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

Table colour image

3. County Durham

1,318.03

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4. Gateshead

1,306.86

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5. Newcastle

1,279.68

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6. Sunderland Teaching

1,268.47

Table colour image

7. Barnsley

1,262.36

Table colour image

8. Salford

1,236.28

Table colour image

9. Darlington

1,228.65

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10. South Tyneside

1,220.18

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Lowest no. per 1,000 people

1. Brent Teaching

347.48

Table colour image

2. Newham

370.35

Table colour image

3. Ealing

371.48

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4. City and Hackney Teaching

385.94

Table colour image

5. Redbridge

395.73

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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

Comments

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  • rate this
    +1

    Comment number 45.

    This report counts the number of prescriptions. Maybe it is not a regional reflection of the patients, it could equally be interpreted as a reflection of the doctors.

  • rate this
    +4

    Comment number 44.

    42. "For them, taking a pill proves they have medical problems, that life is harder for them. Placebos would work just as well."

    You know that the fact that a placebo might work does not mean that there was no genuine medical problem there, right? I mean, I'd guess that you don't know that from your post, but I might be wrong.

  • rate this
    +4

    Comment number 43.

    @42.SwampPuppet
    "Placebos would work just as well."

    Where's your evidence in relation to depression? Got none? Then stop making ignorant statements on a subject you clearly know nothing about.

    Come back when you've got some facts.

  • rate this
    -24

    Comment number 42.

    I'm fat - give me some diet pills.
    I'm depressed - give me some anti-depressant pills
    I'm old - give me some hormone replacement pills.

    I know people who boast about all the pills they take. As though they must be some champion to endure life with all those problems. For them, taking a pill proves they have medical problems, that life is harder for them. Placebos would work just as well.

  • rate this
    +20

    Comment number 41.

    Comment 37 is an excellent summary of depression. If someone said I could have untreated depression for life, or be in a wheelchair, I'd rather cut my own spinal cord than have the living hell of clinical depression. Those who have had full blown depression will fully understand this statement. Those who think this is nonsense and depression is a 'mood' aren't eligible to comment!

  • rate this
    -6

    Comment number 40.

    My dad had migraines for 50 years, tried every medication available with side effects and saw every specialist the NHS had available. After retiring his migraine attacks doubled. After three sessions of Hypnotherapy with me his migraines went. The NHS treat the symptoms and not the cause, the reason for them failing so badly.

  • rate this
    +6

    Comment number 39.

    Would perhaps help if the North East wasn't treat like scum.

  • rate this
    +20

    Comment number 38.

    I started taking anti-depressants about 18 months ago, during a period of long term unemployment. I'd tried talking therapy and not really got anywhere with it. The pills haven't solved my problems, but they've made them easier to deal with.

    I think unemployment - with the associated isolation and lack of daily structure - seems to exacerbate any tendency towards depression massively.

  • rate this
    +36

    Comment number 37.

    Clinical depression isn't 'just in the mind' - it's understood to be caused by too low levels of neurotransmitters e.g. serotonin or noradrenline, or mal-absorption of them. Circumstances are important but are not the only factor. A person can't 'snap out of it' by willpower alone any more than they can walk with a paralysed leg. But, antidepressants don't fix any underlying problems e.g. stress

  • Comment number 36.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    +1

    Comment number 35.

    If the government would like to save on bills for all my medication, just buy me a large glass of Cognac, an R&J Short Churchill and a Cyanide pill.

    As for the mystery of anti-depressant use, just look towards the quality of life in the areas of higher usage. Say no more!

  • rate this
    -29

    Comment number 34.

    It is interesting to note that most of the areas with higher usage of these drugs are in the areas controlled by the Labour party.
    I wonder if there is a correlation between the get up and go Conservative types and the depressive, chip on the shoulder, expect it all from somebody else Labour types.
    Interesting.

  • rate this
    +2

    Comment number 33.

    Is there any correlation between this and wealth distribution?

  • rate this
    -9

    Comment number 32.

    I am an expert on mental health, as far as I am concerned, the NHS are amateurs with a lot of money to throw at it. Antidepressants should be used as the last option. People in the North are more liable to suffer, because industry there were reliant on was destroyed in the 80's, many have never recovered from this. Industry is as important as the service sector in this country.

  • rate this
    +3

    Comment number 31.

    9 Catherine
    I was prescribed Venlafaxine for an undiagnosed stomach prob too. I was told that there's a secondary effect that's been found to help some stomach problems, though it's not clear why. It was fairly effective (previously several stomach meds were ineffective, so wasn't just placebo effect) but you need to be careful coming off it due to withdrawal.

    Hope your daughter recovers soon

  • rate this
    +1

    Comment number 30.

    24.sparrow on-a-balance-beam wagpie
    That is a bit of an assumption, how do you know who has or hasn't suffered from depression from reading a few lines of text?

  • rate this
    +11

    Comment number 29.

    @Velvetstreak. Couldn't agree more. Brain physiology has a significant influence on moods and behaviour. Can one 'snap out of..' the chemical makeup of their brain? No, not without help, in much the same way a diabetic depends on insulin.

    Sadly though, I expect a rise in prescriptions this winter due to SAD and exacerbated by the awful summer weather.

  • rate this
    +18

    Comment number 28.

    My life was saved by anti-depressants. Some two years ago I was on the very edge of suicide, and only the intervention of medical help - by way of medication - saved me. I had no history of depression.

    CBT was almost non-existent where I am in Suffolk. I was assigned a psychiatrist, but in 9 months had 3 different doctors due to "shortages". People need realize this can be ESSENTIAL help.

  • rate this
    +43

    Comment number 27.

    @20.chewho
    "Recipients of anti-depressants are likely not depressed but unhappy... stop medicalising natural human responses to sadness."

    Ignorant rubbish. Clearly you know NOTHING about the illness of depression. The emotion is not sadness, it's ANXIETY in mild form, FEAR most of the time, DREAD at the extreme. It has NOTHING to do with 'happiness'. It is tested for and diagnosed as an ILLNESS.

  • rate this
    +8

    Comment number 26.

    As 22. Kevin says, many people suffering from nerve pain are currently being prescribed an anti depressant called amitriptyline as it's effective at relieving symptoms. This article is nonsense.

 

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