England 2022/23
Published 6 July 2023.
This narrative was last reviewed and updated on 15 September 2023.
Notice of correction
We’ve identified that the model used to produce the charts and commentary in section 3 ‘Prescribing during the COVID-19 pandemic’ wasn’t trained on the correct data.
New charts and commentary for section 3 have been produced. Data and commentary in section 2 was not affected and has not changed. You can find more details in section 5.10 ‘Revisions and corrections to this release’.Changes to these statistics
For this release, we have combined our annual and quarterly publications. The supporting summary tables have been expanded to provide quarterly and monthly data at a more granular level than previously released.
We have made changes to how we count patients and assign them to an Index of Multiple Deprivation (IMD) quintile. Some historical figures may have changed from previous releases. You can read more about these changes in section 5.
We are interested in any feedback about the publication, which you can send by using our Official Statistics feedback survey.Key findings
In 2022/23:
There were 86 million antidepressant items prescribed in 2022/23, to an estimated 8.6 million identified patients.
Hypnotics and anxiolytics items and identified patients both decreased by 2%.
Four of the five drug groups had higher prescribing in the most deprived areas.
Of the five British National Formulary (BNF) sections covered in these statistics, four had increases in items and identified patients across 2022/23.
The only BNF section to decrease since 2021/22 was hypnotics and anxiolytics. Items fell by 2% to 14 million and identified patients fell by 2% to 1.9 million in 2022/23.
Antidepressants remained the BNF section with the largest number of identified patients and items prescribed. In 2022/23, 86 million antidepressants were prescribed to an estimated 8.6 million identified patients. This was an increase of around 2%, or 200,000 more identified patients than 2021/22.
Prescribing of Central Nervous System (CNS) stimulants and drugs for ADHD increased by 32% in adults over 18 and 12% in children 17 and under. 2022/23 was the first time that more adult patients have been prescribed drugs from this section than child patients, in the time period covered by these statistics.
Central Nervous System (CNS) stimulants and drugs for ADHD was the only BNF section with more male patients than female patients. In the other four this was the reverse, with more female patients than male patients.
Four out of five BNF sections had more identified patients in the most deprived areas compared to the least deprived areas. Drugs for dementia was the only BNF section in this publication to have more identified patients in the least deprived areas.
1. Things you should know
1.1 Scope
Background
The NHS Long Term Plan published in 2019 focuses on improving mental health care in the UK. It aims to provide more funding for mental health services, particularly for children and people with dementia. The Core20PLUS5 approach to reduce health inequalities also seeks to improve community care for those with severe mental illnesses.
This publication provides information on medicines used to treat mental health conditions in England. It covers medicines prescribed in England that are then dispensed in the community in England, Scotland, Wales, Isle of Man or the Channel Islands. The publication does not include data on medicines used in hospitals, prisons or prescribed by private doctors. It also explores how the COVID-19 pandemic has affected the use of these medicines.
The five sections of the British National Formulary (BNF) included in this publication cover medicines which are primarily used to treat anxiety, depression, psychosis, attention deficit hyperactivity disorder (ADHD), and dementia. We do not capture the clinical indication of a prescription, so there may be instances where these drugs are used for other conditions.
Medicines are not the only way to treat mental health conditions, and this publication does not capture information on the use of other mental health services, such as psychological therapies. Therefore, this publication may not give a complete picture of the number of people receiving treatment for mental health conditions. Information on where to find related statistics can be found in Section 4.
This summary narrative does not discuss the costs associated with the provision of these medicines, but this information is available in the supporting summary tables which accompany this release.
1.2. Definitions
Item
A single unit of medication listed separately on a prescription form. In this publication, an example of an item would be Fluoxetine 20mg tables x56.
Patient
A unique NHS number captured from a prescription form or electronic prescription service (EPS) message.
Classification
This publication uses the British National Formulary (BNF), which lists medicines used in the UK and classifies them according to their primary therapeutic use. Medication may also be prescribed for other purposes beyond their intended use. For example, certain antidepressants may be recommended to individuals experiencing chronic pain. The NHSBSA does not capture the clinical indication of a prescription during processing.
1.3. Time periods
The data in this publication covers the period from April 2015 to March 2023. Q1, Q2, Q3, and Q4 refer to different periods within a financial year.
