Medicines Used in Mental Health

England 2015/16 to 2020/21

Published 8 July 2021

Key findings

• there were 79.4 million antidepressant drug items prescribed to 7.87 million identified patients in 2020/21. The number of antidepressant items issued and the number of patients receiving antidepressant drugs increased for the fifth consecutive year. However, the rates of increase between 2019/20 and 2020/21 were less than in previous years.

• in 2020/21, 4.05 million drugs for dementia items were prescribed to 275,000 patients. This was a decrease from 2019/20 following 4 consecutive years of increases in the number of items prescribed and the number of identified patients.

• of the 5 drug groups analysed in this publication, 4 had a larger proportion of identified patients that were female. The exception to this is CNS stimulants and drugs used for ADHD, which had almost 3 times as many males receiving prescribing than females.

• all 5 groups of drugs were prescribed more often to patients living in more deprived areas of England. The largest disparity was for drugs used in psychoses and related disorders, which saw 163% more patients receiving prescribing from practices in the most deprived areas of the country compared to the least deprived.

• in 2020/21, the most common age group to receive prescribing for 3 of the 5 drug groups was 50 to 54. The exceptions to this were CNS stimulants and drugs used for ADHD and drugs for dementia. The most popular age group for CNS stimulants and drugs used for ADHD was 10 to 14, while the most popular age group for drugs for dementia was 80 to 84.

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1. Introduction

1.1. Scope

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 England, that are subsequently dispensed in the community in England, Scotland, Wales, Isle of Man or the Channel Islands by a pharmacy, appliance contractor, dispensing doctor, or has been personally administered by a GP practice. They do not include data on medicines used in secondary care, prisons, or issued by a private prescriber.

These statistics detail:

• the total number of prescription items issued for medicines used to improve mental health
• the number identified patients that have that have received prescribing of these medicines
• demographic breakdowns of prescribing by age group
• demographic breakdowns by sex
• demographic breakdowns by a measure of deprivation.

The costs associated with the provision of these medicines are not discussed in this summary. However, they are available within the supporting summary tables that accompany this release.

A quarterly summary is also released alongside these statistics that provides high level monthly and quarterly trends for medicines used to improve mental health in England, as well as exploring the impacts of the COVID-19 pandemic.

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
• central nervous system (CNS) stimulants and drugs used for attention deficit hyperactivity disorder (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 the NHSBSA during processing, and therefore we cannot determine the reason that a prescription was issued. Due to this, these statistics may not give an accurate estimation of the population receiving treatment for a specific mental health condition.

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.

1.2. Definitions

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 tables x56.

There are many costs incurred when a dispensing contractor fulfils a prescription. 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.

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). Across 2020/21, use of the Electronic Prescription Service (EPS) has increased considerably during the COVID-19 pandemic. As this process captures NHS numbers digitally rather than through scanned paper forms, this has naturally led to an increase in the proportions of identified patients in 2020/21 than seen in previous years.

Where patients are identified, to assign them to a single age band their age is calculated on the 30 September of the given financial year. For patients where date of birth has not been captured, they have been included in an unknown category.

Sex information was not available from PDS for a small number of patients in each year, typically fewer than 100. This may be because it was not disclosed by the patient or not recorded by the organisation that collected the data. These patients have been omitted from the respective figures but can be found in the Statistical Summary Tables for the respective BNF Chapter.

1.3. 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.

These statistics do not contain any personally identifiable data. More details on the statistical disclosure control applied to these statistics is available in section 5 of this summary. More information about how the NHSBSA protects personal information can be found in the statement on confidentiality and access.

Table 1: The proportion of items for which an NHS number was recorded for listed BNF sections

Source: Statistical summary tables - patient identification rates

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2. Results and commentary

2.1. Antidepressants

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

More information about these medicines can be found in section 3 of this summary.

