The north/south divide on antidepressants

 
Bottle of pills

New figures reveal that the NHS in England spent more than £270m on antidepressants last year - a massive 23% increase on 2010. The health service spent almost £1m a week more on the drugs than the year before.

Antidepressant use has been growing rapidly for decades. In 1991, English pharmacies handed over nine million items. In 2001, it was 24.3 million. Now the number has grown to 46.7 million prescriptions issued - a 9.1% rise on the previous year.

So what do we make of this? Are we witnessing a significant decline in mental health, exacerbated, perhaps, by the financial crisis? Is the country becoming addicted to popping pills? Or is this evidence of changes in prescribing practice, more people being diagnosed and given pills for longer?

Happiest places in the UK

Mark's blog on 24 July on the top five happiest parts of the UK
  • Well-being statistics released last week showed islands in north of Scotland to be least anxious
  • Leicestershire, inner London, Middlesbrough, South Ayrshire and Peterborough most anxious
  • Bath and North Somerset ranked highest for life satisfaction, Merthyr Tydfil ranked lowest
  • And Blackpool ranked lowest when asked how happy they felt yesterday

It can't be, as some GPs have suggested, that the rise in the number of "items" is down to surgeries prescribing smaller doses more often - the amount spent on ingredients is also rising fast. All the evidence points to a rapid increase in the number of pills being swallowed.

The rise comes at a time when doctors working for the NHS in England are being encouraged to move away from antidepressants for the treatment of mild depression and anxiety in favour of psychological therapies.

I first wrote about this issue in 2009 when I obtained figures under freedom of information. I suggested then that the prescribing statistics painted a troubling picture of well-being in northern England.

These latest figures show the same clear geographical variation in prescribing rates for antidepressants - with an interesting correlation to the well-being data published last week.

Blackpool is the place with the highest use of antidepressants in England - an astonishing 1,430 prescriptions signed for every thousand patients in the primary care trust. The PCT issued 221,000 items with 155,000 people on its books.

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The lowest rates of antidepressant use are predominantly in London - which may represent markedly different prescribing practice in the capital”

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Blackpool also emerged as England's unhappiest place in last week's well-being survey data, with 36% of adult residents giving a score of 6/10 or less when asked to rate how happy they were the day before.

According to the latest figures, the next five places with high prescribing rates for antidepressants are all clustered in the North-East of England - Redcar and Cleveland, County Durham, Gateshead, Newcastle and Sunderland. County Durham, incidentally, was the second most unhappy place in England according to the well-being figures.

The places with the lowest rates of antidepressant use are predominantly in London - a finding which may represent markedly different prescribing practice in the capital but is also, perhaps, explained by the mobility of urban populations. The data is based on GP lists which are known to be more out of date in city areas where patients move in and out more often.

Top 10 and bottom 10, plus bottom 10 outside London

Map showing highest/lowest no of prescriptions/1,000 people

The official guidance to GPs from the National Institute for Clinical Excellence (Nice) says this: "Do not use antidepressants routinely to treat persistent sub-threshold depressive symptoms or mild depression because the risk-benefit ratio is poor."

Instead, GPs are encouraged to offer cognitive behavioural therapy (CBT) and structured group physical activity programmes. The latest figures suggest this guidance may not be followed through by general practitioners, despite a huge increase in the availability of CBT in England.

A programme called Improving Access to Psychological Therapies (IAPT) was begun in 2007, since when the NHS has trained and employed almost 4,000 psychological therapists with a further 2,400 to be trained in the next couple of years.

A paper in the British Medical Journal in 2009 attempted to explain the rise in antidepressant prescribing and concluded that it was down to "small changes in the proportion of patients receiving long term treatment". In other words, once people are given their first pills they tend to stay on them for years, if not decades.

Antidepressants can be very effective for people with depression and anxiety, and it may be that better diagnosis is revealing large numbers of new people who are benefiting from some excellent drugs now available.

But there must be a concern that what we are actually seeing is a health service too ready to give patients pills for mental conditions which are helped better in other ways.

Antidepressant prescriptions by PCT

Highest number per 1,000 people

1. Blackpool

1,430.85

Table colour image

2. Redcar and Cleveland

1,391.36

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3. County Durham

1,318.03

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4. Gateshead

1,306.86

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5. Newcastle

1,279.68

Table colour image

6. Sunderland Teaching

1,268.47

Table colour image

7. Barnsley

1,262.36

Table colour image

8. Salford

1,236.28

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9. Darlington

1,228.65

Table colour image

10. South Tyneside

1,220.18

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Lowest no. per 1,000 people

1. Brent Teaching

347.48

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2. Newham

370.35

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3. Ealing

371.48

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4. City and Hackney Teaching

385.94

Table colour image

5. Redbridge

395.73

Table colour image

6. Waltham Forest

412.62

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7. Wandsworth Teaching

418.02

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8. Lambeth

420.22

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9. Kensington and Chelsea

420.67

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10. Southwark

429.49

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Lowest no. per 1,000 people outside London

1. Heart of Birmingham

454.47

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2. Luton

556.67

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3. Surrey

591.06

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4. Havering

599.42

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5. Milton Keynes

611.26

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6. Berkshire East

632.94

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7. Buckinghamshire

633.55

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8. Birmingham East and North

645.21

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9. Hertfordshire

659.39

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10. Derby City

669.62

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Mark Easton, Home editor Article written by Mark Easton Mark Easton Home editor

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  • rate this
    +4

    Comment number 25.

