1.1. Scope

Mental health is a key area of the NHS Long Term Plan published in 2019. The Long Term Plan looks at increasing funding for overall mental health, children’s mental health and supporting care for people with dementia. It also focuses on improving community care for severe mental illness which is also one of the five clinical areas of focus of the Core20PLUS5 approach to reducing health inequalities.

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 of identified patients that have received prescribing of these medicines
• demographic breakdowns of prescribing by age group and sex
• 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 psychological 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) 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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2.1. 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.

Figure 1: Number of prescribed items - BNF 4.3: Antidepressant drugs

Source: Statistical summary tables - Antidepressant drugs

There were 83.4 million antidepressant items prescribed in 2021/22. This was a 34.8% increase from 61.9 million items in 2015/16, and a 5.07% increase from 79.4 million items in 2021/22. Since 2015/16, other antidepressant drugs usage has increased by 63.3% from 12.5 million items to 20.4 million in 2021/22. 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 35.2% from 33.3 million items to 45.0 million in 2021/22. Although prescribing volumes for monoamine-oxidase inhibitors (MAOIs) are already quite low, they have decreased by 59.8% since 2015/16 from 47,900 items per year to 19,200 in 2021/22.

Figure 2: Number of identified patients - BNF 4.3: Antidepressant drugs

Source: Statistical summary tables - Antidepressant drugs

In 2021/22, 8.32 million patients received at least one prescription item for antidepressant drugs. This was an increase of 21.6% from 6.84 million patients in 2015/16, and a 5.72% increase from 7.87 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 52.0% from 1.21 million identified patients to 1.84 million in 2021/22. SSRIs have also seen a large increase in the number patients receiving prescribing since 2015/16 of 23.9% from 4.24 million identified patients to 5.25 million in 2021/22. However, it should be noted that increases in identified patient numbers are likely to be overestimated, as the proportion of patients who could be identified also increased. In 2015/16, 94.2% of antidepressant items were prescribed to identified patients, this increased by 4.75 percentage points in 2021/22 to 99.0% of items.

The total identified patients for all reported antidepressant drugs are 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 is counted in the subtotal for relevant paragraph. However, these patients have only been counted once when looking at BNF section totals for each relevant section.

Figure 3: Number of identified patients by sex 2021/22 - BNF 4.3: Antidepressant drugs

Source: Statistical summary tables - Antidepressant drugs

In 2021/22, 65.8% of identified patients that received an antidepressant item were female compared to 34.2% who were male. This equates to 5.47 million female identified patients and 2.85 million males. 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%.

Figure 4: Number of identified patients by age band and sex 2021/22 - BNF 4.3: Antidepressant drugs

Source: Statistical summary tables - Antidepressant drugs

The most common group to receive prescribing for antidepressant drugs in 2021/22 was female patients aged 50 to 54 with 544,000 identified patients, 6.54% of all patients. The next most common groups were female patients aged 55 to 59 with 530,000 and 6.38% of identified patients, and female patients 45 to 49 with 459,000 and 5.52% of identified patients.

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.

Figure 6: Number of prescribed items - BNF 4.1: Hypnotics and anxiolytics

Source: Statistical summary tables - Hypnotics and anxiolytics

There were 14.0 million hypnotic and anxiolytic items prescribed in 2021/22. This was a 12.0% decrease from 15.9 million items in 2015/16, and a 1.88% decrease from 14.3 million in 2020/21. Since 2015/16, prescribing of hypnotics, anxiolytics, and barbiturates have decreased. Prescribing of:

• hypnotics decreased by 11.4% from 9.17 million items in 2015/16 to 8.13 million in 2021/22

• anxiolytics decreased by 12.7% from 6.77 million items in 2015/16 to 5.91 million in 2021/22

• barbiturates decreased by 74.4% from 5,510 items in 2015/16 to 1,410 items in 2021/22.

Figure 7: Number of identified patients - BNF 4.1: Hypnotics and anxiolytics

Source: Statistical summary tables - Hypnotics and anxiolytics

In 2021/22, 1.95 million identified patients received at least one prescription item for hypnotics and anxiolytics. This was a decrease of 17.9% from 2.38 million identified patients in 2015/16, and a 0.92% decrease from 1.97 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 has decreased from 1.30 million in 2015/16 to 1.02 million in 2021/22, a decrease of 21.1%

• hypnotic item has decreased by 15.7%, from 1.30 million in 2015/16 to 1.10 million in 2021/22

• barbiturate item has decreased by 77.7%, from 332 identified patients in 2015/16 to 74 in 2021/22.

However, it should be noted that increases in identified patient numbers are likely to be overestimated, as the proportion of patients who could be identified also increased. In 2015/16, 91.5% of hypnotics and anxiolytics items were prescribed to identified patients, this increased by 5.36 percentage points in 2021/22 to 96.9% of items.

