Medicines Used in Mental Health -
Prescribing during the COVID-19 pandemic

England - April to June 2024

Published 12 September 2024

Summary

In Q1 2024/25, antipsychotics and drugs for dementia remained below the range of expected items based on pre-pandemic prescribing trends.

CNS stimulants and drugs for ADHD items continued to increase beyond the range of expected values.

Antidepressant items and hypnotics and anxiolytics items have mostly followed the expected trend.

1. Things you should know

1.1. Scope

This publication provides information exploring how the COVID-19 pandemic has affected the use of medicines used to treat mental health 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. The publication does not include data on medicines used in hospitals, prisons or prescribed by private doctors.

Further information on the drug groups covered here can be found in the overview and relevant summaries also included in this release.

1.2. Prescribing during the COVID-19 pandemic

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 June 2024 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

2.1. Antidepressant prescribing

Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.3: Antidepressant drugs

Chart

Figure 1 : Antidepressant prescribing

Table

Table 1: Antidepressant prescribing

Year Month	Antidepressant prescribed items	Antidepressant expected items	99% Prediction interval (Lower)	99% Prediction interval (Upper)
202003	6,718,618	6,477,955	6,094,844	6,861,067
202004	6,405,931	6,181,665	5,799,271	6,564,060
202005	6,175,165	6,341,671	5,959,276	6,724,065
202006	6,396,987	6,442,329	6,062,919	6,821,738
202007	6,704,149	6,537,963	6,156,492	6,919,433
202008	6,081,072	6,334,185	5,946,799	6,721,571
202009	6,579,381	6,469,501	6,089,356	6,849,646
202010	6,733,187	6,679,635	6,299,489	7,059,780
202011	6,516,477	6,473,531	6,088,926	6,858,136
202012	6,996,019	6,737,472	6,358,062	7,116,882
202101	6,645,783	6,597,211	6,212,606	6,981,817
202102	6,273,879	6,260,507	5,880,788	6,640,227
202103	7,053,684	6,940,336	6,543,341	7,337,331
202104	6,824,049	6,505,446	6,114,033	6,896,859
202105	6,528,480	6,665,451	6,274,038	7,056,864
202106	6,945,741	6,766,109	6,377,814	7,154,405
202107	6,943,368	6,861,743	6,471,534	7,251,952
202108	6,645,081	6,657,966	6,261,576	7,054,355
202109	6,970,860	6,793,281	6,404,317	7,182,245
202110	6,688,123	6,864,815	6,473,402	7,256,228
202111	6,966,668	6,935,912	6,547,616	7,324,207
202112	7,285,896	7,061,253	6,672,957	7,449,548
202201	6,931,763	6,920,992	6,527,369	7,314,615
202202	6,496,648	6,584,288	6,195,589	6,972,987
202203	7,356,419	7,264,116	6,857,607	7,670,626
202204	6,870,173	6,829,226	6,426,557	7,231,896
202205	7,171,131	7,127,832	6,727,787	7,527,876
202206	6,987,069	6,812,690	6,388,956	7,236,423
202207	6,943,591	7,046,924	6,645,900	7,447,947
202208	7,154,706	7,120,346	6,720,939	7,519,753
202209	7,124,481	6,978,462	6,575,792	7,381,131
202210	7,057,024	7,188,596	6,785,926	7,591,265
202211	7,240,204	7,259,692	6,860,248	7,659,136
202212	7,221,950	7,385,033	6,985,589	7,784,477
202301	7,274,108	7,244,772	6,839,906	7,649,639
202302	6,703,644	6,908,068	6,508,134	7,308,003
202303	7,669,612	7,587,897	7,169,740	8,006,054
202304	6,869,356	7,014,407	6,582,415	7,446,398
202305	7,337,387	7,313,012	6,897,029	7,728,996
202306	7,453,005	7,413,670	7,000,999	7,826,341
202307	7,271,593	7,370,704	6,956,362	7,785,046
202308	7,437,950	7,444,127	7,031,443	7,856,810
202309	7,288,980	7,440,842	7,027,637	7,854,048
202310	7,420,900	7,512,376	7,096,393	7,928,359
202311	7,500,095	7,583,473	7,170,801	7,996,144
202312	7,430,724	7,570,214	7,152,057	7,988,370
202401	7,709,840	7,707,153	7,294,482	8,119,824
202402	7,238,627	7,370,449	6,954,548	7,786,349
202403	7,366,747	7,634,477	7,199,772	8,069,183
202404	7,604,907	7,615,387	7,187,133	8,043,642
202405	7,796,503	7,775,393	7,347,138	8,203,647
202406	7,257,931	7,598,851	7,165,545	8,032,156

Between March 2020 and June 2024, there were 364 million antidepressants prescribed to identified patients with a known age and gender. This was 56,000 items more than expected based on historical trends. Antidepressant items stayed within the expected range of values over this period.