Source: Statistical summary tables - Antidepressant drugs

There were 79.4 million antidepressant items prescribed in 2020/21. This was a 28.3% increase from 61.9 million items in 2015/16, and a 4.04% increase from 76.3 million items in 2019/20. Since 2015/16, other antidepressant drugs usage has increased by 52.8% from 12.5 million items to 19.1 million in 2020/21. This is the largest percentage increase of all the groups of antidepressant drugs. Selective serotonin re-uptake inhibitors (SSRIs) have also seen a large increase in usage since 2015/16, increasing by 28.6% from 33.3 million items to 42.8 million in 2020/21. Although prescribing volumes for monoamine-oxidase inhibitors (MAOIs) are already quite low, they have decreased by 58.3% since 2015/16 from 47,900 items per year to 19,900 in 2020/21.

Source: Statistical summary tables - Antidepressant drugs

In 2020/21, 7.87 million patients received at least one prescription item for antidepressant drugs. This was an increase of 15.0% from 6.84 million patients in 2015/16, and a 1.00% increase from 7.79 million patients in the previous financial year. The long term trends for both identified patients and prescribed items are increasing. Other antidepressant drugs have seen the largest percentage increase since 2015/16 of 41.0% from 1.21 million identified patients to 1.70 million in 2020/21. SSRIs have also seen a large increase in the number patients receiving prescribing since 2015/16 of 16.6% from 4.24 million identified patients to 4.94 million in 2020/21.

Patients receiving Tricyclic and related antidepressant drugs were the only group to show a different trend to prescribed items, with the number of identified patients decreasing between 2015/16 and 2020/21 by 0.50% from 2.30 million to 2.29 million.

The total identified patients for all reported antidepressant drugs is lower than the total identified patients for individual groups of drugs. This is because any patient who received medicines from more than one BNF paragraph are counted in the subtotal for relevant paragraph. However, these patients have only been counted once when looking at BNF section totals.

Source: Statistical summary tables - Antidepressant drugs

In 2020/21, 65.9% of identified patients that received an antidepressant item were female compared to 34.1% who were male. This equates to 5.18 million female identified patients and 2.68 million male. These proportions have stayed broadly the same since 2015/16, which had the highest proportion of female patients in the period with 66.0%. Financial year 2019/20 had the lowest proportion of female patients in the period of 65.6%.

Source: Statistical summary tables - Antidepressant drugs

The most common age group to receive prescribing for antidepressant drugs in 2020/21 was 50 to 54. 795,000 identified patients aged 50 to 54 received at least one antidepressant drug item in 2020/21, this was 10.1% of all patients. The next most common age groups were 55 to 59 with 764,000 and 9.72% of identified patients, and 45 to 49 with 708,000 and 9.00% of identified patients.

2.1.1. Prescribing in adults and children

There is a keen interest in the prescribing of antidepressant drugs in children. Children are classed as patients aged 17 and under at 30 September for the given financial year.

Table 2: Number of child and adult patients - BNF 4.3: Antidepressant drugs (millions of patients)

Source: Statistical summary tables - Antidepressant drugs

There were 65,300 identified patients aged 17 and under who received at least one antidepressant prescription item in 2020/21. This was the lowest number of children receiving antidepressant drugs in the period and accounted for 0.89% of all identified patients. This was also a 5.13% decrease in the number of identified patients aged 17 and under when compared with 2019/20.

Source: Statistical summary tables - Antidepressant drugs

In 2020/21, 1.21 million patients were prescribed antidepressant drugs from practices in the most deprived areas in England. This was 119% more than the 550,000 patients that received prescribing for antidepressants from practices in the least deprived areas. In general, more people were prescribed antidepressant drugs from practices in more deprived areas in 2020/21.

The English Indices of Deprivation have been used to provide a measure of patient deprivation. The deprivation deciles reported are those of the prescribing practice that a patient has received a prescription item from. More information on this measure can be found in section 4 of this summary.

2.2. 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

More information about these medicines can be found in section 3 of this summary.

