England April 2015 to June 2020
Quarterly Summary Statistics
Published 10 September 2020
Lsat reviewed and updated 10 December 2020
Key findings
The number of prescriptions for medicines used in mental health has fluctuated since March 2020, following lockdown restrictions being announced by the UK government on 23 March 2020 in response to the coronavirus (COVID-19) pandemic.
Four of the five drug groups used in these statistics saw a fall in levels of prescribing in Q1 2020/21 compared to the previous quarter. Drugs used in psychoses and related disorders was the only group to see an increase.
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.
Due to the implementation of lockdown measures on 23 March 2020 following the COVID-19 outbreak, this publication also includes analysis on prescribing figures observing the months following lockdown. It is important to note that these statistics can not infer causality of lockdown measures on the prescribing figures.
This publication presents data from April 2015 to June 2020, the most recent available.
Go to the annual Medicines Used in Mental Health - England webpage to find the most recent annual summary, background information, and explanatory notes that apply to the statistics presented in this release.
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.
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 a single series on a chart, you can click the series names you are not interested in 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: Quarterly Summary Tables - Quarterly table
3.56 million hypnotics and anxiolytics items were prescribed for the first quarter of financial year 2020/21. This was a 2.32% fall from 3.64 million items in the corresponding quarter in 2019/20, and a 2.61% fall from 3.65 million items in the preceding quarter. This matches the long term trend for hypnotics and anxiolytics which have been steadily declining in usage since Q1 2015/16.
The number of patients prescribed at least one hypnotic and anxiolytic item in Q1 2020/21 was 1.05 million. This was a 6.20% decrease from 1.11 million patients in the corresponding quarter in 2019/20, and a 5.86% decrease from the previous quarter. The long term trends for patients receiving one or more hypnotic and anxiolytic items match that of the prescribing of items.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for hypnotics and anxiolytics show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
Prescribing during the COVID-19 lockdown
National lockdown was implemented on 23 March 2020. Prescribing of hypnotics and anxiolytics during March 2020 saw a 0.50% increase in prescribed items compared to March 2019, along with a 1.27% decrease in the number of patients. April 2020 similarly saw a small increase of 1.31% in the number of prescribed items compared to April 2019, accompanied by a 0.93% decrease in patients.
May 2020 saw the biggest changes in number of items prescribed and patients receiving hypnotic and anxiolytic items. 9.48% less items were prescribed in May 2020 when compared to May 2019. May 2020 also saw a 5.86% decrease in the number of patients when compared with May 2019.
The relatively low level of prescribing in May 2020 was partially offset by an increase in June 2020, when there was an increase in items of 1.71% as compared to June 2019. The number of patients in June 2020 remained lower than the same month in 2019.
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: Quarterly Summary Tables - Quarterly table
19.2 million antidepressant drugs items were prescribed for the first quarter of financial year 2020/21. This was a 3.82% increase from 18.5 million items in the corresponding quarter in 2019/20, and a 2.13% decrease from 19.6 million items in the preceding quarter. Antidepressant drugs have been steadily increasing in usage since Q1 2015/16.
The number of patients prescribed at least one or more antidepressant drugs items in Q1 2020/21 was 5.88 million. This was a 2.07% increase from 5.76 million patients in the corresponding quarter in 2019/20, and a 1.88% decrease from the previous quarter. The long term trends for patients receiving one or more antidepressant drugs items match that of the overall prescribing of items.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for antidepressant drugs show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
Prescribing during the COVID-19 lockdown
National lockdown was implemented on 23 March 2020. Prescribing of antidepressant drugs during March 2020 saw a 10.8% increase in prescribed items compared to March 2019, along with a 9.00% increase in the number of patients. April 2020 saw an increase of 7.39% in the number of prescribed items compared to April 2019, accompanied by a 4.34% increase in patients.
May 2020 is the only month between July 2019 and June 2020 in which there were fewer prescribed items than the same month in the previous year, with volumes decreasing by 3.18% when compared to May 2019. However, the volume of patients that received an antidepressant drugs item increased slightly in May 2020 by 0.28% when compared to May 2019.