2.2. Hypnotics and anxiolytics prescribing

Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.1: Hypnotics and anxiolytics

Chart

Figure 2 : Hypnotics and anxiolytics prescribing

Table

Table 1: Hypnotics and anxiolytics prescribing

Year Month	Hypnotics and anxiolytics prescribed items	Hypnotics and anxiolytics expected items	99% Prediction interval (Lower)	99% Prediction interval (Upper)
202003	6,718,618	6,477,955	6,094,844	6,861,067
202004	6,405,931	6,181,665	5,799,271	6,564,060
202005	6,175,165	6,341,671	5,959,276	6,724,065
202006	6,396,987	6,442,329	6,062,919	6,821,738
202007	6,704,149	6,537,963	6,156,492	6,919,433
202008	6,081,072	6,334,185	5,946,799	6,721,571
202009	6,579,381	6,469,501	6,089,356	6,849,646
202010	6,733,187	6,679,635	6,299,489	7,059,780
202011	6,516,477	6,473,531	6,088,926	6,858,136
202012	6,996,019	6,737,472	6,358,062	7,116,882
202101	6,645,783	6,597,211	6,212,606	6,981,817
202102	6,273,879	6,260,507	5,880,788	6,640,227
202103	7,053,684	6,940,336	6,543,341	7,337,331
202104	6,824,049	6,505,446	6,114,033	6,896,859
202105	6,528,480	6,665,451	6,274,038	7,056,864
202106	6,945,741	6,766,109	6,377,814	7,154,405
202107	6,943,368	6,861,743	6,471,534	7,251,952
202108	6,645,081	6,657,966	6,261,576	7,054,355
202109	6,970,860	6,793,281	6,404,317	7,182,245
202110	6,688,123	6,864,815	6,473,402	7,256,228
202111	6,966,668	6,935,912	6,547,616	7,324,207
202112	7,285,896	7,061,253	6,672,957	7,449,548
202201	6,931,763	6,920,992	6,527,369	7,314,615
202202	6,496,648	6,584,288	6,195,589	6,972,987
202203	7,356,419	7,264,116	6,857,607	7,670,626
202204	6,870,173	6,829,226	6,426,557	7,231,896
202205	7,171,131	7,127,832	6,727,787	7,527,876
202206	6,987,069	6,812,690	6,388,956	7,236,423
202207	6,943,591	7,046,924	6,645,900	7,447,947
202208	7,154,706	7,120,346	6,720,939	7,519,753
202209	7,124,481	6,978,462	6,575,792	7,381,131
202210	7,057,024	7,188,596	6,785,926	7,591,265
202211	7,240,204	7,259,692	6,860,248	7,659,136
202212	7,221,950	7,385,033	6,985,589	7,784,477
202301	7,274,108	7,244,772	6,839,906	7,649,639
202302	6,703,644	6,908,068	6,508,134	7,308,003
202303	7,669,612	7,587,897	7,169,740	8,006,054
202304	6,869,356	7,014,407	6,582,415	7,446,398
202305	7,337,387	7,313,012	6,897,029	7,728,996
202306	7,453,005	7,413,670	7,000,999	7,826,341
202307	7,271,593	7,370,704	6,956,362	7,785,046
202308	7,437,950	7,444,127	7,031,443	7,856,810
202309	7,288,980	7,440,842	7,027,637	7,854,048
202310	7,420,900	7,512,376	7,096,393	7,928,359
202311	7,500,095	7,583,473	7,170,801	7,996,144
202312	7,430,724	7,570,214	7,152,057	7,988,370
202401	7,709,840	7,707,153	7,294,482	8,119,824
202402	7,238,627	7,370,449	6,954,548	7,786,349
202403	7,366,747	7,634,477	7,199,772	8,069,183
202404	7,604,907	7,615,387	7,187,133	8,043,642
202405	7,796,503	7,775,393	7,347,138	8,203,647
202406	7,257,931	7,598,851	7,165,545	8,032,156

There were 58.3 million hypnotics and anxiolytics items prescribed to identified patients with a known age and gender between March 2020 and June 2024. This was 0.32% more than the 58.1 million items expected based on historical trends, and hypnotics and anxiolytics items stayed within the expected range of values for this period.