These statistics include the period of the coronavirus (COVID-19) pandemic. A detailed timeline of events and restrictions in the UK during this time can be found on the UK parliament website. The impact of COVID-19 should be considered when comparing across time periods.
1.4. Patient identification
When the NHSBSA processes prescriptions it is not always possible to capture the NHS number of the patient. Table 1 shows the proportion of items for which a patient could be identified. This means that the data relating to patient counts represents most, but not all, patients.
Due to an increase in digital prescription processing through the Electronic Prescription Service (EPS) during the COVID-19 pandemic, more patients were identified in 2020/21, 2021/22 and 2022/23 compared to previous years. As patient identification rates increased, any increases in the number of identified patients between periods are likely to be an overestimate of the actual increase in patient numbers. This is because the proportion of patients who could be identified has increased. Conversely, any decrease over the same period is likely to be an underestimate of the actual decrease.
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.
Gender 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 statistics do not include any information that is personally identifiable. You can find more information about how the NHSBSA protect personal information in the confidentiality and access statement.
Table 1: The proportion of items for which an NHS number was recorded for listed BNF sections 2018/19 to 2022/23
Source: Statistical summary tables - patient identification rates
2. Results and commentary
2.1. Antidepressants
Antidepressant drugs are effective for treating more severe depression, but National Institute for Health and Care Excellence (NICE) guidance suggests antidepressant medication should not be initially offered for less severe depression, unless requested by the patient. If a patient with less severe depression has not requested medication, psychological therapy should be considered as a first line of treatment. However, a trial of antidepressant therapy may be considered in cases resistant to psychological treatments or associated with other problems. NICE has released updated guidance to recommend that adult patients who are stopping antidepressants should have their dose reduced in stages across time.
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
Figure 1: Number of prescribed items by financial year - BNF 4.3: Antidepressant drugs
86 million antidepressant items prescribed in 2022/23.
8.6 million identified patients were prescribed an antidepressant in 2022/23.
SSRIs remained the drug group with the highest number of items and patients, while MAOIs continued to decrease.
Source: Annual statistical summary tables - Antidepressant drugs
In 2022/23 there were 86.3 million antidepressant items prescribed, 3.39% more than in 2021/22. Antidepressant items have increased steadily each year since 2015/16 across three out of four BNF paragraphs. In contrast, MAOIs have decreased by 60.1% over the same time period, down to 19,100 items in 2022/23.
Figure 2: Number of identified patients by financial year - BNF 4.3: Antidepressant drugs
Source: Annual statistical summary tables - Antidepressant drugs
An estimated 8.56 million identified patients were prescribed at least one antidepressant item in 2022/23. This was 2.43% more than 2021/22. Identified patients have risen over time since 2015/16, with a similar upward trend to items. The number of identified patients prescribed SSRIs has continued to rise for the second year in a row after stalling in 2020/21, with 5.39 million identified patients in 2022/23.
Any patient who was prescribed items from more than one BNF paragraph is counted in the subtotal for each relevant paragraph. However, these patients have only been counted once in the BNF section totals for each relevant section. The total number of identified patients is therefore lower than if the totals for each paragraph are added together.
Figure 3: Number of prescribed items and identified patients by financial quarter - BNF 4.3: Antidepressant drugs
22 million antidepressant items prescribed in Q4 2022/23.
6.7 million identified patients were prescribed an antidepressant in Q4 2022/23.
Source: Quarterly statistical summary tables - Antidepressant drugs
Antidepressant items and identified patients have both increased across all four quarters of 2022/23. Between January to March 2023 antidepressant prescribing increased to 21.9 million items. This was only 0.58% more than the previous quarter, and 4.08% more than the same quarter in 2021/22. Identified patients increased to 6.72 million in January to March 2023, a small increase of 1.66% from the previous quarter.
Both antidepressant items and patients showed a small decrease between January to February 2023, before increasing again in March. This seasonal variation matches the same pattern seen in January to March in every year since 2015/16.
Figure 4: Number of identified patients by age band and gender 2022/23 - BNF 4.3: Antidepressant drugs
More female patients than male patients were prescribed antidepressants in 2022/23
Female patients aged 50 to 54 were the largest group of identified patients.
