Page last updated: 18-DEC-2007

Prescribing for Mental Health


Statistical Publication Notice

18 December 2007

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Medicines used in Mental Health (annual update)

 

INTRODUCTION

ISD maintains a detailed database of all NHS prescriptions dispensed in the community in Scotland. The information is supplied to ISD by Practitioner Services Division (PSD)of National Services Scotland, who are responsible for the processing and pricing of all prescriptions dispensed in Scotland.
 
These data are augmented with information on prescriptions written in Scotland that were dispensed elsewhere in the United Kingdom. All these prescriptions are dispensed by community pharmacies, dispensing doctors and a small number of specialist appliance suppliers.
 
GPs write the vast majority of these prescriptions, with the remainder written mainly by nurses and dentists. They also include prescriptions written in hospitals that are dispensed in the community, but exclude drugs dispensed within hospitals themselves.
 
Medicines used in mental health includes details on prescribing trends for hypnotics, anxiolytics & barbiturates, drugs used in psychoses and related disorders, antidepressants, central nervous system stimulants and other drugs used for Attention Deficit Hyperactivity Disorder (ADHD) and drugs used for treatment of dementia.  All data are presented at Scotland and NHS Board level.  Statistics are presented for 2006/07 and include the number of items prescribed.

KEY POINTS

  • The prescribing of hypnotics, anxiolytics and barbiturates rose between 2005/06 and 2006/07 by 1.24%, from 2.10 million items to 2.13 million times.
  • The rate of increase in the prescribing of medicines indicated for depression increased, from 1.4% in 2005/06 to 3.57% in 2006/07.  In total 3.65 million 'antidepressant' items were prescribed in 2006/07.
  • The volume of medicines indicated for psychoses and related disorders rose between 2005/06 and 2006/07 up from 626,185 to 670,842 items; an increase of 7.13%.
  • Prescriptions for medicines used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) increased by 20.1% to 59,461 prescribed items between 2005/06 and 2006/07.
  • The number of prescriptions dispensed for medicines indicated for dementia continues to rise, up 14%, to 83,643 items in 2006/07.

INTERPRETATION

Changes in the number of prescribed items can be accounted for by both, changes in the number of individuals receiving medication and potentially,  the differences for those drugs which are being written for shorter intervals.

DETAILED FINDINGS

Hypnotics (BNF 4.1.1)

  • Prescribing of hypnotic drugs, used in the treatment of insomnia, fell by 29.5%, down from 1.56 million items in 1992/93 to 1.10 million in 2006/07.
  • Use of the benzodiazepine - Temaepam, has declined by 64% since 1992/93, but is still the most commonly prescribed hypnotic.
  • Prescribing of Zopiclone - a non benzodiazepine, has increased six fold since 1992/93 and now lies the second most commonly prescribed hypnotic.

Anxiolytics (BNF 4.1.2),

  • Prescribing of anxiolytic drugs, indicated for anxiety and insomnia, has increased by 2.3% between 2005/06 and 2006/07, up from 1.00 million to 1.03 million items.
  • Overall prescribing in of anxiolytics, in contrast to the hypnotics has increased by 31.2% since 1992/93.
  • Diazepam is the most commonly prescribed anxiolytic drugs, comprising 81.3% of all anxiolytic prescribing.

Barbiturates (BNF 4.1.3)

  • Barbiturate prescribing continues to decline, down from 2,092 to 1,860 items between 2005/06 and 2006/07.
  • Overall the prescribing of barbiturates has fallen by 85.8% since 1992/93.
  • Medical opinion is that barbiturates should only be used in the treatment of severe, intractable insomnia in those patients already taking barbiturates and avoided in the elderly.