Source: Statistical summary tables - Hypnotics and anxiolytics

There were 14.3 million hypnotic and anxiolytic items prescribed in 2020/21. This was a 10.3% decrease from 15.9 million items in 2015/16, and a 2.27% decrease from 14.6 million in 2019/20. Since 2015/16, prescribing of hypnotics, anxiolytics, and barbiturates have decreased. Prescribing of:

• hypnotics decreased by 10.1% from 9.17 million items in 2015/16 to 8.25 million in 2020/21

• anxiolytics decreased by 10.5% from 6.77 million items in 2015/16 to 6.06 million in 2020/21

• barbiturates decreased by 65.5% from 5,510 items in 2015/16 to 1,900 items in 2020/21.

Source: Statistical summary tables - Hypnotics and anxiolytics

In 2020/21, 1.97 million identified patients received at least one prescription item for hypnotics and anxiolytics. This was a decrease of 17.2% from 2.38 million identified patients in 2015/16, and a 7.19% decrease from 2.12 million identified patients in the previous financial year. The number of identified patients prescribed anxiolytics has decreased at a sharper rate than for hypnotics.

The number of identified patients prescribed at least one:

• anxiolytic item have decreased from 1.30 million in 2015/16 to 1.02 million in 2020/21, a decrease of 21.1%

• hypnotic item have decreased by 13.3%, from 1.30 million in 2015/16 to to 1.13 million in 2020/21

• barbiturate item have decreased by 63.6%, from 332 identified patients in 2015/16 to 121 in 2020/21.

However, note that the proportion of patients that could be identified differed between 2015/16 and 2020/21, and that these changes are only indicative of changes in numbers of all patients.

The total identified patients for all reported hypnotics and anxiolytics drugs is lower than the total identified patients for individual groups of drugs. This is because any patient who received medicines from more than one BNF paragraph are counted in the subtotal for the relevant paragraph. However, these patients have only been counted once when looking at BNF section totals.

Source: Statistical summary tables - Hypnotics and anxiolytics

In 2020/21, 61.3% of identified patients that received a hypnotic and anxiolytic item were female, compared to 38.7% who were male. This equates to 1.21 million female identified patients and 763,000 male identified patients. In comparison, in 2015/16, 61.8% of identified patients that received a hypnotic and anxiolytic item were female compared to 38.2% who were female. This equated to 1.47 million female identified patients and 908,000 who were male. These proportions have stayed broadly the same since 2015/16, which had the highest proportion of female patients in the period.

Source: Statistical summary tables - Hypnotics and anxiolytics

The most common age group to receive prescribing for hypnotics and anxiolytics in 2020/21 was 50 to 54. 173,000 identified patients aged 50 to 54 received at least one hypnotics and anxiolytics item in 2020/21, this was 8.75% of all patients. The next most common age groups were 55 to 59 with 166,000 and 8.43% of identified patients, and 45 to 49 with 158,000 and 8.02% of identified patients.

The number of identified patients who received prescribing for hypnotics and anxiolytics has been decreasing since 2015/16 for most age groups. The exceptions are for age groups 5 to 9 and 10 to 14, where the combined total has increased by 78.9% from 41,900 in 2015/16 to 75,000 in 2020/21.

This increase is also reflected in the number of items that were prescribed to 5 to 14 years old identified patients: the number of items prescribed to 5 to 14 years old identified patients increased from 258,000 items in 2015/16 to 515,000 items in 2020/21, an increase of 99.7%.

Note when interpreting these results that the proportion of patients that could be identified differed between years, and demographics might also have changed.

Source: Statistical summary tables - Hypnotics and anxiolytics

In 2020/21, 259,000 patients were prescribed a hypnotics and anxiolytics item from practices in the most deprived areas in England. This was 67.8% more than the 154,000 patients that received prescribing for hypnotics and anxiolytics from practices in the least deprived areas. In general, more people were prescribed hypnotics and anxiolytics from practices in more deprived areas in 2020/21.

The English Indices of Deprivation have been used to provide a measure of patient deprivation. The deprivation deciles reported are those of the prescribing practice that a patient has received a prescription item from. More information on this measure can be found in section 4 of this summary.

2.3. Antipsychotics

Drugs used in psychoses and related disorders, also known as antipsychotics, these drugs are used to treat psychoses and related disorders. These drugs are classified and described under the BNF 68 section 4.2:

• BNF paragraph 4.2.1 - Antipsychotic drugs
• BNF paragraph 4.2.2 - Antipsychotic depot injections
• BNF paragraph 4.2.3 - Drugs for mania and hypomania

More information about these medicines can be found in section 3 of this summary.