Source: Annual statistical summary tables - Antidepressant drugs
As in previous years, 2022/23 had noticeable differences in prescribing across gender, with 5.59 million female patients and 2.93 million male patients.
Female patients aged 50 to 54 were the largest group across all age and gender groups at 6.40% of all identified patients, followed by female patients aged 55 to 59 and female patients aged 60 to 64. Although the number of male patients was lower, similar age groups were the most common within male patients. The largest group of male patients was those aged 55 to 59, followed by those aged 50 to 54 and those aged 60 to 64.
When interpreting demographic information the underlying populations should also be considered.
Figure 5: Number of identified patients by IMD quintile 2022/23 - BNF 4.3: Antidepressant drugs
2.1 million patients were prescribed antidepressants in the most deprived areas in England in 2022/23.
40% more patients received prescribing for antidepressants in the most deprived areas compared to the least deprived.
Source: Annual statistical summary tables - Antidepressant drugs
In 2022/23, there were 2.14 million identified patients receiving prescribing for antidepressants in the most deprived areas in England, 39.8% more than the least deprived areas. In general, more people were prescribed antidepressant drugs in more deprived areas in 2022/23. This pattern across IMD quintiles has remained consistent since 2015/16.
The English Indices of Deprivation have been used in this publication to provide a measure of patient deprivation. The patient’s postcode has been used to assigned them to an IMD quintile. You can find more information about this in section 5 of this summary.
Figure 6: Number of identified patients per 1,000 population by ICB 2022/23 - BNF 4.3: Antidepressant drugs
NHS North East and Cumbria ICB had highest number of identified patients for antidepressants per 1,000 population at 240.
NHS North East London ICB had the lowest at 108.
Source: Annual statistical summary tables - Antidepressant drugs
The figures in Figure 6 have been calculated by joining the Office for National Statistics (ONS) Mid-2020 Population Estimates for Lower Layer Super Output Areas in England to our data to obtain the estimated population of each ICB.
In 2022/23 NHS North East and Cumbria was the ICB had the highest rate of antidepressant prescribing. An estimated 240 identified patients per 1,000 population received at least one antidepressant item.
NHS North East London ICB had the lowest rate, with an estimated 108 identified patients per 1,000 population.
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: Annual statistical summary tables - Antidepressant drugs
There were 71,300 identified patients aged 17 or under who received antidepressant prescribing in 2022/23. This was less than 1% of identified patients with a known age who were prescribed antidepressants. The number of identified patients under 17 prescribed antidepressants was almost unchanged from the previous year, while the number of patients aged 18 or over has continued to increase across the same time period.
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
Figure 7: Number of prescribed items by financial year - BNF 4.1: Hypnotics and anxiolytics
14 million Hypnotics and anxiolytics items prescribed in 2022/23.
2 million identified patients were prescribed a hypnotics and anxiolytics drug in 2022/23.
Barbiturates have the smallest volume of prescribing within this section and have seen the biggest decrease.
Source: Annual statistical summary tables - Hypnotics and anxiolytics
In 2022/23 there were 13.8 million hypnotic and anxiolytic items prescribed, 1.95% less than in 2021/22. Though this decrease is around 2% for both hyponotic and anxiolytics paragraphs, barbiturate items have reduced by nearly half in the same time period though this does not affect the overall trend given the volume of prescribing. Overall hypnotic and anxiolytic items have decreased each year since 2015/16 across all three BNF paragraphs.
Figure 8: Number of identified patients by financial year - BNF 4.1: Hypnotics and anxiolytics
Source: Annual statistical summary tables - Hypnotics and anxiolytics
There were an estimated 1.9 million identified patients prescribed at least one hypnotic and anxiolytic item in 2022/23. This was 1.78% less than 2021/22. Identified patients show a similar downward trend to items, and have decreased over time since 2015/16 to 2022/23.
Any patient who was prescribed items from more than one BNF paragraph is counted in the subtotal for each relevant paragraph. However, these patients have only been counted once in the BNF section totals for each relevant section. The total number of identified patients is therefore lower than if the totals for each paragraph are added together.
Figure 9: Number of prescribed items and identified patients by financial quarter - BNF 4.1: Hypnotics and anxiolytics
3.4 million Hypnotics and anxiolytics items prescribed in Q4 2022/23.
