Abstract
BackgroundLittle is known about trends in prescribing of anxiolytics (antidepressants, benzodiazepines, beta-blockers, anticonvulsants, and antipsychotics) for treatment of anxiety. Several changes may have affected prescribing in recent years, including changes in clinical guidance.AimTo examine trends in prescribing for anxiety in UK primary care between 2003 and 2018.Design and settingA population-based cohort study using Clinical Practice Research Datalink (CPRD) data.MethodAnalysis of data from adults (n = 2 569 153) registered at CPRD practices between 2003 and 2018. Prevalence and incidence rates were calculated for prescriptions of any anxiolytic and also for each drug class. Treatment duration was also examined.ResultsBetween 2003 and 2018, prevalence of any anxiolytic prescription increased from 24.9/1000 person-years-at-risk (PYAR) to 43.6/1000 PYAR, driven by increases in those starting treatment, rather than more long-term use. Between 2003 and 2006, incidence of any anxiolytic prescription decreased from 12.8/1000 PYAR to 10.0/1000 PYAR; after which incidence rose to 13.1/1000 PYAR in 2018. Similar trends were seen for antidepressant prescriptions. Incident beta-blocker prescribing increased over the 16 years, whereas incident benzodiazepine prescriptions decreased. Long-term prescribing of benzodiazepines declined, yet 44% of prescriptions in 2017 were longer than the recommended 4 weeks. Incident prescriptions in each drug class have risen substantially in young adults in recent years.ConclusionRecent increases in incident prescribing, especially in young adults, may reflect better detection of anxiety, increasing acceptability of medication, or an earlier unmet need. However, some prescribing is not based on robust evidence of effectiveness, may contradict guidelines, and there is limited evidence on the overall impact associated with taking antidepressants long term. As such, there may be unintended harm.
Highlights
Anxiety disorders are common and usually managed in primary care (1)
Antidepressant prescribing for generalised anxiety disorder (GAD) has increased over the same period, it is not known if long-term use has increased (5)
The 2011 National Institute for Health and Care Excellence (NICE) guidelines recommended that antipsychotics should not be prescribed for treatment of GAD (2)
Summary
Anxiety disorders are common and usually managed in primary care (1). The National Institute for Health and Care Excellence (NICE) stepped care guidelines recommend psychological therapy at step 2, followed by the option of medication at step 3 (2). Antidepressant prescribing for generalised anxiety disorder (GAD) has increased over the same period, it is not known if long-term use has increased (5). Due to their potential for dependency, benzodiazepines are not recommended for long-term use (6). There are no data on the prescribing of antipsychotics for anxiety (with the exception of GAD (5)), or on other drugs used for anxiety – beta-blockers and anticonvulsants – in recent years. Little is known about trends in prescribing of anxiolytics (antidepressants, benzodiazepines, beta-blockers, anticonvulsants, antipsychotics) for the treatment of anxiety. Long-term prescribing of benzodiazepines declined, yet 44% of prescriptions in 2017 were longer than the recommended four weeks. Incident prescriptions in each drug class rose substantially in young adults in recent years.
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