England April 2015 to September 2020
Quarterly Summary Statistics
Published 10 December 2020
Key findings
19.6 million antidepressant drugs were prescribed between July and September 2020. This was a 2% increase from 19.2 million items in the previous quarter, and a 4% increase from 18.9 million items when compared with the same quarter last year.
Prescribing of drugs for dementia continued to show a downward trend. 1.00 million items of drugs for dementia were prescribed between July and September 2020. This was a 5% decrease from same quarter last year, and over a 3% decrease from 1.04 million items in the previous quarter.
All of the drug groups in this publication have shown greater levels of variation in monthly prescribing since the introduction of measures to tackle the COVID-19 pandemic on 23 March 2020.
All of the drug groups observed a significant decrease in monthly prescribing between July and August 2020, which has not been typically observed in previous years.
1. Introduction
Mental health is a key area of the NHS Long Term Plan published in 2019.
This publication aims to describe the prescribing of medicines used to improve mental health, in a primary care setting in England that are subsequently dispensed in the community. They do not include data on medicines used in secondary care, prisons, or issued by a private prescriber.
These statistics use the BNF therapeutic classifications defined in the British National Formulary (BNF) using the classification system prior to BNF edition 70. Each January the NHSBSA updates the classification of drugs within the BNF hierarchy which may involve some drugs changing classification between years of data. Five sections of the British National Formulary (BNF) are covered within these statistics:
- Hypnotics and anxiolytics
- Drugs used in psychoses and related disorders
- Antidepressant drugs
- CNS stimulants and drugs used for ADHD
- Drugs for dementia
These medicines are classified by their primary therapeutic indication. However, it is possible that they can be prescribed for other reasons outside of this primary therapeutic indication. For example, some antidepressants can be used to treat people suffering from chronic primary pain. The clinical indication of a prescription is not captured by NHSBSA during processing, and therefore we cannot determine the reason that a prescription was issued. Drug therapy is just one way that mental health conditions can be treated. These statistics do not give an indication of the number of patients accessing other mental health services, such as therapy. Due to this, these statistics may not give an accurate estimation of the population receiving treatment for a specific mental health condition.
Throughout this publication the term ‘item’, short for ‘prescription item’, means a single instance of a drug that is listed as a separate entry on a prescription form. For example, Fluoxetine 20mg tablets x56.
There are many costs incurred when a dispensing contractor fulfils a prescription, such as the single activity fee or controlled drug fees. The costs reported in this publication represent the basic price of the item and the quantity prescribed. This is sometimes called the ‘Net Ingredient Cost’ (NIC). The basic price is given either in the Drug Tariff or is determined from prices published by manufacturers, wholesalers or suppliers. Basic price is set out in Parts VIII and IX of the Drug Tariff. For any drugs not in Part VIII, the price is usually taken from the manufacturer, wholesaler or supplier of the product.
Due to the implementation of lockdown measures on 23 March 2020 following the COVID-19 outbreak, this publication also includes analysis on prescribing figures observing the months following lockdown. It is important to note that these statistics can not infer causality of lockdown measures on the prescribing figures.
This publication presents data from April 2015 to September 2020.
References to quarters in these statistics are:
- Q1 refers to the first quarter (April to June) of the given financial year. For example, Q1 2015/16 refers to the period April 2015 to June 2015.
- Q2 refers to the second quarter (July to September) of the given financial year. For example, Q2 2015/16 refers to the period July 2015 to September 2015.
- Q3 refers to the third quarter (October to December) of the given financial year. For example, Q3 2015/16 refers to the period October 2015 to December 2015.
- Q4 refers to the fourth quarter (January to March) of the given financial year. For example, Q4 2015/16 refers to the period January 2016 to March 2016.
You can go to the annual Medicines Used in Mental Health - England webpage to find the most recent annual summary, background information, and explanatory notes that apply to the statistics presented in this release.
Patient identification
When the NHSBSA processes prescriptions, the NHS number of the patient is identified for most, but not all, prescriptions. The proportion of items for which a patient could be identified is shown in table 1. This means that data relating to patient counts represents most, but not all, patients.
In this release the term ‘patient/s’ is used to mean a unique, valid NHS number that has been captured from a prescription form and subsequently verified by the NHS Personal Demographics Service (PDS).
Table 1: The proportion of items for which an NHS number was recorded for listed BNF sections 2020/2021
2. Results and commentary
The charts in this report are interactive and allow you to isolate the topics that you are interested in by selecting or deselecting a series from the legend of the chart. For example, if you only want to view a single series on a chart, you can click the series names you are not interested in in the legend of the chart to deselect them. If you wish to include them again just click their legend entry again.