1.1 million identified patients received a Hypnotics and anxiolytics drug in Q4 2022/23.
Both items and patients continue to trend downwards over time.
Source: Quarterly statistical summary tables - Hypnotics and anxiolytics
Hypnotics and anxiolytics items and identified patients were fairly level across all four quarters of 2022/23, however there was a slight increase in identified patients from Q3 2022/23 to Q4 2022/23 from 1.04 million to 1.06 million. This was not reflected in the number of items, which stayed similar across Q4 2022/23. Overall, both identified patients and items were lower than they were during the same quarter in 2021/22.
Figure 10: Number of identified patients by age band and gender 2022/23 - BNF 4.1: Hypnotics and anxiolytics
There were more female patients prescribed a hypnotics and anxiolytics item than male patients.
Female patients aged 55 to 59 were the most common prescribing group in 2022/23.
Source: Annual statistical summary tables - Hypnotics and anxiolytics
The number of hypnotics and anxiolytics patients differed in prescribing across gender, with 1.16 million female patients and 0.76 million male patients in 2022/23. This pattern has been seen consistently in previous years.
Female patients aged 55 to 59 were the largest group across all age and gender groups at 5.27% of all identified patients, followed by female patients aged 50 to 54 and female patients aged 60 to 64. Similar age groups were the most common within male patients, but there were also noticeable numbers of male patients in younger age groups, compared to female patients. The largest group of male patients was those aged 55 to 59, followed by those aged 50 to 54 and those aged 60 to 64.
When interpreting demographic information the underlying populations should also be considered.
Figure 11: Number of identified patients by IMD quintile 2022/23 - BNF 4.1: Hypnotics and anxiolytics
Source: Annual statistical summary tables - Hypnotics and anxiolytics
There were an estimated 428,000 identified patients receiving prescribing for hypnotics and anxiolytics in the most deprived areas in England in 2022/23. This was 15% more than the 372,000 identified patients from in the least deprived areas. In general, more people were prescribed hypnotics and anxiolytics medicines in more deprived areas in 2022/23. This pattern has remained consistent since 2015/16.
Figure 12: Number of identified patients per 1,000 population by ICB 2022/23 - BNF 4.1: Hypnotics and anxiolytics
NHS Devon ICB had highest number of identified patients for this section, at 55 per 1,000 population.
NHS South East London ICB had the lowest at 25.
Source: Annual statistical summary tables - Hypnotics and anxiolytics
The figures in Figure 12 have been calculated by joining the Office for National Statistics (ONS) Mid-2020 Population Estimates for Lower Layer Super Output Areas in England to our data to obtain the estimated population of each ICB.
In 2022/23 NHS Devon ICB was the ICB with the highest estimated number of identified patients who received at least one hypnotics and anxiolytics item per 1,000 residents, with an estimated 55 patients per 1,000 population.
NHS South East London ICB was the ICB with the lowest estimated number of identified patients who received at least one hypnotics and anxiolytics item per 1,000 residents in 2022/23. This ICB had an estimated 25 patients per 1,000 population.
2.3. Antipsychotics
These drugs are used to treat psychoses and related disorders, and are referred to under the umbrella term antipsychotics. 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
2.4. Central nervous system (CNS) stimulants and drugs used for ADHD
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
Figure 19: Number of prescribed items by financial year - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
2.5 million Central nervous system (CNS) stimulants and drugs used for ADHD items prescribed in 2022/23.
230,000 identified patients received prescribing in 2022/23.
The upwards trend in both items and patients continues to grow.
Source: Annual statistical summary tables - Central nervous system (CNS) stimulants and drugs used for ADHD
In 2022/23 there were 2.54 million CNS stimulants and drugs used for ADHD items prescribed, a 19.3% increase on 2021/22. CNS stimulants and drugs used for ADHD items have consistently trended upwards since 2015/16, with a steeper trajectory from 2020/21.
This BNF section only contains one BNF paragraph and many chemical substances, therefore discussion in this narrative has been limited to section level. Data is provided at chemical substance level in the relevant supporting summary tables.