In June 2020 there was small increase in numbers of prescribed items and patients for antidepressant drugs. Prescribed items increased by 7.74% when compared to June 2019, and the number of patients increased by 6.67%.
Central nervous system stimulants and drugs used for attention deficit hyperactivity disorder
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: Quarterly Summary Tables - Quarterly table
428 thousand CNS stimulants and drugs used for ADHD were prescribed for the first quarter of financial year 2020/21. This was a 1.12% decrease from 433 thousand items in the corresponding quarter in 2019/20, and a 10.2% decrease from 476 thousand items in the preceding quarter. This goes against the long term trend for CNS stimulants and drugs used for ADHD which have been steadily increasing in usage since Q1 2015/16.
The number of patients prescribed at least one item from the “CNS stimulants and drugs used for ADHD” group in Q1 2020/21 was 118 thousand. This was a 3.55% increase from 114 thousand patients in the corresponding quarter in 2019/20, and a 6.42% decrease from the previous quarter. The long term trends for patients receiving an item from the “CNS stimulants and drugs used for ADHD” group match that of the overall prescribing of items.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for CNS stimulants and drugs used in ADHD show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
Prescribing during the COVID-19 lockdown
National lockdown was implemented on 23 March 2020. Prescribing of CNS stimulants and drugs used in ADHD during March 2020 saw a 14.5% increase in prescribed items compared to March 2019, along with a 17.5% increase in the number of patients. April 2020 saw an increase of 6.73% in the number of prescribed items compared to April 2019, accompanied by a 10.5% increase in patients.
May 2020 shows a sharp decline in the prescribing of CNS stimulants and drugs used for ADHD with prescribed items falling by 8.95% compared to May 2019. However, the number of patients receiving prescribing remained similar, increasing by 0.33% when compared to May 2019.
In June 2020 we see the decrease in prescribed items stabilise, falling by just 0.40% when compared to June 2020. However, we do see an increase in the number of patients for CNS stimulants and drugs used in ADHD of 5.88%.
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: Quarterly Summary Tables - Quarterly table
1.04 million drugs for dementia items were prescribed for the first quarter of financial year 2020/21. This was a 0.95% increase from 1.03 milliion items in the corresponding quarter in 2019/20, and a 1.00% decrease from 1.05 million items in the preceding quarter. This goes against the long term trend for drugs for dementia which have been steadily increasing in usage since Q1 2015/16.
The number of patients prescribed at least one drug for dementia item in Q1 2020/21 was 231 thousand. This was a 1.53% increase from 227 thousand patients in the corresponding quarter in 2019/20, and a 1.61% decrease from the previous quarter. The long term trends for patients receiving one or more drugs for dementia items match that of the overall prescribing of items.
Source: Quarterly Summary Tables - Monthly table
The monthly time series for drugs used in dementia show some regular patterns as well as month-to-month variation. Some of the regular changes may reflect seasonal patterns; most notably there tends to be less prescribing in months with fewer dispensing days, such as February.
Prescribing during the COVID-19 lockdown
National lockdown was implemented on 23 March 2020. Prescribing of drugs for dementia during March 2020 saw a 4.57% increase in prescribed items compared to March 2019, along with a 3.99% increase in the number of patients. April 2020 saw an increase of 8.71% in the number of prescribed items compared to April 2019, accompanied by a 4.97% increase in patients.
May 2020 shows a sharp decline in the prescribing of drugs for dementia with prescribed items falling by 6.61% compared to May 2019. The number of patients receiving drugs for dementia decreased by 1.06% when compared to May 2019.
In June 2020 we see an increase in prescribing rates again, with 1.23% more items being issued in June 2020 when compared to June 2019. However, this below the average rate of increase seen before the implementation of lockdown. The number of patients also increases slightly by 0.49%.
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 quarterly summary is intended to supplement annual 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.
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.
6. Accessibility
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7. Revisions to this document
10 December 2020:
- Added an accessibility section.
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