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England 2015/16 to 2019/20

Published 10 September 2020

Last reviewed and updated 9 December 2020


Key findings

  • The number of prescriptions for medicines used in mental health has increased between 2015/16 and 2019/20. Both the number of prescription items and the number of patients prescribed those items increased. There was increased use of prescription medicines used for:

    • 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.
  • There was a reduction in the use of prescription medicines used for hypnotics and anxiolytics over the same period.

  • Four out of the five groups of mental health drugs had a larger number of prescription medicines being prescribed to females than males. The exception to this is CNS stimulants and drugs used for ADHD, to almost three times as many males as females being prescribed these medications.

  • All five groups of medicines used in mental health were prescribed more often to people living in more deprived areas.

  • For hypnotics and anxiolytics, drugs used in psychoses and related disorders, and antidepressant drugs prescribing was most prevalent in patients aged 40-65. Prescribing for CNS stimulants and drugs used for ADHD was most prevalent in patients aged 24 and under, and drugs for dementia was most prevalent in patients aged 60 and over.


1. Introduction

Mental health is a key area of the NHS Long Term Plan published in 2019.

This publication aims to describe the prescribing of medicines used to improve mental health, in a primary care setting in England that are subsequently dispensed in the community. They do not include data on medicines used in secondary care, prisons, or issued by a private prescriber.

These statistics use the BNF therapeutic classifications defined in the British National Formulary (BNF) using the classification system prior to BNF edition 70. Each January the NHSBSA updates the classification of drugs within the BNF hierarchy which may involve some drugs changing classification between years of data. Five sections of the British National Formulary (BNF) are covered within these statistics:

  • Hypnotics and anxiolytics
  • Drugs used in psychoses and related disorders
  • Antidepressant drugs
  • CNS stimulants and drugs used for ADHD
  • Drugs for dementia

These medicines are classified by their primary therapeutic indication. However, it is possible that they can be prescribed for other reasons outside of this primary therapeutic indication. For example, some antidepressants can be used to treat people suffering from chronic primary pain. The clinical indication of a prescription is not captured by NHSBSA during processing, and therefore we cannot determine the reason that a prescription was issued. Due to this, these statistics may not give an accurate estimation of the population receiving treatment for a specific mental health condition.

Drug therapy is just one way that mental health conditions can be treated. These statistics do not give an indication of the number of patients accessing other mental health services, such as therapy.

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.

Patient identification

When the NHSBSA processes prescriptions, the NHS number of the patient is identified for most, but not all, prescriptions. The proportion of items for which a patient could be identified is shown in table 1. This means that data relating to patient counts represents most, but not all, patients.

In this release the term ‘patient/s’ is used to mean a unique, valid NHS number that has been captured from a prescription form and subsequently verified by the NHS Personal Demographics Service (PDS).

Where patients are identified, to assign them to a single age band their age is calculated at 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.

Table 1: The proportion of items for which an NHS number was recorded for listed BNF sections 2015/16 to 2019/20

Source: Statistical Summary Tables - Patient Identification Rates


2. Results and commentary

The charts in this report are interactive, and allow you to isolate the topics that you are interested in by selecting or deselecting a series from the legend of the chart. For example, if you only want to view the earliest financial year and latest financial year that data is available for, you can click the other financial years in the legend of the chart to deselect them. If you wish to include them again just click their legend entry again.

Hypnotics and anxiolytics

Hypnotics are used to treat insomnia - a difficulty getting to sleep or staying asleep long enough to feel refreshed. Most hypnotics will sedate if given during the day. Anxiolytics are used in the treatment of anxiety states and if given at night will help to induce sleep. The drugs classified as hypnotics and anxiolytics are described in the BNF 68 section 4.1:

  • BNF paragraph 4.1.1 - Hypnotics
  • BNF paragraph 4.1.2 - Anxiolytics
  • BNF paragraph 4.1.3 - Barbiturates

Source: Statistical Summary Tables - Hypnotics and anxiolytics - STP table

14.6 million hypnotic and anxiolytic items were prescribed in 2019/20. This was an 8.2% fall from 15.9 million items in 2015/16. The use of hypnotics and anxiolytics has decreased slowly since 2015/16. A small number of barbiturates are also prescribed each year, following the same trend as hypnotics and anxiolytics. The low level of prescribing for barbiturates may reflect the National Institute for Health and Care Excellence (NICE)’s advice against the use of intermediate-acting barbiturates except in the treatment of severe intractable insomnia in patients already taking barbiturates. NICE also advises that use of long-acting barbiturates as a sedative is not justified.