Figure 20: Number of identified patients by financial year - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
Source: Annual statistical summary tables - Central nervous system (CNS) stimulants and drugs used for ADHD
In 2022/23, 233,000 identified patients received at least one prescription item for CNS stimulants and drugs used for ADHD. This was 22.9% more than 2021/22. Identified patients have increased over time since 2015/16 to 2022/23, with a very similar upward trend to items.
Figure 21: Number of prescribed items and identified patients by financial quarter - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
690,000 Central nervous system (CNS) stimulants and drugs used for ADHD items prescribed in Q4 2022/23.
190,000 identified patients received prescribing in Q4 2022/23.
Both items and identified patients increased across all four quarters of 2022/23.
CNS stimulants and drugs used for ADHD items and identified patients have both increased across all four quarters of 2022/23. Between January to March 2023 prescribing in this section increased to 687,000 items. This was 6.39% more than the previous quarter, and 21.4% more than the same quarter in 2021/22. Identified patients also increased to 192,000 in January to March 2023, an increase of 5.86% from the previous quarter and 20.8% more than the same quarter in 2021/22.
Figure 22: Number of identified patients by age band and gender 2022/23 - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
In 2022/23 the number of male patients was almost double the number of female patients for this section.
Male patients aged 10 to 14 were the most common prescribing group in 2022/23.
Source: Annual statistical summary tables - Central nervous system (CNS) stimulants and drugs used for ADHD
The long term figures for this section show a noticeable difference in prescribing across gender for Central nervous system (CNS) stimulants and drugs used for ADHD. This continued in 2022/23, with 153,000 male patients and 78,900 female patients.
Male patients aged 10 to 14 were the largest group across all age and gender groups at 20.3% of all identified patients, followed by male patients aged 15 to 19 with 13.6% of identified patients. Although the number of female patients was lower, similar age groups were the most common. The largest group of female patients was those aged 10 to 14, followed by those aged 15 to 19.
When interpreting demographic information the underlying populations should also be considered.
Figure 23: Number of identified patients by IMD quintile 2022/23 - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
Source: Annual statistical summary tables - Central nervous system (CNS) stimulants and drugs used for ADHD
In 2022/23, 56,000 patients were prescribed CNS stimulants and drugs used for ADHD items in the most deprived areas in England. This was 25% more than those in the least deprived areas. In general, more people were prescribed CNS stimulants and drugs used for ADHD items in more deprived areas in 2022/23. This pattern has remained consistent since 2015/16.
Figure 24: Number of identified patients per 1,000 population by ICB 2022/23 - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
Source: Annual statistical summary tables - Central nervous system (CNS) stimulants and drugs used for ADHD
The figures in Figure 24 have been calculated by joining the Office for National Statistics (ONS) Mid-2020 Population Estimates for Lower Layer Super Output Areas in England to our data to obtain the estimated population of each ICB.
In 2022/23 NHS Cheshire and Merseyside ICB was the ICB with the highest estimated number of identified patients who received at least one CNS stimulants and drug used for ADHD item per 1,000 residents with an estimated 9 patients per 1,000 population.
NHS Humber and North Yorkshire ICB was the ICB with the lowest estimated number of identified patients prescribed at least one CNS stimulants and drug used for ADHD item, at 2 per 1,000 population.
2.4.1. Prescribing in adults and children
There is some interest in the prescribing of Central nervous system (CNS) stimulants and drugs used for ADHD in children. Children are classed as patients aged 17 and under at 30 September for the given financial year.
Figure 25: Number of child and adult patients by financial year - BNF 4.4: Central nervous system (CNS) stimulants and drugs used for ADHD
In 2022/23 more adults than children were prescribed drugs in this section.
Between 2021/22 and 2022/23, prescribing has risen by 32% in adults and 12% in children.
Source: Annual statistical summary tables - Central nervous system (CNS) stimulants and drugs used for ADHD
In 2022/23 a greater number of adults were prescribed at least one CNS stimulants and drugs used for ADHD item, with 120,000 patients compared to 112,000 child patients. This is the first time within the period covered by the data that more adults than children were prescribed items in this section.
Prescribing in adults has increased more than in children since 2021/22, with 31.8% more adult identified patients compared to 12.5% more child identified patients. The proportion of adult identified patients versus child identified patients within this section has been increasing since 2015/16.
