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


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2. Redcar and Cleveland


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3. County Durham


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4. Gateshead


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5. Newcastle


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6. Sunderland Teaching


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7. Barnsley


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8. Salford


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9. Darlington


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10. South Tyneside


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Lowest no. per 1,000 people

1. Brent Teaching


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2. Newham


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3. Ealing


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4. City and Hackney Teaching


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5. Redbridge


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6. Waltham Forest


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7. Wandsworth Teaching


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8. Lambeth


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9. Kensington and Chelsea


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10. Southwark


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Lowest no. per 1,000 people outside London

1. Heart of Birmingham


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2. Luton


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3. Surrey


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4. Havering


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5. Milton Keynes


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6. Berkshire East


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7. Buckinghamshire


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8. Birmingham East and North


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9. Hertfordshire


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10. Derby City


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Mark Easton Article written by Mark Easton Mark Easton Home editor

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  • Comment number 245.

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

  • rate this

    Comment number 244.

    I have to agree with 240 generic_user, I am usually aware what triggers my depression off, and sometimes I can override it by "pulling myself together" LOL, but that can take 12 hours or 12 weeks, it's very frustrating, being aware it's hanging around, and then guilt creeps in because I know I am not acting as a 'normal person'. I tried pills for a 6 month period once, made me worse, never again.

  • rate this

    Comment number 243.

    "There's a famous seaside place called Blackpool,
    That's noted for fresh air and fun"

  • rate this

    Comment number 242.


    "...I have the perfect career, friends, family, girlfriend..."


    No you don't.

    No one does.

    Don't believe the bullies who tell you you do.

  • rate this

    Comment number 241.

    236: The "dangerous side-effects" of my citalopram:
    * reduced frequency of migraines from 12-15/year to 3-4/year;
    * reduced severity of migraines, from almost always requiring time off work to 1 in 3 needing time off;
    * reduced menstrual cramps, from "unable to walk or work" to "a little pain";
    * total relief from PMT;
    all in addition to treating depression.

    You can pry them from my dead fingers.

  • rate this

    Comment number 240.

    @47 Tim...

    Clearly you've never suffered from depression. It's nothing to do with "sorting your problems out".

    Depression happens regardless of your situation. My life is going very well; I have the perfect career, friends, family, girlfriend. Yet I'm depressed. My problem is chemical, not professional or social.

    It's a bit like being diabetic, there are certain body functions that simply fail.

  • rate this

    Comment number 239.

    Strange to see areas Britain's uverpopulated and noisiest cities having LESS prescribing,Seems the glories of the beaches of the Fylde coast TOWN don't outweigh the peace of LONDON, BIRMINGHAM,or DERBY!
    Something isn't right with the simple line being offered in this piece!

  • rate this

    Comment number 238.

    222: What rubbish! Atos and Dwp together make it near-impossible to get long-term sickness benefits. Monday's Dispatches showed an Atos trainer telling trainee work capability assessors "As long as [the claimant has] got one finger and [(s)he] can press a button you don't score anything for manual dexterity". The test is extra-hard for mental patients: you will NOT get signed off for stress.

  • rate this

    Comment number 237.


    "...As an NHS psychotherapist..."


    If everyone was happy and rational you'd be out of a job, then?

  • rate this

    Comment number 236.

    As an NHS psychotherapist I am disheartened by the short-term decision making that is applied to mental illness. In the long term, offering patients one or two years of weekly psychotherapy could save money currently spent on medication. The dangerous side-affects of many of these drugs raises ethical issues. They are not designed for long-term use. Secondary illness costs the NHS even more money.

  • rate this

    Comment number 235.


    "...Britain's cities overpopulated and noisiest in Europe..."


    Fine point well made.

    I stepped out at dawn one morning, before the noise started, and I can't explain the effect the sweet sounds of the birdsong had on me.

    It invincibly put me in my place, but in a good way.

  • rate this

    Comment number 234.

    Stats on mental health in this country are appalling, 1 in 4 suffering etc. Governments prefer not to look at causes (check out the economic situation in the worst places) so look to docs to provide a quick fix. Pills are cost effective and put a lid on the situation. Any talking therapy,CBT or counselling etc, costs more and the waiting list ,about 6 months, is
    Expect more of the same.

  • rate this

    Comment number 233.

    NOISE POLLUTION affecting quality of life. residential areas are getting noisier and noisier, due to massive increase in road trafic. Cars built 40% heavier than 20-30 years ago, grind away on our rough road surfaces. The number 1 selling accessory in the motorcycle industry is a loud pipe, usually between 2 and 4 times louder than standard. Britain's cities overpopulated and noisiest in Europe.

  • rate this

    Comment number 232.

    Might this increase in pharmaceuticals be in part because in many areas NHS provision of talking and counselling therapies has virtually disappeared? CBT is offered as a group learning activity, for example, raher than as 6 sessions with a qualified practitioner

  • rate this

    Comment number 231.

    @ Mark Easton: "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."

    What utter rubbish! Doctors prescribe ADs - after consultation - precisely because they KNOW how serious, horrific and life-threatening depression is.

    Jokers take note: 1. ADs are effective. 2. Counselling is usually advised in tandem.

  • rate this

    Comment number 230.

    Is it just me, or do other people who suffer from depression and take anti-depressants find that the results of research such as this make it somewhat more difficult to tell people you are taking mediaction..?

  • rate this

    Comment number 229.

    This article and the way the statistics are being used is totally misleading. Many anti-depressent drugs have many other functions. I like many others have been diagnosed with Amitriptyline because it has a dual function of managing chronic pain. Admittedly, I was most cynical, but they have helped the pain considerably.

  • rate this

    Comment number 228.

    Not all antidepressant use is for depression.

    I take a daily dose of 25mg of amitriptyline, a vanishingly small dose. This is for chronic pain, not depression, and is amazingly effective.

    I am not depressed, nor was I before starting this course, although I hurt a lot. In fact freedom from pain keeps me cheerful and active.

  • rate this

    Comment number 227.

    Who is behind it all? ....Pharmaceutical Oligopolies.
    Modern Farming & Food Processing leaves food nutrient deficient.
    We get 50% of the nutrients our Grandparents did.
    Thus 80% of us have Serotonin Starvation.
    This causes PHYSICAL changes to the brain.
    CBT and Drugs may help, (but best as a combined approach).
    Alternatives to antidepressants DO exist and are possibly more effective.

  • rate this

    Comment number 226.

    Be clear folks, govt has no strategy on mental health. It creates an environment that is so socio-toxic, then pumps a couple of mill into CBT, like that's the answer! It is scandalous, especially while the budget for MH care ( NHS generally, to be fair) is being slashed.
    The NHS is swamped. Utterly. On a shoestring.
    Yet a recent LSE study shows 38% of all morbidity in the UK is mental illness.


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