Source: Statistical summary tables - Drugs used in psychoses and related disorders

There were 13.0 million antipsychotics items prescribed in 2020/21. This was an 18.0% increase from 11.0 million items in 2015/16, and a 3.23% increase from 12.6 million items in 2019/20. Antipsychotic drugs items increased by 22.2% between 2015/16 and 2020/21, from 9.39 million items to 11.5 million. Both antipsychotic depot injections and drugs used for mania and hypomania decreased in usage between 2015/16 and 2020/21. The number of antipsychotic depot injections items decreased by 19.1% from 155,000 to 125,000, while drugs used for mania and hypomania decreased by 4.36% from 1.49 million to 1.43 million.

Source: Statistical summary tables - Drugs used in psychoses and related disorders

In 2020/21, 847,000 identified patients received at least one prescription item for antipsychotics. This was an increase of 19.5% from 709,000 patients in 2015/16, and a 6.19% increase from 798,000 identified patients in the previous financial year. The long term trends for identified patients are broadly similar to those of prescribed items. In 2020/21, 805,000 identified patients received at least one antipsychotic drugs item, an increase of 22.1% from 659,000 in 2015/16.

Antipsychotic depot injections and drugs used for mania and hypomania also saw decreases in the number of identified patients between 2015/16 and 2020/21. 13,700 identified patients received at least one antipsychotic depot injection item in 2020/21, a 24.6% decrease from 18,100 in 2015/16. In 2020/21, 74,800 identified patients received at least one drugs used for mania and hypomania item, an 11.0% decrease from 84,100 in 2015/16.

The total identified patients for all reported antipsychotic drugs is lower than the total identified patients for individual groups of drugs.This is because any patient who received medicines from more than one BNF paragraph are counted in the subtotal for the relevant paragraph. However, these patients have only been counted once when looking at BNF section totals.

Source: Statistical summary tables - Drugs used in psychoses and related disorders

In 2020/21, 53.6% of identified patients that received an antipsychotic item where female, compared to 46.3% who were male. This equates to 455,000 female identified patients and 393,000 male. The proportion of female identified patients increased by 1.17% between 2015/16 and 2020/21, with a corresponding decrease in male identified patients.

Please note, the proportions of male and female patients for antipsychotics do not add up to 100%, this is because a very small number of patients are classified as having an ‘Unknown’ sex. These patients are not represented in the chart but can be found in the relevant supporting summary table.

Source: Statistical summary tables - Drugs used in psychoses and related disorders

The most common age group to receive prescribing for antipsychotics in 2020/21 was 50 to 54. 72,700 identified patients aged 50 to 54 received at least one antipsychotic item in 2020/21, this was 8.58% of all patients. The next most common age groups were 55 to 59 with 71,000 and 8.38% of identified patients, and 45 to 49 with 67,500 and 7.96% of identified patients.

Source: Statistical summary tables - Drugs used in psychoses and related disorders

In 2020/21, 141,000 patients were prescribed antipsychotic items from practices in the most deprived areas in England. This was 163% more than the 53,700 patients that received prescribing for antipsychotic items from practices in the least deprived areas. In general, more people were prescribed antipsychotics from practices in more deprived areas in 2020/21.

The English Indices of Deprivation have been used to provide a measure of patient deprivation. The deprivation deciles reported are those of the prescribing practice that a patient has received a prescription item from. More information on this measure can be found in section 4 of this summary.

2.4. CNS stimulants and drugs used for ADHD

Central nervous system stimulants and drugs used for attention deficit hyperactivity disorder 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

More information about these medicines can be found in section 3 of this summary.

Source: Statistical summary tables - CNS stimulants and drugs used for ADHD

There were 1.83 million CNS stimulants and drugs used for ADHD items prescribed in 2020/21. This was a 40.3% increase from 1.31 million items in 2015/16, and a 1.85% increase from 1.80 million items in 2019/20. The BNF section 4.4 - CNS stimulants and drugs used for ADHD only contains one BNF paragraph and many chemical substances, therefore no further breakdowns of this section have been provided as part of this narrative. However, these breakdowns are available from the relevant supporting summary table.