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
Figure 26: Number of prescribed items by financial year - BNF 4.11: Drugs for dementia
4.2 million drugs for dementia items prescribed in 2022/23.
290,000 identified patients received a drugs for dementia item in 2022/23.
Drugs for dementia have continued to return to an upwards trend, after an earlier dip in 2020/21.
Source: Annual statistical summary tables - Drugs for dementia
In 2022/23 there were 4.24 million drugs for dementia items prescribed, 4.19% more than in 2021/22. Drugs for dementia items have increased across three out of four BNF chemical substances in this section. In contrast, Galantamine items have decreased by 5.20% since 2021/23.
Figure 27: Number of identified patients by financial year - BNF 4.11: Drugs for dementia
Source: Annual statistical summary tables - Drugs for dementia
An estimated 293,000 identified patients were prescribed at least one drugs for dementia item in 2022/23. This was 6.08% more than 2021/22. Identified patients have risen over time since 2015/16 to 2022/23 for three out of four chemical substances, with the overall trend being similar to items.
Any patient who was prescribed items from more than one BNF chemical substance is counted in the subtotal for each relevant chemical substance. However, these patients have only been counted once in the BNF section totals for each relevant section. The total number of identified patients is therefore lower than if the totals for each chemical substance are added together.
Figure 28: Number of prescribed items and identified patients by financial quarter - BNF 4.11: Drugs for dementia
1.1 million drugs for dementia items prescribed in Q4 2022/23.
240,000 identified patients were prescribed a drugs for dementia item in Q4 2022/23.
Items consistently trended upwards, but items decreased in the most recent quarter.
Source: Quarterly statistical summary tables - Drugs for dementia
Drugs for dementia item identified patients have increased across all four quarters of 2022/23. Items increased during the first three quarters until Q4 2022/23, where they dipped by 0.69%. Overall both patients and items are higher than the same quarter in 2021/22.
Figure 29: Number of identified patients by age band and gender 2022/23 - BNF 4.11: Drugs for dementia
Source: Annual statistical summary tables - Drugs for dementia
As in previous years, 2022/23 had noticeable differences in prescribing across gender, with 179,000 female patients and 114,000 male patients.
Female patients aged 85 to 89 were the largest group across all age and gender groups, at 15.6% of all identified patients. This was followed by female patients aged 80 to 84 with 14.7% of identified patients. Although the number of male patients was lower, similar age groups were the most common within male patients. The largest group of male patients was those aged 80 to 84, followed by those aged 85 to 89.
When interpreting demographic information the underlying populations should also be considered.
Figure 30: Number of identified patients by IMD quintile 2022/23 - BNF 4.11: Drugs for dementia
54,000 patients in the most deprived areas in England in 2022/23.
More patients were prescribed a drugs for dementia item in the least deprived areas.
Source: Annual statistical summary tables - Drugs for dementia
In 2022/23, an estimated 53,700 identified patients were prescribed drugs for dementia items in the most deprived areas in England. This was 26% fewer identified patients than in the least deprived areas. In general, more people were prescribed drugs for dementia items in the least deprived areas in 2022/23. This pattern has remained consistent since 2016/17.
Drugs for dementia is the only BNF section in this publication where prescribing was higher in the least deprived areas in 2022/23, compared to the most deprived areas.
Figure 31: Number of identified patients per 1,000 population by ICB 2022/23 - BNF 4.11: Drugs for dementia
Source: Annual statistical summary tables - Drugs for dementia
The figures in Figure 31 have been calculated by joining the Office for National Statistics (ONS) Mid-2020 Population Estimates for Lower Layer Super Output Areas in England to our data to obtain the estimated population of each ICB.
In 2022/23 NHS Gloucestershire ICB had the highest rate of prescribing of drugs for dementia items. An estimated 9 identified patients per 1,000 population received at least one drugs for dementia item.
NHS Birmingham and Solihull ICB was the ICB with the lowest estimated number of identified patients prescribed a drugs for dementia item per 1,000 residents in 2022/23, with an estimated 3 patients per 1,000 population.
3. Prescribing during the COVID-19 pandemic
Prescribing of antidepressants, hypnotics and axiolytics, and antipsychotics stayed mostly within the range of expected items based on pre-pandemic trends.
