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

Table colour image

4. Gateshead

1,306.86

Table colour image

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

Table colour image

9. Darlington

1,228.65

Table colour image

10. South Tyneside

1,220.18

Table colour image

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

Table colour image

4. City and Hackney Teaching

385.94

Table colour image

5. Redbridge

395.73

Table colour image

6. Waltham Forest

412.62

Table colour image

7. Wandsworth Teaching

418.02

Table colour image

8. Lambeth

420.22

Table colour image

9. Kensington and Chelsea

420.67

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10. Southwark

429.49

Table colour image

Lowest no. per 1,000 people outside London

1. Heart of Birmingham

454.47

Table colour image

2. Luton

556.67

Table colour image

3. Surrey

591.06

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4. Havering

599.42

Table colour image

5. Milton Keynes

611.26

Table colour image

6. Berkshire East

632.94

Table colour image

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

Table colour image
 
Mark Easton, Home editor Article written by Mark Easton Mark Easton Home editor

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  • rate this
    +2

    Comment number 65.

    "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 "

    My God, you're ignorant. It's no coincidence that the highest no. of antidepressants are prescribed in areas long victim to idealogically-driven economic and social destruction.

    The

  • rate this
    +4

    Comment number 64.

    I work in a pharmacy and we have a top 50 of the most commonly prescribed drugs. It shocks me that nearly half are some form of anti-depressant or anxiety drug. I feel doctors are too eager to deal with mental health the chemical way and not guiding people to alternative methods. Most of these drugs still have not been around long enough to know what the long term effects will be.

  • rate this
    +5

    Comment number 63.

    Re 'starscry', if waiting lists for operations were this long there would be uproar. But those with mental health problems find it hard to fight back so it goes unnoticed. I understand there is a high turnover of 'CBT' staff so the new trainees are simply filling gaps.

  • rate this
    +1

    Comment number 62.

    Depression is horrible, and patients need help. But SSRI inhibitors, which must be taken for a long time and have horrible side-effects if stopped too quickly, were not used in the past. I was twiced prescribed other anti-depressants for around 3 months. Could it be that modern pills are designed to be used for longer, thereby swelling the profits of the drug companies even further?

  • rate this
    +5

    Comment number 61.

    @57. DB1957

    I agree, amitriptyline is prescribed for a wide range of chronic illnesses such as fibromyalgia, multiple sclerosis and long term nerve pain. In fact amitriptyline, although listed as an anti depressant, is rarely used to treat depressive conditions. This article doesn't take that into consideration.

  • rate this
    +5

    Comment number 60.

    I am currently taking antidepressant medication prescribed to treat my depression. I have been offered CBT by my NHS PCT - but the waiting list is 2 years long. This is twice what it was 4 years ago when i was in the same situation so id love to know where all the "new trained staff" are going because it definitely isnt Oxfordshire!!!

  • rate this
    +6

    Comment number 59.

    Severe depression is a mental health issue which will will have little influence by where someone lives.

    Minor depression, like crime, will be hugely influenced by economic security. It's no surprise that Blackpool and Redcar, places with huge economic difficulties and poverty, are the top two for AD prescriptions.

    The North, plus Wales, is isolated from the cushy south and we all know it.

  • rate this
    +20

    Comment number 58.

    Here's a few facts for those of you who deride depression.
    Suicide is the main cause of death in under 25 year old males.
    In the UK, after almost 10 years of annual decline in suicide, the recession triggered sharp spike in suicide. The UK rate increased by 8% 2007 to 2009, and a similar rise 2009 to 2011.
    In Greece, in 2010 a 25% increase in suicide; 2011 40% increase.
    In UK 6 month wait forCBT

  • rate this
    +1

    Comment number 57.

    Is this study related to "people with depression" or "antidepressant prescriptions written"? I take a tricyclic antidepressant because it helps control the pain of a spinal condition. I'm pretty sure I'm not the only one.

  • rate this
    +14

    Comment number 56.

    47.

    Stress and depression aren't the same thing. They're not even similar really. Depression doesn't require an external cause; it can distort your whole outlook and makes every problem seem interlinked and unassailable. Medication helps to change that; in fact, taking them IS taking responsibility, by doing something proactive about your condition.

  • rate this
    +1

    Comment number 55.

    46 - alcohol and substance abuse are more prevalent in the North too, only emphasising the split in the Nation

  • rate this
    +4

    Comment number 54.

    @suzkid 27

    I think its a shame, really, that you felt the need to very selectively quote and thereby distort my comment. My points were about the well documented connection between values and mental state and the equally well recognised over-prescription of medication by GPs. Depression is indeed a terrible condition but not everyone prescribed anti-depressants is actually depressed.

  • rate this
    +5

    Comment number 53.

    Anti depressives work well for some people but therapies need to be available too and community centre places(other than pubs) where a people at home all day in these days of high unemployment, retirement, young children, and ill health could meet other people without being labelled as a 'drop in' centre. In town centre.eg Low cost sport centres/coffee shopsin libraries etc.Central and for all.

  • rate this
    +5

    Comment number 52.

    The IAPT programme has been a failure as PCTs have majored on CBT (cognitive behavioural therapy) almost to the exclusion of other forms of therapy. The reason for this is simple - NICE always aim for evidence-based therapies but when dealing with mental health, a far more expansive approach is needed. Mental health problems can't always be 'fixed' with a limited number of sessions as with CBT.

  • rate this
    +2

    Comment number 51.

    "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. "

    Depressive Labour types are depressed because they're depressive Labour types? Good to see you're keeping your personal biases in check there.

    It is certainly depressing to be left-wing right now though.

  • rate this
    +16

    Comment number 50.

    Velvet Streak@17 describes it precisely. Those who have never suffered it have no idea how it feels to be trapped in a deep, dark pit where one prays for death. I experienced this even when life was good - dad a diplomat, lots of exciting travel etc.. I was tried on several drugs including Amitriptyline/Venlafaxine/Prozac/Citalopram before Sertraline (at maximum dose) gave me breathing space.

  • rate this
    -15

    Comment number 49.

    "Antidepressants can be very effective for people with depression"

    The evidence for this is very poor. Readers in doubt can begin by consulting Moncrieff (2008) The myth of the chemical cure and Kirsch (2009) The emperor's new drugs. As a summary - this can be summarised as saying the effect of anti-depressants appears consistent with a placebo effect.

  • rate this
    +1

    Comment number 48.

    I was treated with antidepresents for over 10 years, then CBT helped so much I could quit chemicals. Part of the depression was feeling dissociated from the world - life, love, laughter had no meaning. The N is dissociated from the SE centric 'so called UK' - the Northern zeitgeist will always tend to depression, up here we're on the outside - it needs to be addressed politically

  • rate this
    -24

    Comment number 47.

    People in this country are always looking for a pill to deal with an issue, it is time you took responsibility for the issue, rather than relying on something else. I suffered with high levels of stress 20 years ago so know exactly what I am talking about.

  • rate this
    +13

    Comment number 46.

    The difficulty with mental health, specifically depression is that you don't really ever know the actual figures. How many people are self-medicating with alcohol/substances? Are more people coming forward for treatment? It has always been a grey area.

 

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