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."

Dr Clare Gerada: Anti-depressants save lives

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

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6. Sunderland Teaching

1,268.47

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7. Barnsley

1,262.36

Table colour image

8. Salford

1,236.28

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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

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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

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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 Article written by Mark Easton Mark Easton Home editor

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  • rate this
    -3

    Comment number 125.

    Why are people taking more anti-depressants? Because we've realised life is boring and pointless and we need something to take the edge off. I personally prefer a beer or a nice single malt!

  • rate this
    +3

    Comment number 124.

    Anyone considered how much money is saved by people taking anti-depressants? Maybe the NHS is saving over all with people not needing to constantly go to the doctor, less suicides or suicide attempts? As someone who has suffered from PTSD manifesting as anxiety and hypochondria for 13 years, being on tablets has saved my doctor & hospital hours of having to put up with me.

  • rate this
    -1

    Comment number 123.

    Anyone been to Blackpool lately................Last time I went I felt the need for anti depressants.
    Mind you if I lived in a high rise in London I would feel the same.

  • rate this
    +7

    Comment number 122.

    I got prescribed anti-depressents to treat severe anxiety which literally came from no where and resulted in me having 5-6 panic attacks a day. It was all a chemical inbalance and had nothing to do with being happy (I am a confident and happy person).The pills have given me my old life back and has really helped me. Please dont gloss people over with the same brush.

  • rate this
    +5

    Comment number 121.

    Typical GP-bashing again. The vast majority of GPs are well aware of the guidelines! But the waiting list in our area for councelling or CBT is 2 years, with no structured activity programmes at all to refer to. There's not many patients who want to spend 2 years feeling low and depressed whilst waiting for treatment, and unless someone can afford private therapy, the only option is tablets

  • rate this
    +2

    Comment number 120.

    After recently losing my father anti-depressants were the crutch I needed and the scaffolding necessary to deal with a nightmare situation. There is nothing worse than the places one's mind can take us to if in a bleak state - it's a constant battle. I also believe any results showing the U.K as a 'happy nation' are complete eyewash. Living, for most of us, in these times is nigh on intolerable.

  • rate this
    +14

    Comment number 119.

    47 @Tim
    No, you don't know what you're talking about. Stress is not depression and depression is not stress. Has it occurred to you that people who seek help for depression are actually taking responsibility for their condition and seeking help?

  • rate this
    +2

    Comment number 118.

    Went shopping in Blackpool this morning and was serenaded by a group of tramps singing the circle of life from the Lion King, eating an Al Fresco Mac Donald breakfast washed down with Tennets Super.

    None of them looked depressed.

  • rate this
    +3

    Comment number 117.

    Take a nice happy chap from say Henley, and move him north to an area where he is surrounded by the relics of our once great industrial empire, no hope of a job, in a spartan housing estate where the police can't do anything about the local yobs, then check his before and after Valium consumption.

  • rate this
    0

    Comment number 116.

    I have the opposite feeling, when I holiday in the north my heart lifts.

  • rate this
    +2

    Comment number 115.

    perhaps the increase in antidepressants is directly in line with the reduction in mental health practitioners employed, and the services available for psycological therapies. I am currently on a 19 month waiting list for CBT for anxiety and depression. So called early intervention does not exist.

  • rate this
    +2

    Comment number 114.

    @suzkid
    82
    "What is more important is to ridicule ignorance such as this."

    Perhaps you might give some consideration to the possibility that someone having a different view to yourself does not necessarily equate with ignorance, and that histrionics is a rather poor way of engaging in a debate :)

  • rate this
    +3

    Comment number 113.

    Sometimes time is of the essence in treating depression. Long waiting lists for CBT which doesn't help everyone. Addressing underlying issues is paramount: with a society / Govt that seems increasingly pround of its cruelty and lack of compassion, rises in mental illness are inevitable.
    BTW Whats with the premod? Worried someone might criticise the O*****cs? Doesn't exactly facilitate debate!

  • rate this
    +4

    Comment number 112.

    Think we have to accept everyone is different, and some people just cope easier with life's difficulties than others.

    I've had lot of what life can throw at you - horrid divorce, numerous bereavements one after the other, loss of a baby, bullying boss - but have come through without anti-depressants. It's been tough, but I consider myself very fortunate that I've managed without medication.

  • rate this
    0

    Comment number 111.

    They use more illegal drugs instead in the south!

  • rate this
    -4

    Comment number 110.

    If I lived up north, I'd want anti-depressants too!

    And before I get dived on, I'm originally from there! Seriously, with the economy in the state it is, lower wages, fewer jobs... it's no wonder more people want drugs to take the pain away.

  • rate this
    +2

    Comment number 109.

    Oh I love the British "stiff upper lip" contigent... As stated by others, depression does not mean "unhappy" it can mean a miriad of issues that affect us in the complex culture we have created in the modern world.

    I have decided to take SSRI's for the rest of my life as it allows me to manage what seems to be an inbuilt anxiety resulting in an inability to concentrate. The effect is stunning!

  • rate this
    -1

    Comment number 108.

    I think that it’s more to do with the social/cultural backgrounds of doctors who subscribe the pills! Basically, a middle to upper class background doctor practicing in traditionally working class/poor constituents probably thinks that the patients have a reason to be unhappy and their lives are miserable compared to what the lifestyle that the doctor enjoys and experienced while growing up. ->

  • rate this
    +2

    Comment number 107.

    I agree that antidepressents are 'just a plaster'. They work for a while, they your body gets used to them and you need a different 'type' to have the same effect. A lot of people take themselves to the doc on a whim too. A few down days and they think theyre depressed, but depression is a big black hole that you can't crawl out of without help. Councelling and guidance is the answer not pills

  • rate this
    +4

    Comment number 106.

    89

    Well said!

    It has always amazed me that doctors think that ten minutes are considered suitable for a patient to describe their symptoms. This is fine for someone with a sneeze or a twisted ankle but as you say for anything more complex the allotted time is quite insufficient.

 

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