Over the past year, CNS stimulants and drugs used for ADHD items have consistently exceeded the range of expected values.
We have created a model to help users interpret the impact of the COVID-19 pandemic on prescribing trends.
The number of expected prescription items for each BNF section during this period has been calculated by extrapolating figures for March 2020 to March 2023 according to:
- the trend in prescription items for each section between April 2015 and February 2020
- the number of dispensing days that occur in each month
- the typical differences between each month of the year observed between April 2015 and February 2020
- the typical differences between each combination of 20 year age band group and gender
A linear regression model has been used to estimate the number of items prescribed, to stay relatively simple and consistent with the model used in previous releases. The model estimates the expected number of items prescribed based on pre-pandemic trends, for each combination of age band and gender. These estimates have then been added together to get an estimate of the total items expected per month, with a 99% prediction interval (PI) calculated.
Prediction interval (PI)
A range calculated based on the uncertainty around the fit of the model. A 99% PI means the new observation is likely to fall within the interval of predicted values 99% of the time.
The data used in this model has been split into groups by patients’ 20 year age band and gender. As age band and gender were included in the model, the model was only fitted to data where age band and gender were both known. This means the charts of predictions made using the model are not based on the same full data used in the rest of this publication. These charts cannot be directly compared to each other or to the quarterly and monthly charts of items prescribed. More information on the methodology behind the model can be found in the background and methodology document.
3.1. Antidepressant Prescribing
Figure 32: Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.3: Antidepressant drugs
Source: Quarterly Summary Tables - Monthly table
Between March 2020 and March 2023 there were 253 million antidepressant items prescribed to identified patients with a known age and gender. This was 0.57% more than the 252 million items expected based on historical trends, so antidepressant items remained well within the expected values for this period.
3.2. Hypnotics and anxiolytics prescribing
Figure 33: Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.1: Hypnotics and anxiolytics
Source: Quarterly Summary Tables - Monthly table
There were 42.0 million hypnotics and anxiolytics items prescribed between March 2020 and March 2023 to identified patients with a known age and gender. This follows the expected number of items for this time period, as there were only 0.42% more items prescribed than the 41.8 million items expected based on historical trends. Hypnotics and anxiolytics therefore mostly stayed within the range of values expected for items in this period, with the exception of April 2020.
3.4. CNS stimulants and drugs used for ADHD prescribing
Figure 35: Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.4: CNS stimulants and drugs used for ADHD
Source: Quarterly Summary Tables - Monthly table
From March 2020 to March 2023, 5.86 million CNS stimulants and drugs used for ADHD items were prescribed to identified patients with known age and gender. This was 13.2% more than the 5.17 million items expected based on historical trends. Since March 2022, CNS stimulants and drugs used for ADHD items have remained consistently higher than the range of items expected based on historical trends. Since 2015/16 there has always been an increase between February and March, with a noticeably steeper increase between February and March 2023 than previous years.
The model is based on data containing identified patients with known age and gender only. As CNS stimulants and drugs used for ADHD have a relatively low patient identification rate, a lower proportion of prescribing is included in the model data. For example, patient identification for this BNF section was 79.3% in Q1 of 2015/16, rising to 87.7% in Q4 of 2022/23. This may have an impact on how well the model can extrapolate expected values from the data.
3.5. Drugs for dementia prescribing
Figure 36: Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.11: Drugs for dementia
Source: Quarterly Summary Tables - Monthly table
There were 12.3 million drugs for dementia items prescribed from March 2020 to March 2023 to identified patients with known age and gender. This was 11.6% less than the 13.9 million items expected to be prescribed. Drugs for dementia items have generally fallen below the range of values expected for items across this time period, with only one month in the past year within the 99% prediction interval.
4. Background
This publication provides information on medicines used to treat mental health conditions in England. It covers medicines prescribed in England that are then dispensed in the community in England, Scotland, Wales, Isle of Man of the Channel Islands by a pharmacy, appliance contractor, dispensing doctor, or have been personally administered by a GP practice. The publication does not include data on medicines used in hospitals, prisons or prescribed by private doctors.
4.1. 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.
4.2. 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.
4.4. Central nervous system (CNS) 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.
4.5. 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.