Hypnotics and anxiolytics
Hypnotics are used to treat insomnia - a difficulty getting to sleep or staying asleep long enough to feel refreshed. Most hypnotics will sedate if given during the day. Anxiolytics are used in the treatment of anxiety states and if given at night will help to induce sleep. The drugs classified as hypnotics and anxiolytics are described in the BNF 68 section 4.1:
- BNF paragraph 4.1.1 - Hypnotics
- BNF paragraph 4.1.2 - Anxiolytics
- BNF paragraph 4.1.3 - Barbiturates
Source: Quarterly Summary Tables - Quarterly table
3.54 million hypnotics and anxiolytics items were prescribed during the second quarter of financial year 2020/21. This was a 3.26% decrease from 3.66 million items compared with the same quarter a year ago, and a 0.49% decrease from 3.56 million items in the previous quarter. This continues the long-term trend for hypnotics and anxiolytics which have been steadily declining in usage since 2015. This has resulted in 464,000 fewer items per quarter since Q2 2015/16, a decrease of 10.0%.
1.05 million patients were prescribed at least one hypnotic and anxiolytic item in the second quarter of 2020/21. This was a 5.84% decrease from 1.12 million patients compared with the same quarter a year ago, but a 0.49% increase from 1.045 million patients in the previous quarter. The long-term trends for patients receiving one or more hypnotic and anxiolytic items match that for prescribed items, resulting in 166 thousand fewer patients per quarter since Q2 2015/16, a decrease of 13.9%.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for hypnotics and anxiolytics show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for a 10.1% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between July and August of 9.90% from 1.23 million to 1.11 million items, which is not usually observed at this time of the year.
Prescribing during the COVID-19 pandemic
A national lockdown was implemented on 23 March 2020 until 4 July 2020. There were 8.33 million hypnotic and anxiolytic items prescribed in the 7 months March to September 2020. This was a 2.32% decrease from the 8.53 million items prescribed when compared with the same 7 months in 2019.
As patients can appear in more than one month of data adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one hypnotic and anxiolytic item in the 7 months March to September 2020 was 689 thousand. This was a decrease of 1.75% from an average of 701 thousand patients when compared with the same 7 month period in 2019.
This is consistent with the long-term trend for hypnotics and anxiolytics, which have been decreasing in usage since April 2015.
Antidepressant drugs
Antidepressant drugs are effective for treating moderate to severe depression. Antidepressant drugs are not generally advised for the routine treatment of mild depression, and psychological therapy should be considered initially. However, a trial of antidepressant therapy may be considered in cases resistant to psychological treatments or associated with other problems.
Antidepressant drugs are described in the BNF 68 section 4.3:
- BNF paragraph 4.3.1 - Tricyclic and related antidepressant drugs
- BNF paragraph 4.3.2 - Monoamine-oxidase inhibitors (maois)
- BNF paragraph 4.3.3 - Selective serotonin re-uptake inhibitors (SSRIs)
- BNF paragraph 4.3.4 - Other antidepressant drugs
Source: Quarterly Summary Tables - Quarterly table
19.6 million antidepressant drugs items were prescribed in the second quarter of financial year 2020/21. This was a 3.77% increase from 18.9 million items compared with the same quarter a year ago, and a 1.84% increase from 19.2 million items in the previous quarter. Antidepressant drugs have been steadily increasing in usage since 2015, with an increase of 4.22 million items per quarter from Q2 2015/16 to Q2 2020/21, an increase of 29.9%.
6.01 million patients were prescribed at least one antidepressant drug item in Q2 2020/21. This was a 3.49% increase from 5.80 million patients when compared with the same quarter in 2019/12, and a 2.17% increase from 5.88 million patients in the previous quarter. The long-term trends for patients receiving antidepressant drugs match that of the overall prescribing of items, with an increase of 1.15 million patients per quarter since Q2 2015/16, an increase of 24.0%.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for antidepressant drugs show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for a 9.02% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between July and August of 9.30% from 6.77 million to 6.15 million items, which is not usually observed at this time of the year.
Prescribing during the COVID-19 lockdown
A national lockdown was implemented on 23 March 2020. There were 45.6 million antidepressant drugs prescribed in the 7 months March to September 2020. This was a 4.81% increase from 43.5 million items prescribed when compared with the same 7 months in 2019.
As patients can appear in more than one month of data adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one antidepressant item in the 7 months March to September 2020 was 4.17 million. This was an increase of 5.73% from an average of 3.95 million patients when compared with the same 7 month period in 2019.
This is consistent with the long-term trend for antidepressant drugs, which have steadily increased in monthly usage since April 2015.