    My husband was given anti depressants and was not properly reviewed for 10 years. Finnally the community mental health team checked him out but offered no counciling or support, so he is still on the anti depressants.

  • rate this
    +25

    Comment number 24.

    As usual on a story about mental health/depression, out come the ignorant and ill-informed. Medication can be genuinely helpful, and in some cases an absolute lifesaver. Don't knock it when you've had NO experience of the condition.

  • rate this
    +14

    Comment number 23.

    I see many say "it's all in the mind" - yes, it is, and sometimes it's also a physiological or chemical imbalance and needs treating. If it was just "in the mind", explain why I, with a good job, loving family and generally cheerful outlook, have needed treatment twice in the last 10 years to help bring me out of a deep, black pit.

  • rate this
    +25

    Comment number 22.

    Does the research actually differentiate between the prescription and the symptom?

    I was prescribed what is usually an anti-depressant for controlling chronic spinal pain.

    Without context this research looks totally pointless.

  • rate this
    +1

    Comment number 21.

    I'm surprised Luton is one of the lowest, it's the most depressing place I've ever lived in.

  • rate this
    -15

    Comment number 20.

    Many recipients of anti-depressants are likely not depressed at all but unhappy, for which there is no pill. In a materialist society with values based on acquisition & consumerism of course more people will be unhappy in a slump. Since there's no forseeable end to economic decline perhaps it would be wise to a) re-assess our system of values b) stop medicalising natural human responses to sadness

  • rate this
    -26

    Comment number 19.

    8Double Dip Dave
    Actually if you want to play politics over it, the north may be more depressed by their Labour voting tendency for a way and style of life that ruined the country, and is not and never can be a sustainable option, borrowing for ever more to throw away. Being forced to live within your means not greedy desires handed to you on a plate is depressing if conned it was ever an option

  • rate this
    0

    Comment number 18.

    Pills are the equivalent of elastoplast for the majority of cases.

    They are there to numb the underlying cause which in many cases relates to low self esteem.

    Some areas are depressing to live in for a variety of socialyl related causes. Dealing with these is far more expensive than dishing out anti-depressants.

  • rate this
    +23

    Comment number 17.

    I find this discussion profoundly disturbing. Depressive illness is very real and life-compromising. It feels like the sky is falling down, there is no hope in anything, and you just hope for death.
    You can't reason with it because it is irrational. You can't fix brain physiology with psychological therapy, no matter how much money the government would like to save.

  • rate this
    -14

    Comment number 16.

    In the US drugs are used to fix the many mental issues its patients have, no matter how trivial. It is a short term solution to cover the symptoms rather than the causes. The UK should spend time and effort in ensuring people don't need to be prescribed drugs which they then become dependent on because they can't see any other way. Medication is great for physical issues but not psychological ones

  • rate this
    +7

    Comment number 15.

    I see Blackpool are top

    Have you ever been to Blackpool?

    If so, you would understand why they are top

  • rate this
    0

    Comment number 14.

    For me,it's very much about consistency&training-i've experienced a huge range of contradictory approaches&bizarre attitudes in the 11 years I've been on Citalopram-during which I have lived all over the country-which in itself has meant I've been on them longer. I have explored/recorded this here - http://fostresswrites.blogspot.co.uk/2012/06/mind-gap-gps-mental-health-and-young.html

  • rate this
    +7

    Comment number 13.

    The biggest problem for people with mental health issues is that most GPs react to a depressed patient by throwing pills at them. I've been diagnosed for over half of my life and have had a grand total of 3 doctors who genuinely tried to help sort out the root cause of the problem rather than just bombarding me with medication.

    Finding a GP that cares shouldn't be a cause for celebration.

  • rate this
    -10

    Comment number 12.

    I would put money on the fact that most of these people aren't depressed at all, simply "unhappy".

    There is a massive difference and throwing antidepressants at it is not the fix.

  • rate this
    -36

    Comment number 11.

    I'm glad I live in a happy place.
    depression is all in the mind

  • rate this
    +3

    Comment number 10.

    9

    I hope you are being ironic. The best route to curing a mental condition is to accept it and ensure it is properly treated.

    I agree that GPs can easily misdiagnose simply due to the demands on their time but the timely pursuit of the right diagnosis and treatment is essential. At least give the medication a try: if it doesn't work then tell the doctor it is wrong.

  • rate this
    0

    Comment number 9.

    My daughter has been prescribed antidepressants for an ongoing stomach pain, which has lasted over 9months and still undiagnosed. If there's not a diagnosis soon, she will become depressed resulting in her having to take them.

  • rate this
    +4

    Comment number 8.

    It's hardly surprising that depression is on the increase, when you have an uncaring government in power, who are only there to serve their bankers chums.
    The rest of us, it seems, can go to hell.

  • rate this
    +2

    Comment number 7.

    While the numbers of prescriptions has increased, the cost per prescription has fallen dramatically. While part of this is due to drugs losing their monopoly, for the most part it is because GPs are writing prescriptions for smaller amounts (thus keeping contact with patients) - this is particularly true in Wales where free prescriptions remove cost considerations.

  • rate this
    +1

    Comment number 6.

    Good article on Today, Mark.

    Perhaps a correlation between anti-depressant use and alcohol abuse might prove interesting as well?

    Humanity evolved over 45 thousand years from self-sustaining communities of hunter-gatherers. This does not fit our modern culture at all. Neuroses are to be expected.

 

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