2.3. Drugs used in psychoses and related disorders prescribing

Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.2: Drugs used in psychoses and related disorders

Chart

Figure 3 : Drugs used in psychoses and related disorders prescribing

Table

Table 3: Drugs used in psychoses and related disorders prescribing

Year Month	Antipsychotics prescribed items	Antipsychotics expected items	99% Prediction interval (Lower)	99% Prediction interval (Upper)
202003	1,037,009	1,046,830.9	996,049.6	1,097,612
202004	1,079,336	996,043.4	945,357.1	1,046,730
202005	1,013,540	1,021,463.2	970,776.9	1,072,149
202006	1,038,625	1,040,854.8	990,564.2	1,091,145
202007	1,079,545	1,059,274.7	1,008,710.9	1,109,838
202008	983,140	1,025,659.8	974,312.0	1,077,008
202009	1,045,050	1,041,844.8	991,456.8	1,092,233
202010	1,072,652	1,076,139.2	1,025,751.2	1,126,527
202011	1,031,098	1,037,384.5	986,405.2	1,088,364
202012	1,108,327	1,085,503.0	1,035,212.4	1,135,794
202101	1,045,984	1,054,640.3	1,003,661.0	1,105,620
202102	988,366	998,869.7	948,538.0	1,049,201
202103	1,099,638	1,108,882.8	1,056,261.3	1,161,504
202104	1,066,131	1,034,634.0	982,752.4	1,086,516
202105	1,016,027	1,060,053.8	1,008,172.2	1,111,935
202106	1,079,784	1,079,445.4	1,027,977.0	1,130,914
202107	1,085,623	1,097,865.3	1,046,143.3	1,149,587
202108	1,038,802	1,064,250.5	1,011,709.2	1,116,792
202109	1,076,503	1,080,435.5	1,028,878.5	1,131,992
202110	1,037,084	1,091,268.6	1,039,387.0	1,143,150
202111	1,072,411	1,099,436.4	1,047,968.0	1,150,905
202112	1,121,018	1,124,093.6	1,072,625.2	1,175,562
202201	1,067,743	1,093,230.9	1,041,056.4	1,145,405
202202	996,212	1,037,460.3	985,938.4	1,088,982
202203	1,117,151	1,147,473.4	1,093,590.8	1,201,356
202204	1,053,616	1,073,224.6	1,019,850.9	1,126,598
202205	1,089,868	1,122,105.7	1,069,080.0	1,175,131
202206	1,064,952	1,071,113.5	1,014,947.8	1,127,279
202207	1,057,104	1,112,994.7	1,059,839.2	1,166,150
202208	1,087,249	1,126,302.4	1,073,361.2	1,179,244
202209	1,078,059	1,095,564.8	1,042,191.1	1,148,939
202210	1,077,985	1,129,859.2	1,076,485.5	1,183,233
202211	1,097,745	1,138,027.1	1,085,081.0	1,190,973
202212	1,097,434	1,162,684.3	1,109,738.2	1,215,630
202301	1,099,345	1,131,821.6	1,078,156.7	1,185,486
202302	1,007,760	1,076,051.0	1,023,039.8	1,129,062
202303	1,144,055	1,186,064.1	1,130,637.6	1,241,491
202304	1,027,505	1,088,354.0	1,031,093.7	1,145,614
202305	1,096,242	1,137,235.1	1,082,096.7	1,192,373
202306	1,113,956	1,156,626.7	1,101,927.3	1,211,326
202307	1,083,969	1,151,585.3	1,096,664.4	1,206,506
202308	1,114,264	1,164,893.1	1,110,192.1	1,219,594
202309	1,084,101	1,157,616.8	1,102,846.6	1,212,387
202310	1,103,567	1,168,449.9	1,113,311.5	1,223,588
202311	1,114,309	1,176,617.7	1,121,918.3	1,231,317
202312	1,101,118	1,177,813.6	1,122,387.1	1,233,240
202401	1,138,952	1,193,873.5	1,139,174.1	1,248,573
202402	1,070,880	1,138,102.9	1,082,975.4	1,193,230
202403	1,083,355	1,177,732.1	1,120,112.1	1,235,352
202404	1,115,029	1,173,867.2	1,117,102.3	1,230,632
202405	1,137,208	1,199,287.0	1,142,522.1	1,256,052
202406	1,070,605	1,171,756.1	1,114,321.6	1,229,191

From March 2020 to June 2024 there were 55.8 million antipsychotics items prescribed to identified patients with known age and gender. This was 2.88% fewer than the 57.5 million items that were expected to be prescribed. Antipsychotics items have previously stayed mostly within the range of expected values, but were below this range for all three months of Q1 2024/25.