Source: Statistical Summary Tables - Hypnotics and anxiolytics - National table

2.1 million identified patients were prescribed at least one hypnotic or anxiolytic item in 2019/20 in England. This was 10.9% lower than 2.4 million patients in the peak of 2016/17. Approximately 2 million more hypnotics items are prescribed each year compared to anxiolytics. However, more patients have received an anxiolytic item in every year except 2015/16. The number of patients receiving a barbiturate was small and decreased each year, falling by 51.5% between 2015/16 and 2019/20.

The total number of patients was lower than the sum of the values shown in figure 2. This is because any patient who recieved medicines from more than one BNF paragraph would have been counted in the subtotal for each relevant paragraph.

Source: Statistical Summary Tables - Hypnotics and anxiolytics - Sex table

61.4% of patients in 2019/20 that were prescribed a hypnotic and anxiolytic item were female, 38.6% were male. These proportions have stayed broadly the same since 2015/16.

Source: Statistical Summary Tables - Hypnotics and anxiolytics - Age band table

There was a reduction in the number of people prescribed hypnotics and anxiolytics in each age group of 20 years or older between 2015/16 and 2019/20. On average there was a 32.7% increase in the number of patients under the age of 20 receiving a hypnotic and anxiolytic item between 2015/16 and 2019/20. The largest increase was for patients aged 10-14, growing by 62.9%.

Source: Statistical Summary Tables - Hypnotics and anxiolytics - IMD table

The English Indices of Deprivation 2019 have been used to provide a measure of patient deprivation. 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.

Figure 5 shows that more people were prescribed hypnotics and anxiolytics from practices in more deprived areas than from less deprived areas in each year from 2015/16 to 2019/20.

Antidepressant drugs

Antidepressant drugs are effective for treating moderate to severe depression. Antidepressant drugs are not generally advised for the routine treatment of mild depression, and psychological therapy should be considered initially. However, a trial of antidepressant therapy may be considered in cases resistant to psychological treatments or associated with other problems.

Antidepressant drugs are described in the BNF 68 section 4.3:

  • BNF paragraph 4.3.1 - Tricyclic and related antidepressant drugs
  • BNF paragraph 4.3.2 - Monoamine-oxidase inhibitors (maois)
  • BNF paragraph 4.3.3 - Selective serotonin re-uptake inhibitors (SSRIs)
  • BNF paragraph 4.3.4 - Other antidepressant drugs

Source: Statistical Summary Tables - Antidepressant drugs - STP table

76.3 million antidepressant items were prescribed in 2019/20, a 23.3% increase from 61.9 million items in 2015/16. Prescribing for antidepressant drugs has steadily increased since 2015/16, driven by increases in selective serotonin re-uptake inhibitors (SSRIs) and other antidepressant drugs. Tricyclic and related antidepressant drugs were prescribed more frequently since 2015/16. However, there were 30.9% fewer prescription items for moais in 2019/20 than in 2015/16.

Source: Statistical Summary Tables - Antidepressant drugs - National table

7.79 million identified patients received at least one prescription item for antidepressant drugs in 2019/20 in England, this was an increase of 13.9% from 6.84 million patients in 2015/16. The numbers of patients receiving a tricyclic and related antidepressant drug have stayed very similar over the five year period 2015/16 to 2019/20, and the number of patients receiving maosis, whilst small already, has decreased by 28.6% from 4,240 patients in 2015/16, to 3,080 in 2019/20.

The largest changes in number of patients over the five year period have been for SSRIs and other antidepressant drugs. The number of patients prescribed SSRI’s has increased from 4.24 million patients in 2015/16 to 4.93 million in 2019/20, a 16.4% change. The number of patients receiving at least one other antidepressant drug has increased from 1.21 million patients in 2015/16 to 1.64 million in 2019/20, a 35.5% increase.

The total number of patients was lower than the sum of the values shown in figure 12. This is because any patient who recieved medicines from more than one BNF paragraph would have been counted in the subtotal for each relevant paragraph.

Source: Statistical Summary Tables - Antidepressant drugs - Sex table

65.6% of patients in 2019/20 that were prescribed a drug for dementia item were female, 34.4% were male. These proportions have stayed broadly the same since 2015/16, in which 66.0% were females, and 34.0% were males.

Source: Statistical Summary Tables - Antidepressant drugs - Age band table

Between 2015/16 and 2019/20, levels of prescribing have increased in most age groups. Only the 40-44 age group has seen a drop in levels of prescribing of antidepressant drugs of 1.67%. The largest increase in prescribing for antidepressant drugs belongs to the 70-74 age group, with a raise of 25.0%.

Prescribing in adults and children

There is keen interest in the prescribing of antidepressant drugs in children, therefore we have included the additional breakdown below. Children are classed as patients aged 17 and under at 30 September for the given financial year.

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

Source: Statistical Summary Tables - Antidepressant drugs - Prescribing in children table

Prescribing of antidepressant drugs in children has increased relatively slowly, by 4.89% since 2015/16. Whereas prescribing of antidepressants in adults aged 18 and over have increased by 14.2% between 2015/16 and 2019/20.