5. About these statistics
This publication is part of a series by the NHSBSA, which can be found on our Medicines Used in Mental Health webpage. This release is intended to continue the annual summary statistics released in each year and combine it with the quarterly summary for quarter 4 of the 2022/23 financial year. To learn more about how this series compares to our other publications, you can view the Official Statistics guidance table on our statistical collections page.
5.1. Changes to this publication
For this release we have changed some of the underlying methodology used to count patients, to align with patient counts in our other data products. We have also changed how we assign items and patients to an IMD quintile. The data now uses the postcode of the patient, rather than the postcode of the practice associated with the prescription.
Due to combining the annual and quarterly releases, we have published some demographic level and ICB level information by financial quarter. Previously this data was only published by financial year.
More information on changes to the methodology can be found in our background and methodology note under the resources section of the webpage for this publication.
5.2. 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 patient 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.
5.3 Index of deprivation (IMD)
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 quintile is derived from the postcode of the patient an item has been prescribed to. Quintile 1 represents the 20% most deprived areas and quintile 5 is the 20% least deprived areas. There are a small number of items each year that we have reported as having an unknown IMD quintile. These are items where we have been unable to match the patient postcode to a postcode in the National Statistics Postcode Lookup (NSPL) - May 2023.
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. We have aggregated these deciles into quintiles in this publication, for use alongside the NHS Core20PLUS5 approach.
5.4. Geographies included in this publication
The patient deprivation measures given in these statistics are based upon the LSOA of the postcode of the patient as matched to the May 2023 NSPL file. However, higher geographies included in the statistical summary tables of this publication, such as ICB, use NHSBSA administrative records, not geographical boundaries, and more closely reflect the operational organisation of practices than other geographical data sources.
5.5 Statistical Disclosure Control (SDC)
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.
5.6. Rounding
The high-level figures in this statistical summary have been rounded where appropriate for clarity. In most cases rounding has been to three significant figures in the main text and two significant figures in the key findings and information boxes. 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.
5.7. Trends during COVID-19
The number of items for each BNF section in the 34-month period March 2020 to March 2023 were compared to the number of items expected to be prescribed based on trends from the ‘pre-COVID-19’ period. The monthly data for April 2015 to February 2020 was used to extrapolate expected figures for March 2020 to March 2023. These figures were extrapolated according to:
- the trends between April 2015 and February 2020
- the number of dispensing days that occur in each month
- the typical differences between each month of the year observed between April 2015 and February 2020
- the typical differences between each combination of 20 year age band group and gender
This model states expected figures if trends had continued as before but doesn’t confirm causation of any differences. Factors other than COVID-19 may have influenced prescribing, such as:
- changes in patient behaviour, demographics, or morbidity
- external environmental factors that could drive prescribing
- any (and all) policy initiatives and guidance
- other local priorities and resources
5.8. Averages
Where this document refers to ‘average’, this is the mean unless otherwise stated. This is calculated by adding the number of items/patients/months together and dividing this by the number of items/patients/months.
5.9. 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.
5.10 Revisions and corrections to this release
We’ve identified an error in the training of the model used to produce the data, charts, and commentary for section 3 ‘Prescribing during the COVID-19 pandemic’. The model was initially trained on all months in the dataset, instead of only trained on pre-pandemic months from April 2015 to February 2020. This resulted in incorrect values for the expected items and prediction intervals used in this section, and therefore the accompanying charts and commentary in this section were also incorrect.
The affected charts and commentary in this section have been corrected by training the model only on data for April 2015 to February 2020, then applying the model to data from March 2020 to March 2023 to give the corrected values for expected items and associated 99% prediction interval. Charts and commentary have been recreated using the new corrected data.
This error was limited to section 3 and did not affect the data, charts, or commentary in section 2. We apologise for any inconvenience caused.
6. Accessibility
If you need information on this website in a different format like accessible PDF, large print, easy read, audio recording or braille, you can contact us by:
Email: nhsbsa.accessibility@nhs.net
Phone: 0191 203 5318
We’ll consider your request and get back to you in 5 working days.
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.
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
NHS Business Services Authority
Stella House
Goldcrest Way
Newburn Riverside
Newcastle upon Tyne
NE15 8NY
Responsible statistician: Grace Libby