Trends and geographical variation in antidepressant prescribing in primary care in England: a descriptive analysis

Abstract

BackgroundDuring the last decade antidepressant prescribing has increased substantially in the UK. This study aims to investigate trends and geographical variation in antidepressant prescribing in England in primary care. MethodsWe obtained monthly antidepressant data from OpenPrescribing.net from December, 2013, until November, 2018. The dataset included information about the number of dispensed items per month and the actual total cost by each clinical commissioning group (CCGs). We studied three antidepressant prescribing measures—the total number of antidepressant items prescribed, the number of antidepressant items prescribed per 1000 registered patients, and the actual cost per item. To examine CCG-level trends for each measure, we calculated deciles and extreme percentiles for each month and plotted time-trend graphs. FindingsDuring the study period, the average monthly numbers of antidepressants prescribed increased by 24% from 4 697 000 to 5 846 000. However, the average monthly rate per 1000 registered patients increased by 19%. A geographical variation was visible in prescribing behaviour across CCGs over the latest 12 months. There was over a 14-times difference between the lowest and highest total number of antidepressant items prescribed within CCGs (7569–110 830), with the highest prescribers in the South West and North of England and East Anglia. However, looking at antidepressant items prescribed per 1000 registered patients, there was 5-times difference, with the highest prescribers in North England and the East Midlands and East Anglia. CCGs within the South East and Greater London were the lowest prescribers. There was over a 2-times difference for the cost per item across CCGs, with the highest cost per item in the South East and Greater London region. Between the lowest and highest percentiles, the difference in the total number of antidepressant items has increased from 34,261 to 46,870 and the difference in items per 1000 registered patients has increased from and 84 to 107. However, the difference between the lowest and highest percentiles of the cost per item has decreased from 2·4 to 1·4. InterpretationWe observed an increasing overall trend in the total number of antidepressant items prescribed, but the cost showed a decreasing trend. Considerable geographical variation persisted across CCGs. The main limitation of the study was that there was no information available to estimate sex or age adjusted rates of antidepressant prescription. FundingNone