Central nervous system stimulants and drugs used for attention deficit hyperactivity disorder
CNS stimulants and drugs used for ADHD are described in the BNF 68 section 4.4:
- BNF chemical substance 0404000D0 - Caffeine
- BNF chemical substance 0404000E0 - Caffeine citrate
- BNF chemical substance 0404000L0 - Dexamfetamine sulfate
- BNF chemical substance 0404000M0 - Methylphenidate hydrochloride
- BNF chemical substance 0404000R0 - Modafinil
- BNF chemical substance 0404000S0 - Atomoxetine hydrochloride
- BNF chemical substance 0404000T0 - Dexmethylphenidate hydrochloride
- BNF chemical substance 0404000U0 - Lisdexamfetamine dimesylate
- BNF chemical substance 0404000V0 - Guanfacine
- BNF chemical substance 0404000W0 - Pitolisant hydrochloride
Source: Quarterly Summary Tables - Quarterly table
440 thousand CNS stimulants and drugs used for ADHD were prescribed in the second quarter of financial year 2020/21. This was a 2.09% increase from 431 thousand items compared with the same quarter a year ago, and a 2.86% increase from 428 thousand items in the previous quarter.
121 thousand patients were prescribed at least one CNS stimulant and drugs used for ADHD item in Q2 2020/21. This was a 5.24% increase from 115 thousand patients compared with the same quarter a year ago, and a 2.91% increase from 118 thousand patients in the previous quarter.
These increases in the numbers of items prescribed and patients is consistent with the long-term trends for CNS stimulants and drugs used for ADHD following a sharp decrease in Q1 2020/21.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for CNS stimulants and drugs used in ADHD show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for an 8.11% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between July and August of 9.34% from 149 thousand to 135 thousand items, which is not usually observed at this time of the year.
Prescribing during the COVID-19 lockdown
A national lockdown was implemented on 23 March 2020. There were 1.04 million CNS stimulants and drugs used for ADHD prescribed in the 7 months March to September 2020. This was a 2.51% increase from 1.01 million items prescribed when compared with the same 7 months in 2019.
As patients can appear in more than one month of data adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one CNS stimulant and drugs used in ADHD item in the 7 months March to September 2020 was 85 thousand. This was an increase of 8.69% from an average of 79 thousand patients when compared with the same 7 month period in 2019.
Following a peak of prescribing in March 2020 the levels of prescribing for CNS stimulants and drugs used in ADHD have remained lower than March 2020, despite upward trend present before March 2020.
Drugs for dementia
Dementia is a progressive clinical syndrome characterised by a range of cognitive and behavioural symptoms that can include memory loss, problems with reasoning and communication, a change in personality, and a reduced ability to carry out daily activities such as washing or dressing. Alzheimer’s disease is the most common type of dementia; other common types of dementia include vascular dementia (where dementia is due to cerebrovascular disease), dementia with Lewy bodies (where dementia is due to protein deposits in the brain), mixed dementia, and frontotemporal dementia (where dementia is due to progressive nerve loss in either the frontal or temporal lobes of the brain).
Drugs for dementia are described in the BNF 68 section 4.11:
- BNF chemical substance 0411000D0 - Donepezil hydrochloride
- BNF chemical substance 0411000E0 - Rivastigmine
- BNF chemical substance 0411000F0 - Galantamine
- BNF chemical substance 0411000G0 - Memantine hydrochloride
Source: Quarterly Summary Tables - Quarterly table
1.00 million drugs for dementia were prescribed in the second quarter of financial year 2020/21. This was a 4.90% decrease from 1.06 million items compared with the same quarter a year ago, and a 3.29% decrease from 1.04 million items in the previous quarter.
224 thousand patients were prescribed at least one drugs for dementia item in Q2 2020/21. This was a 3.27% decrease from 231 thousand patients compared with the same quarter a year ago, and a 3.17% decrease from 231 thousand patients in the previous quarter.
Drugs for dementia have experienced 3 consecutive quarters of decreases in the numbers of items prescribed and patients following a peak in Q3 2019/20. Typically, the pattern of prescribing follows a decrease between quarter 3 and 4, followed by three consecutive increases from quarter 4 to quarter 3 of the next year.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for drugs used in dementia show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
The largest monthly decrease is usually observed from January to February, which in 2020 accounted for a 9.18% decrease in prescribed items. In 2020 there was also a significant decrease in the number of items prescribed between July and August of 7.98% from 348 thousand to 320 thousand items, which is not usually observed at this time of the year.
Prescribing during the COVID-19 lockdown
A national lockdown was implemented on 23 March 2020. There were 2.39 million drugs for dementia prescribed in the 7 months March to September 2020. This was a 1.10% decrease from 2.42 million items prescribed when compared with the same 7 months in 2019.
As patients can appear in more than one month of data adding the patients for different months together would result in an inaccurate estimate of the number of unique patients that have received prescribing in this period. Therefore, we have calculated the mean average number of patients for comparison purposes. This average is calculated by summing the number patients for the periods in question and dividing that by the number of months in the period.
