (2017). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329088/ Accessed on 01/03/2018

NHS (2016). Clinical depression. Available at https://www.nhs.uk/conditions/clinical-depression/causes/ Accessed on 01/03/2018

ONS (2017). Overview of the UK population: July 2017 Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/july2017 Accessed on 01/03/2018

OpenPrescribing.net (2019). Amitriptyline. Available at: https://openprescribing.net/chemical/0403040Y0/  Accessed on 01/03/2018

OpenPrescibing.net (2019). Duloxetine. Available at: https://openprescribing.net/chemical/0403040Y0/ Accessed on 01/03/2018

The Guardian (2018). Four million people in England are long-term users of antidepressants. Available at: https://www.theguardian.com/society/2018/aug/10/four-million-people-in-england-are-long-term-users-of-antidepressants Accessed on 01/03/2018

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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