2.4. CNS stimulants and drugs used for ADHD prescribing

Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.4: CNS stimulants and drugs used for ADHD

Chart

Figure 4 : CNS stimulants and drugs used for ADHD prescribing

Table

Table 4: CNS stimulants and drugs used for ADHD prescribing

Year Month	CNS stimulants and drugs used for ADHD prescribed items	CNS stimulants and drugs used for ADHD expected items	99% Prediction interval (Lower)	99% Prediction interval (Upper)
202003	144,881	129,842.7	113,333.2	146,352.2
202004	129,907	123,584.9	107,106.3	140,063.5
202005	123,321	129,135.5	112,656.9	145,614.1
202006	128,445	131,667.1	115,317.1	148,017.0
202007	133,352	131,035.9	114,597.2	147,474.7
202008	120,218	121,019.2	104,325.5	137,712.9
202009	138,361	131,206.0	114,824.4	147,587.7
202010	141,933	133,492.6	117,111.0	149,874.3
202011	139,243	131,588.2	115,014.3	148,162.0
202012	145,063	135,919.9	119,569.9	152,269.8
202101	138,712	134,337.4	117,763.5	150,911.2
202102	130,045	127,769.4	111,406.1	144,132.7
202103	150,785	141,401.4	124,293.6	158,509.1
202104	147,307	132,784.9	115,917.7	149,652.1
202105	144,893	138,335.5	121,468.3	155,202.7
202106	153,605	140,867.0	124,134.2	157,599.9
202107	152,060	140,235.9	123,420.6	157,051.3
202108	139,810	130,219.2	113,137.5	147,300.9
202109	156,001	140,406.0	123,644.3	157,167.7
202110	151,860	140,333.9	123,466.7	157,201.1
202111	160,135	143,146.8	126,414.0	159,879.7
202112	165,758	145,119.8	128,387.0	161,852.7
202201	164,720	143,537.3	126,574.9	160,499.8
202202	152,559	136,969.4	120,219.1	153,719.6
202203	178,616	150,601.3	133,083.6	168,119.1
202204	167,159	141,984.9	124,632.5	159,337.2
202205	179,134	149,894.2	132,655.0	167,133.3
202206	180,822	145,349.6	127,089.6	163,609.6
202207	176,605	147,077.2	129,795.8	164,358.6
202208	169,471	141,777.9	124,566.2	158,989.6
202209	186,428	147,247.3	129,894.9	164,599.6
202210	184,634	149,533.9	132,181.5	166,886.2
202211	193,054	152,346.8	135,133.5	169,560.1
202212	188,092	154,319.8	137,106.5	171,533.1
202301	193,392	152,737.3	135,290.3	170,184.3
202302	187,974	146,169.3	128,934.9	163,403.8
202303	219,067	159,801.3	141,781.6	177,821.0
202304	193,548	148,826.1	130,210.2	167,442.0
202305	214,281	156,735.4	138,809.4	174,661.5
202306	218,414	159,267.0	141,483.7	177,050.3
202307	214,101	156,277.2	138,421.9	174,132.5
202308	207,934	150,977.8	133,194.0	168,761.7
202309	214,594	158,805.9	140,999.6	176,612.2
202310	215,168	158,733.8	140,807.8	176,659.9
202311	218,482	161,546.8	143,763.5	179,330.1
202312	212,028	161,161.1	143,141.4	179,180.8
202401	231,297	164,296.0	146,512.7	182,079.3
202402	215,044	157,728.0	139,805.5	175,650.5
202403	231,054	164,283.9	145,551.0	183,016.7
202404	234,993	162,743.5	144,288.7	181,198.3
202405	244,500	168,294.1	149,839.3	186,748.9
202406	231,424	166,108.3	147,435.8	184,780.8

Between March 2020 to June 2024, there were 9.15 million CNS stimulants and drugs used for ADHD items prescribed to identified patients with known age and gender. This was 21.0% more than the 7.57 million items expected based on historical trends, and the actual number of items has consistently remained above the range of expected values since March 2022. The difference in the trend for actual items compared to the expected trend in the model is increasing over time.

The model is based on data containing identified patients with known age and gender only. CNS stimulants and drugs used for ADHD have a relatively low patient identification rate compared to the other BNF sections included in this publication. For example, patient identification for this BNF section was 79.3% in Q1 2015/16, rising to 89.6% in Q1 of 2024/25. As a lower proportion of prescribing is included in the model data, this may have an impact on how well the model can extrapolate expected values from the data. Section 1.4 of the summary report has more information on patient identification rates and a table of rates by BNF section.