The monthly average number of patients receiving at least one drug for dementia in the 7 months March to September 2020 was 189 thousand. This was an increase of 0.79% from an average of 187 thousand patients when compared with the same 7 month period in 2019.
This increase in the number of patients and decrease in prescribed items of drugs for dementia may be due to changes in prescribing habits to help protect patients during the COVID-19 pandemic, issuing prescriptions for longer lengths of time due to shielding measures.
Since April 2020 the levels of prescribing for drugs for dementia show a small downward trend, following an upward trend between April 2015 and March 2020. This may be in response to lockdown and shielding measures that are in place to protect the elderly, who are more likely to receive a prescription for a drug for dementia.
3. Background
Hypnotics and anxiolytics
Hypnotics and anxiolytics are used to treat insomnia and anxiety respectively.
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the morning, despite there being enough opportunity to sleep. The most common problem with insomnia is difficult falling asleep (sleep-onset insomnia). An insomniac may also experience:
- waking in the night
- not feeling refreshed after sleep and not being able to function normally during the day
- feeling irritable and tired and finding it difficult to concentrate
- waking when they have been disturbed from sleep by pain or noise
- waking early in the morning
Anxiety is a feeling of unease, such as worry or fear, which can be mild or severe. Everyone experiences feelings of anxiety at some point in their life and feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life. There are several conditions for which anxiety is the main symptom. Panic disorder, phobias and post-traumatic stress disorder can all cause severe anxiety.
You can find more information about insomnia and anxiety from the NHS website.
Antidepressant drugs
Antidepressant drugs are licensed to treat major depression. Health professionals use the words depression, depressive illness or clinical depression to refer to depression. It is a serious illness and very different from the common experience of feeling unhappy or fed up for a short period of time. Depressed people may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with daily life, and can last for weeks, months or years, rather than days.
It should be noted that antidepressant drugs are used for indications other than depression. For example, migraine, chronic pain, myalgic encephalomyelitis (ME) and a range of other conditions. Therefore, the statistics on these drugs do not relate solely to prescribing for depression.
You can find more information about depression on the NHS website.
Central nervous system stimulants and drugs used for ADHD
Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) refer to a range of problem behaviours associated with poor attention span. These may include impulsiveness and hyperactivity, as well as inattentiveness; behaviours that often prevent children and adults from learning and socialising. ADHD is sometimes referred to as hyperkinetic disorder (HD).
You can find more information about ADHD on the NHS website.
Drugs for dementia
Dementia is a disease that leads to progressive loss of brain function typified by memory loss, confusion, speech difficulties and problems in understanding. There are over 100 different types of dementia. The most common forms are:
- Alzheimer’s disease
- Vascular dementia
- Dementia with Lewy bodies
- Pick’s disease
- Huntington’s disease
- Alcohol-related dementia
- HIV/AIDS related dementia
Dementia mainly affects older people but can also occur in people as young as thirty due to either alcohol abuse or HIV/AIDS. No cure for dementia currently exists. However, drugs may slow the rate of decline or in some patients make a small improvement in symptoms. Despite this, disease progression is inevitable.
You can find more information about the various types of dementia on the NHS website.
4. About these statistics
This quarterly summary is intended to supplement the relevant annual summary statistics released alongside it and can be used in conjunction with previous quarterly summaries.
Patient counts
The patient counts shown in these statistics should only be analysed at the level at which they are presented. Adding together any patient counts is likely to result in an overestimate of the number of patients. A person will be included, or counted, in each category or time period in which they received relevant prescriptions. For example, if a patient received a prescription item for an antidepressant drug in Q1 2020/21, and another in Q2 2020/21 then adding together those totals would count that patient twice. For the same reason, data on patient counts for different BNF sections should not be added together.
Averages
The averages used in this release all use the mean unless otherwise stated.
Planned changes to this publication
This is an experimental official statistic release. Experimental statistics are newly developed or innovative statistics. These are published so that users and stakeholders can be involved in the assessment of their suitability and quality at an early stage. We will regularly be reviewing the methodology used within the statistics.
We will be introducing measures relating to defined daily doses (DDDs) in a future release to allow for easier international comparisons.
5. Statistical disclosure control
Statistical disclosure control has been applied to these statistics. Patient count, items, and net ingredient cost (NIC) have been redacted in the supporting summary tables if they relate to fewer than 5 patients. Further information about our statistical disclosure control protocol can be found on our website.
The high level figures in this statistical summary have been rounded where appropriate for clarity, in most cases to three significant figures. This is to make this narrative as accessible as possible to all readers. The summary tables released with this publication allow users to investigate this data at lower levels of granularity. Figures in the supplementary tables have not been rounded.
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