Source: Statistical summary tables - CNS stimulants and drugs used for ADHD

In 2020/21, 162,000 identified patients received at least one prescription item for CNS stimulants and drugs used for ADHD. This was an increase of 52.6% from 106,000 identified patients in 2015/16, and a 5.59% increase from 153,000 identified patients in the previous financial year.

The BNF section 4.4 - CNS stimulants and drugs used for ADHD only contains one BNF paragraph and many chemical substances, therefore no further breakdowns of this section have been provided as part of this narrative. However, these breakdowns are available from the relevant supporting summary table.

Source: Statistical summary tables - CNS stimulants and drugs used for ADHD

In 2020/21, 72.2% of identified patients that received a CNS stimulant and drugs used for ADHD item were male, compared to 27.8% who were female. This equates to 117,000 male identified patients and 44,900 female. Between 2015/16 and 2020/21, the proportion of identified patients that were male decreased 3.70%, with a corresponding increase in the proportion of female patients.

Source: Statistical summary tables - CNS stimulants and drugs used for ADHD

The most common age group to receive prescribing for CNS stimulants and drugs used for ADHD in 2020/21 was 10 to 14. 48,100 identified patients aged 10 to 14 received at least one CNS stimulant and drugs used for ADHD item in 2020/21, this was 29.8% of all patients. The next most common age groups were 15 to 19 with 32,500 and 20.1% of identified patients, and 05 to 09 with 18,100 and 11.2% of identified patients.

Source: Statistical summary tables - CNS stimulants and drugs used for ADHD

In 2020/21, 23,700 patients were prescribed CNS stimulants and drugs used for ADHD from practices in the most deprived areas in England. This was 84.1% more than the 12,900 patients that received prescribing for CNS stimulants and drugs used for ADHD from practices in the least deprived areas. In general, more people were prescribed CNS stimulants and drugs used for ADHD from practices in more deprived areas in 2020/21.

The English Indices of Deprivation have been used to provide a measure of patient deprivation. The deprivation deciles reported are those of the prescribing practice that a patient has received a prescription item from. More information on this measure can be found in section 4 of this summary.

2.5. 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

More information about these medicines can be found in section 3 of this summary.

Source: Statistical summary tables - Drugs for dementia

There were 4.05 million drugs for dementia items prescribed in 2020/21. This was a 18.9% increase from 3.41 million items in 2015/16, but a 3.93% decrease from 4.21 million items in 2019/20. Since 2015/16, Memantine hydrochloride items have increased by 82.5% from 828,000 to 1.51 million in 2020/21. 2.00 million donepezil hydrochloride items were prescribed in 2020/21. This was a 1.15% increase from 1.98 million items in 2015/16, and a 6.94% decrease from 2.15 million items in 2019/20.

Source: Statistical summary tables - Drugs for dementia

In 2020/21, 275,000 identified patients received at least one prescription item for drugs for dementia. This was an increase of 19.2% from 231,000 identified patients in 2015/16, and a 1.41% decrease from 279,000 identified patients in the previous financial year. The long term trends for identified patients are broadly similar to those of prescribed items. Memantine hydrochloride has seen the largest percentage increase in the number of identified patients since 2015/16 of 77.5%, from 67,400 to 120,000 in 2020/21.

The total identified patients for all reported drugs for dementia is lower than the total identified patients for individual groups of drugs. This is because any patient who received medicines from more than one BNF chemical substance are counted in the subtotal for the relevant chemical substance. However, these patients have only been counted once when looking at BNF section totals.

Source: Statistical summary tables - Drugs for dementia

In 2020/21, 61.3% of identified patients that received a drugs for dementia item were female, compared to 38.7% who were male. This equates to 169,000 female identified patients and 107,000 male. These proportions have stayed broadly the same since 2015/16, which had the highest proportion of female patients in the period with 62.2%. Financial year 2019/20 had the lowest proportion of female patients in the period of 61.2%.