The total identified patients for all reported hypnotics and anxiolytics drugs are 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 is counted in the subtotal for the relevant paragraph. However, these patients have only been counted once when looking at BNF section totals.

Figure 8: Number of identified patients by sex - BNF 4.1: Hypnotics and anxiolytics

Source: Statistical summary tables - Hypnotics and anxiolytics

In 2021/22, 60.9% of identified patients that received a hypnotic and anxiolytic item were female, compared to 39.1% who were male. This equates to 1.19 million female identified patients and 764,000 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 male. 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.

Figure 9: Number of identified patients by age band and sex 2021/22 - BNF 4.1: Hypnotics and anxiolytics

Source: Statistical summary tables - Hypnotics and anxiolytics

The most common group to receive prescribing for hypnotics and anxiolytics in 2021/22 was female patients aged 50 to 54 with 106,000 identified patients, 5.41% of all patients. The next most common groups were female patients aged 55 to 59 with 104,000 and 5.34% of identified patients, and female patients 70 to 74 with 92,800 and 4.75% of identified patients.

Figure 10: Number of identified patients by IMD decile 2021/22 - BNF 4.1: Hypnotics and anxiolytics

Source: Statistical summary tables - Hypnotics and anxiolytics

In 2021/22, 254,000 patients were prescribed a hypnotics and anxiolytics item from practices in the most deprived areas in England. This was 62.2% more than the 157,000 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 2021/22.

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.

Figure 11: Number of prescribed items - BNF 4.2: Drugs used in psychoses and related disorders

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

There were 13.2 million items prescribed for drugs in the BNF section antipsychotics in 2021/22. This was a 19.7% increase from 11.0 million items in 2015/16, and a 1.46% increase from 13.0 million items in 2020/21. There were 11.7 million items prescribed for drugs in the BNF paragraph antipsychotic drugs in 2021/22, an increase of 24.7% from the 9.39 million items prescribed in 2015/16. Both antipsychotic depot injections and drugs used for mania and hypomania decreased in usage between 2015/16 and 2021/22. The number of antipsychotic depot injections items decreased by 22.6% from 155,000 to 120,000 items, while drugs used for mania and hypomania decreased by 7.04% from 1.49 million to 1.39 million items.

Figure 12: Number of identified patients - BNF 4.2: Drugs used in psychoses and related disorders

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

In 2021/22, 839,000 identified patients received at least one prescription item from the BNF section antipsychotics. This was an increase of 18.2% from 709,000 patients in 2015/16, and a 1.00% decrease from 847,000 identified patients in the previous financial year. The long term trends for identified patients are broadly similar to those of prescribed items. In 2021/22, 798,000 identified patients received at least one prescription item from the BNF paragraph antipsychotic drugs, an increase of 21.1% 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 2021/22. 13,000 identified patients received at least one antipsychotic depot injection item in 2021/22, a 21.1% decrease from 18,100 in 2015/16. In 2021/22, 72,300 identified patients received at least one drugs used for mania and hypomania item, a 13.9% decrease from 84,100 in 2015/16. However, it should be noted that changes in identified patient numbers are likely to be overestimated, as the proportion of patients who could be identified also increased. In 2015/16, 91.7% of antipsychotics items were prescribed to identified patients, this increased by 5.03 percentage points in 2021/22 to 96.7% of items.

The total identified patients for all reported antipsychotic drugs are 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 is counted in the subtotal for the relevant paragraph. However, these patients have only been counted once when looking at BNF section totals.

Figure 13: Number of identified patients by sex - BNF 4.2: Drugs used in psychoses and related disorders

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

In 2021/22, 53.7% of identified patients that received an antipsychotic item where female, compared to 46.3% who were male. This equates to 450,000 female identified patients and 388,000 males. The proportion of female identified patients increased by 1.22 percentage points between 2015/16 and 2021/22, with a corresponding decrease in male identified patients.

Figure 14: Number of identified patients by age band and sex 2021/22 - BNF 4.2: Drugs used in psychoses and related disorders

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

The most common group to receive prescribing for antipsychotics in 2021/22 was female patients aged 55 to 59 with 37,000 identified patients, 4.36% of all patients. The next most common age groups were 50 to 54 for male patients with 36,600 and 4.36% of identified patients, and 50 to 54 female patients also with 36,600 and 4.36% of identified patients.

Figure 15: Number of identified patients by IMD decile 2021/22 - BNF 4.2: Drugs used in psychoses and related disorders

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

In 2021/22, 141,000 patients were prescribed antipsychotic items from practices in the most deprived areas in England. This was almost three times as many as the 52,200 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 2021/22.

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.

Figure 16: Number of prescribed items - BNF 4.4: CNS stimulants and drugs used for ADHD

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

There were 2.13 million CNS stimulants and drugs used for ADHD items prescribed in 2021/22. This was a 63.3% increase from 1.31 million items in 2015/16, and a 16.4% increase from 1.83 million items in 2020/21. 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.