2.5. Drugs for dementia prescribing

Expected and actual prescribing activity during the COVID-19 Pandemic - BNF 4.11: Drugs for dementia

Chart

Figure 5 : Drugs for dementia prescribing

Table

Table 5: Drugs for dementia prescribing

Year Month	Drugs for dementia prescribed items	Drugs for dementia used for ADHD expected items	99% Prediction interval (Lower)	99% Prediction interval (Upper)
202003	338,997	351,926.4	310,020.4	393,832.4
202004	353,438	337,046.6	295,219.0	378,874.2
202005	323,312	346,441.2	304,613.6	388,268.8
202006	329,376	353,041.6	311,540.5	394,542.7
202007	338,213	359,672.5	317,946.0	401,399.1
202008	311,315	351,895.9	309,522.4	394,269.5
202009	325,085	356,468.0	314,886.4	398,049.5
202010	333,222	369,416.4	327,834.8	410,997.9
202011	319,495	358,190.7	316,121.3	400,260.1
202012	339,602	371,872.2	330,371.1	413,373.3
202101	319,717	361,128.1	319,058.7	403,197.5
202102	297,535	342,474.9	300,939.9	384,009.9
202103	331,695	378,810.3	335,385.7	422,234.9
202104	322,008	356,381.8	313,567.7	399,195.9
202105	311,445	365,776.4	322,962.3	408,590.5
202106	328,915	372,376.8	329,903.7	414,849.9
202107	332,827	379,007.7	336,325.3	421,690.1
202108	322,312	371,231.1	327,872.7	414,589.5
202109	332,916	375,803.1	333,257.0	418,349.3
202110	319,526	381,202.8	338,388.7	424,016.9
202111	331,904	385,074.6	342,601.5	427,547.7
202112	345,878	391,207.4	348,734.3	433,680.5
202201	328,781	380,463.3	337,407.5	423,519.0
202202	308,562	361,810.1	319,292.9	404,327.3
202203	343,570	398,145.5	353,680.1	442,610.8
202204	328,097	375,717.0	331,671.6	419,762.3
202205	341,392	392,660.3	348,902.1	436,418.5
202206	332,369	376,614.5	330,265.1	422,963.9
202207	333,014	390,794.1	346,928.8	434,659.4
202208	346,787	398,115.0	354,426.5	441,803.5
202209	339,903	387,589.6	343,544.2	431,634.9
202210	342,256	400,538.0	356,492.6	444,583.3
202211	350,054	404,409.8	360,717.2	448,102.3
202212	347,467	410,542.6	366,850.0	454,235.1
202301	348,720	399,798.4	355,512.8	444,084.1
202302	320,442	381,145.3	337,399.1	424,891.4
202303	364,169	417,480.6	371,741.2	463,220.0
202304	329,573	387,503.4	340,250.7	434,756.1
202305	354,931	404,446.7	358,945.1	449,948.4
202306	361,154	411,047.1	365,907.7	456,186.5
202307	354,256	410,129.3	364,807.1	455,451.4
202308	365,528	417,450.2	372,309.5	462,590.8
202309	359,136	414,473.5	369,275.7	459,671.2
202310	367,559	419,873.1	374,371.5	465,374.8
202311	375,358	423,744.9	378,605.5	468,884.3
202312	370,061	422,329.0	376,589.6	468,068.4
202401	382,373	426,682.3	381,542.9	471,821.7
202402	359,884	408,029.2	362,536.5	453,521.8
202403	363,224	421,718.3	374,168.7	469,267.9
202404	378,764	421,936.0	375,092.1	468,779.9
202405	386,858	431,330.6	384,486.7	478,174.5
202406	366,422	422,833.5	375,437.1	470,230.0

There were 17.8 million drugs for dementia items prescribed from March 2020 to and June 2024 to identified patients with known age and gender. This was 11.8% fewer items than the 20.1 million expected to be prescribed during this time period. The actual number of items has generally remained below the range of items expected based on historical trends, though two months of Q1 2024/25 fell within the prediction interval.

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3. Sections in this release

• Medicines used in Mental Health summary
• BNF Section 4.3 - Antidepressant drugs
• BNF Section 4.1 - Hypnotics and anxiolytics
• BNF Section 4.2 - Drugs used in psychoses and related disorders
• BNF Section 4.4 - Central nervous system (CNS) stimulants and drugs used for ADHD
• BNF Section 4.11 - Drugs for dementia
• Medicines used in Mental Health background