Source: Statistical Summary Tables - Antidepressant drugs - IMD table

The English Indices of Deprivation 2019 have been used to provide a measure of patient deprivation. 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 2020.

Figure 15 shows that more people were prescribed antidepressant drugs from practices in more deprived areas than from less deprived areas in each year from 2015/16 to 2019/20. The increase in patients receiving an antidepressant drug since 2015/16 has been fairly evenly shared amongst the IMD deciles, all seeing an increase in patients between 10% and 16% from 2015/16 to 2019/20.

Central nervous system 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

Source: Statistical Summary Tables - CNS stimulants and drugs used for ADHD - STP table

In 2019/20 there were 1.80 million prescriptions for CNS stimulants and drugs used for ADHD, a 37.8% increase from 1.31 million items in 2015/16. Prescribing for CNS stimulants and drugs used for ADHD has steadily increased year on year since 2015/16, driven by yearly increases in methylphenidate hydrochloride and lisdexamfetamine dimesylate items. Methylphenidate hydrochloridev was the most commonly prescribed chemical substance in BNF 68 section 4.4; 1.27 million items were prescribed in 2019/20.

Source: Statistical Summary Tables - CNS stimulants and drugs used for ADHD - National table

153 thousand identified patients received at least one prescription item for CNS stimulants and drugs used for ADHD during 2019/20. This was a 44.6% increase from 106 thousand patients in 2015/16. Similar to the trends in prescribed items, the chemical substances with the largest growth in patients were methylphenidate hydrochloride and lisdexamfetamine dimesylate, increasing by 33.4% and 282% respectively.

The total number of patients was lower than the sum of the values shown in figure 17. This is because any patient who recieved medicines from more than one BNF paragraph would have been counted in the subtotal for each relevant paragraph.

Statistical disclosure control has been applied to this chart for chemical substances that have patient counts less than five for a financial year. These data points have been omitted from figure 17.

Source: Statistical Summary Tables - CNS stimulants and drugs used for ADHD - Sex table

26.4% of patients in 2019/20 that were prescribed a CNS stimulant and drugs used for ADHD item were female, 73.6% were male. These proportions have stayed broadly the same since 2015/16, in which 24.1% were females, and 75.9% were males.

Source: Statistical Summary Tables - CNS stimulants and drugs used for ADHD - Age band table

Between 2015/16 and 2019/20 most age groups have a seen a rise in levels of prescribing. 73.4% of patients in 2019/20 prescribed a CNS stimulants and drugs used in ADHD item in England were under the age of 25. The 30-34 age group has seen the largest proportionate increase in patients between 2015/16 and 2019/20, rising by 127%, whereas the 10-14 age group has increased by 39% over the same period, marking the largest absolute increase of just over 13 thousand.

Source: Statistical Summary Tables - CNS stimulants and drugs used for ADHD - IMD table

The English Indices of Deprivation 2019 have been used to provide a measure of patient deprivation. 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 2020.

Figure 20 shows that more people were prescribed CNS stimulants and drugs used for ADHD from practices in more deprived areas than from less deprived areas in each year from 2015/16 to 2019/20. 83.2% more patients appear in the most deprived decile as opposed to the least deprived decile in 2019/20.

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 (due to cerebrovascular disease), dementia with Lewy bodies, mixed dementia, and frontotemporal dementia.

Drugs for dementia are described in the BNF 68 section 4.11:

  • BNF chemical substance 0411000D0 - Donepezil hydrochloride
  • BNF chemical substance 0411000E0 - Rivastigmine
  • BNF chemical substance 0411000F0 - Galantamine
  • BNF chemical substance 0411000G0 - Memantine hydrochloride

Source: Statistical Summary Tables - Drugs for dementia - STP table

4.21 million drugs for dementia items were prescribed in 2019/20, a 23.7% increase from 3.41 million items in 2015/16. Prescribing for drugs for dementia has steadily increased since 2015/16, driven by increases in prescribing of memantine hydrochloride. Donepezil hydrochloride is the most popular chemical substance in BNF section 4.11 with 2.15 million items prescribed in 2019/20. Since 2015/16 memantine hydrochloride prescribing has increased by 79.3%, from 828 thousand items to 1.48 million in 2019/20.

Source: Statistical Summary Tables - Drugs for dementia - National table

During financial year 2019/20, 279 thousand unique identified patients received at least one prescription item for drugs for dementia in England, this was a 20.8% increase from 231 thousand patients in 2015/16. Similar to the trends in prescribed items, the chemical substance with the largest growth in patients was memantine hydrochloride, increasing by 72.2%.