Source: Statistical summary tables - Drugs for dementia

The most common age group to receive prescribing for drugs for dementia in 2020/21 was 80 to 84. 69,100 identified patients aged 80 to 84 received at least one drugs for dementia item in 2020/21, this was 25.1% of all patients. The next most common age groups were 85 to 89 with 68,800 and 25.0% of identified patients, and 75 to 79 with 48,000 and 17.4% of identified patients.

Source: Statistical summary tables - Drugs for dementia

In 2020/21, 38,000 patients were prescribed drugs for dementia from practices in the most deprived areas in England. This was 43.2% more than the 26,600 patients that received prescribing for drugs for dementia from practices in the least deprived areas. In general, more people were prescribed drugs for dementia from practices in more deprived areas in 2020/21.

The English Indices of Deprivation have been used to provide a measure of patient deprivation. The deprivation deciles reported are those of the prescribing practice that a patient has received a prescription item from. More information on this measure can be found in section 4 of this summary.

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3. Background

3.1. 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), or a range of other conditions. Clinical indication isn’t captured by the NHSBSA. 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.

3.2. 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 in 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.

3.3. Drugs used in psychoses and related disorders

People experiencing psychoses may report hallucinations (seeing or hearing things that other people cannot see or hear) or delusional beliefs (believing things that are not actually true), and may exhibit personality changes and thought disorder. In addition, they may experience difficulty with social interaction and impairment in carrying out daily life activities.

You can find more information about psychoses and related disorders on the NHS website.

3.4. 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.

3.5. 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.

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4. About these statistics

4.1. 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 2018/19, and another in 2019/20 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.

4.2. Patient age and sex

The age and sex of patients used in these statistics is derived from data provided by the NHS Personal Demographics Service (PDS) for NHS numbers that have been successfully verified by them. A patient’s age, used to assign them to an age group, has been calculated at 30 September for the given financial year. It is possible that a patient’s PDS information may change over the course of the year, in these cases patients may be subject to multiple counting in these analyses.

4.3. Index of deprivation

The English Indices of Deprivation 2019 have been used to provide a measure of patient deprivation. The English Indices of Deprivation are an official national measure of deprivation that follows an established methodological framework to capture a wide range of individuals living conditions.

The reported IMD decile, where 1 is the most deprived and 10 the least deprived, is derived from the location of the practice where an item has been prescribed. There are a small number of items each year that we have reported as having an unknown IMD decile. These are items that have been attributed to an unidentified practice within a Primary Care Organisation (PCO), or where we have been unable to match the practice postcode to a postcode in the National Statistics Postcode Lookup (NSPL) - May 2021.

IMD deciles are calculated by ranking census lower-layer super output areas (LSOA) from most deprived to least deprived and dividing them into 10 equal groups. These range from the most deprived 10% (decile 1) of small areas nationally to the least deprived 10% (decile 10) of small areas nationally.

4.4. Geographies included in this publication

The patient deprivation measures given in these statistics are based upon the LSOA of the postcode of the prescribing organisation as matched to the May 2021 NSPL file. However, higher geographies included in the statistical summary tables of this publication, such as STP and NHS England Region use NHSBSA administrative records, not geographical boundaries, and more closely reflect the operational organisation of practices than other geographical data sources.

4.5. 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.

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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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6. Accessibility

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These contact details are only for accessibility queries. This inbox is not for technical queries or IT problems. If you have a query that is not about accessibility, go to the ‘Contact us’ section of this page.

View our Accessibility statement for Official Statistics Narratives.

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7. Feedback and contact us

Feedback is important to us; we welcome any questions and comments relating to these statistics.

You can complete a short survey about this publication to help us improve the Official Statistics that we produce. All responses will remain anonymous, and individuals will not be identifiable in any report that we produce.

You can view our privacy policy on our website to see how your data is used and stored.

You can contact us by:

Email: statistics@nhsbsa.nhs.uk

You can also write to us at:

NHSBSA - Statistics
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Responsible statistician: Matthew Wilson