Figure 17: Number of identified patients - BNF 4.4: CNS stimulants and drugs used for ADHD

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

In 2021/22, 191,000 identified patients received at least one prescription item for CNS stimulants and drugs used for ADHD. This was an increase of 80.1% from 106,000 identified patients in 2015/16, and a 18.0% increase from 162,000 identified patients in the previous financial year. However, it should be noted that increases in identified patient numbers are likely to be overestimated, as the proportion of patients who could be identified also increased. In 2015/16, 80.0% of CNS stimulants and drug items were prescribed to identified patients, this increased by 7.65 percentage points in 2021/22 to 87.6% of items.

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.

Figure 18: Number of identified patients by sex - BNF 4.4: CNS stimulants and drugs used for ADHD

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

In 2021/22, 69.6% of identified patients that received a CNS stimulant and drugs used for ADHD item were male, compared to 30.4% who were female. This equates to 133,000 male identified patients and 58,000 females. Between 2015/16 and 2021/22, the proportion of identified patients that were male decreased 6.30 percentage points, with a corresponding increase in female patients.

Figure 19: Figure 14: Number of identified patients by age band and sex 2021/22 - BNF 4.4: CNS stimulants and drugs used for ADHD

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

The most common group to receive prescribing for CNS stimulants and drugs used for ADHD in 2021/22 was male patients aged 10 to 14, with 43,100 identified patients, 22.6% of all patients. The next most common groups were 15 to 19 male patients with 27,700 and 14.6% of identified patients, and 5 to 9 male patients with 15,200 and 7.98% of identified patients.

Figure 20: Number of identified patients IMD decile 2021/22 - BNF 4.4: CNS stimulants and drugs used for ADHD

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

In 2021/22, 28,000 patients were prescribed CNS stimulants and drugs used for ADHD from practices in the most deprived areas in England. This was 81.4% more than the 15,400 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 2021/22.

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.

Figure 21: Number of prescribed items - BNF 4.11: Drugs for dementia

Source: Statistical summary tables - Drugs for dementia

There were 4.07 million drugs for dementia items prescribed in 2021/22. This was a 19.4% increase from 3.41 million items in 2015/16, but a 0.46% decrease from 4.05 million items in 2019/20. Since 2015/16, Memantine hydrochloride items have increased by 96.0% from 828,000 to 1.62 million in 2021/22. 1.93 million donepezil hydrochloride items were prescribed in 2021/22. This was a 2.50% decrease from 1.98 million items in 2015/16, and a 3.61% decrease from 2.00 million items in 2020/21.

Figure 22: Number of identified patients - BNF 4.11: Drugs for dementia

Source: Statistical summary tables - Drugs for dementia

In 2021/22, 277,000 identified patients received at least one prescription item for drugs for dementia. This was an increase of 19.8% from 231,000 identified patients in 2015/16, and a 0.52% decrease from 275,000 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 94.2%, from 67,400 to 125,000 in 2021/22. However, it should be noted that increases in identified patient numbers are likely to be overestimated, as the proportion of patients who could be identified also increased. In 2015/16, 90.0% of drugs for dementia items were prescribed to identified patients, this increased by 6.61 percentage points in 2021/22 to 96.6% of items.

The total identified patients for all reported drugs for dementia are 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 is counted in the subtotal for the relevant chemical substance. However, these patients have only been counted once when looking at BNF section totals.

Figure 23: Number of identified patients by sex - BNF 4.11: Drugs for dementia

Source: Statistical summary tables - Drugs for dementia

In 2021/22, 61.3% of identified patients that received a drugs for dementia item were female, compared to 38.7% who were male. This equates to 170,000 female identified patients and 107,000 males. 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%.

Figure 24: Number of identified patients by age band and sex 2021/22 - BNF 4.11: Drugs for dementias

Source: Statistical summary tables - Drugs for dementia

The most common group to receive prescribing for drugs for dementia in 2021/22 was female patients 85 to 89 with 43,600 identified patients, 15.7% of all patients. The next most common groups were 80 to 84 female patients with 41,000 and 14.8% of identified patients, and 90+ female patients with 33,900 and 12.2% of identified patients.

Figure 25: Number of identified patients by IMD decile 2021/22 - BNF 4.11: Drugs for dementia

Source: Statistical summary tables - Drugs for dementia

In 2021/22, 37,800 patients were prescribed drugs for dementia from practices in the most deprived areas in England. This was 40.0% more than the 27,000 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 2021/22.

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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3.1. 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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4.1. 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 on 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 2022.

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. Changes to this publication

We have updated figures 4, 9, 14, 19 and 24 relating to the age band and replaced them with figures showing patients broken down by age band and gender.

For full details of the changes made please refer to the Background Information and Methodology note released alongside these statistics.

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