The total number of patients was lower than the sum of the values shown in figure 22. This is because any patient who recieved medicines from more than one BNF paragraph would have been counted in the subtotal for each relevant paragraph.

Source: Statistical Summary Tables - Drugs for dementia - Sex table

61.2% of patients in 2019/20 that were prescribed a drug for dementia item were female, 38.8% were male. These proportions have stayed broadly the same since 2015/16, in which 62.2% were females, and 37.8% were males.

Source: Statistical Summary Tables - Drugs for dementia - Age band table

Drugs for dementia were most often prescribed to patients aged 50 and over; just over half of these patients were in their 80’s.

Source: Statistical Summary Tables - Drugs for dementia - IMD table

The English Indices of Deprivation 2019 have been used to provide a measure of patient deprivation. 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 2020.

Figure 25 shows that more people were prescribed drugs for dementia from practices in more deprived areas than from less deprived areas in each year from 2015/16 to 2019/20. 43.5% more patients appear in the most deprived decile as opposed to the least deprived decile in 2019/20.


3. Background

Hypnotics and anxiolytics

Hypnotics and anxiolytics are used to treat insomnia and anxiety respectively.

Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the morning, despite there being enough opportunity to sleep. The most common problem with insomnia is difficult falling asleep (sleep-onset insomnia). An insomniac may also experience:

  • waking in the night
  • not feeling refreshed after sleep and not being able to function normally during the day
  • feeling irritable and tired and finding it difficult to concentrate
  • waking when they have been disturbed from sleep by pain or noise
  • waking early in the morning

Anxiety is a feeling of unease, such as worry or fear, which can be mild or severe. Everyone experiences feelings of anxiety at some point in their life and feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life. There are several conditions for which anxiety is the main symptom. Panic disorder, phobias and post-traumatic stress disorder can all cause severe anxiety.

You can find more information about insomnia and anxiety from the NHS website.

Antidepressant drugs

Antidepressant drugs are licensed to treat major depression. Health professionals use the words depression, depressive illness or clinical depression to refer to depression. It is a serious illness and very different from the common experience of feeling unhappy or fed up for a short period of time. Depressed people may have feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with daily life, and can last for weeks, months or years, rather than days.

It should be noted that antidepressant drugs are used for indications other than depression. For example, migraine, chronic pain, myalgic encephalomyelitis (ME) and a range of other conditions. Therefore the statistics on these drugs do not relate solely to prescribing for depression.

You can find more information about depression on the NHS website.

Central nervous system stimulants and drugs used for ADHD

Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) refer to a range of problem behaviours associated with poor attention span. These may include impulsiveness and hyperactivity, as well as inattentiveness; behaviours that often prevent children and adults from learning and socialising. ADHD is sometimes referred to as hyperkinetic disorder (HD).

You can find more information about ADHD on the NHS website.

Drugs for dementia

Dementia is a disease that leads to progressive loss of brain function typified by memory loss, confusion, speech difficulties and problems in understanding. There are over 100 different types of dementia. The most common forms are:

  • Alzheimer’s disease
  • Vascular dementia
  • Dementia with Lewy bodies
  • Pick’s disease
  • Huntington’s disease
  • Alcohol-related dementia
  • HIV/AIDS related dementia

Dementia mainly affects older people, but can also occur in people as young as thirty due to either alcohol abuse or HIV/AIDS. No cure for dementia currently exists. However, drugs may slow the rate of decline or in some patients make a small improvement in symptoms. Despite this, disease progression is inevitable.

You can find more information about the various types of dementia on the NHS website.


4. About these statistics

This publication is the first in a new series by NHSBSA. This annual summary is supplemented by quarterly summary statistics released alongside it.

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 recieved 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.

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 2020 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.

Index of deprivation

IMD deciles are calculated by ranking the LSOAs 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.

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. For the next release of this series we will introducing an age standardised prescribing rate to allow for more valid comparisons between geographical areas.

We will also be introducing additional cleansing of patient information to more accurately identify patients. This may change a very small amount of historical data, but will eliminate instances of double counting of patients where their information is inconsistent over time.

We will be introducing measures relating to defined daily doses (DDDs) in a future release to allow for easier international comparisons.


5. Statistical disclosure control

Statistical disclosure control has been applied to these statistics. Patient, item, and net ingredient cost (NIC) have been redacted in the supporting summary tables if they are below five, or a patient count of less than five can be inferred from them. Further information about our statistical disclosure control protocol can be found on our website.

The high level figures in this statistical summary have been rounded where appropriate for clarity, in most cases to three significant figures. This is to make this narrative as accessible as possible to all readers. The summary tables released with this publication allow users to investigate this data at lower levels of granularity. Figures in the supplementary tables have not been rounded.


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7. Revisions to this document

9 December 2020:

  • Added an accessibility section.

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