Drugs used in psychoses and related disorders (BNF 4.2)

  • Between 2005/06 and 2006/07 the prescribing of drugs indicated for psychoses and related disorders increased by 7.1% up from 626,185 to 670,842 items.
  • Prescribing of antipsychotic drugs (BNF 4.2.1) shows a increase of 8.4% between 2005/06 and 2006/07, up from 523,353 to 567,568 items.
  • Antipsychotic depot injections (BNF 4.2.2) prescribing decreased by 2.9%, to 11,292 items between 2005/06 and 2006/07.
  • Prescribing of antimanic drugs (BNF 4.2.3) shows a marginal increase of 0.85% over 2005/06, rising to 91,982 items.
  • The newer atypical antipsychotic drugs account for 61.2% of all antipsychotic (BNF 4.2.1) prescribing in 2006/07.
  • Amisulpride shows the largest increase in use between 2005/06 and 2006/07, over doubling its use.

Antidepressants (BNF 4.3)

  • Over the period 1992/93 to 2006/07 prescribing of medicines indicated for depression has tripled growing from 1.2 million to 3.65 million items.
  • It is estimated that 8.8% of the Scottish population aged 15 and over  make daily use of an antidepressant drug.
  • Gross Ingredient Cost of antidepressant medicines in 2006/07 was £43.7 million, down from £54.9 million in the previous financial year.  The decrease is attributable to a number of drugs being reduced in price.
  • Prescribing of the two main types of antidepressant drugs, the older tricylics and the 'newer' Selective Serotonin Re-uptake Inhibitors (SSRI's) increased by 1.6% and 5.8% repectively in 2006/07.  Monoamine - oxidase Inhibitors (MAOI's) prescribing fell by 4.5%.  'Other' drug category increased by 0.5%, due to higher prescribing of Mirtazpine - up 20% compared to 2005/06.

Central Nervous System (CNS) stimulants and other drugs used for Attention Deficit Hyperactivity Disorder (ADHD) (BNF4.4)

  • The prescribing of drugs indicated for Attention Deficit Hyperactivity Disorder (ADHD) grew by 20.1% between 2005/06 and 2006/07, up from 49,258 to 59,461 prescribed items.
  • The Modified Release (MR) forms of Methylphenidate now accounts for 59.5% of all Methylphenidate prescribing.
  • The Gross Ingredient Cost (GIC) of CNS stimulants, and other drugs used for ADHD increased by 32.1% between 2005/06 and 2006/07, up from £1.89 million to £2.50 million.
  • The largest single user in 2006/07 of ADHD drugs is NHS Fife with 213 prescribed items per 1000 population aged 6 to 14.  The Scottish average for the same period was 101 prescribed items per 1000 population aged 6 to 14.

Drugs for Dementia (BNF 4.11)

  • Some 83,000 prescriptions were issued in 2006/07 for drugs indicated for dementia, an increase of 14.0% on 2005/06.
  • Prescribing of Memantine, the only drug licensed to moderate to severe Alzheimer's disease, grew by 18.9% up from 2,504 to 2,978 items in 2006/07.
  • Overall the Gross Ingredient Cost (GIC) of medicines indicated for the treatment of dementia increased by 17.5% to £8.78 million in 2006/07.

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MAIN CONTACTS:

Margaret Conway
Principal Information Analyst 
0141 282 2265
Healthcare Information Group (Prescribing)
Margaret.Conway@isd.csa.scot.nhs.uk

Victoria Hepworth
Information Analyst/Statistician
0131 275 6225
Healthcare Information Group (Prescribing)
Victoria.Hepworth@isd.csa.scot.nhs.uk

Joanne Collins
Senior Information Analyst
0131 275 6760
Healthcare Information Group (Prescribing)
Joanne.Collins@isd.csa.scot.nhs.uk

Mike Muirhead
Programme Principal
0131 275 6614
Improving Mental Health Information Programme
Mike.Muirhead@isd.csa.scot.nhs.uk

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GLOSSARY:

An item is an individual product prescribed by a doctor, nurse or pharmacist e.g., Aspirin 300mg tablets.  A prescription can contain up to three items.
 
Gross ingredient cost is the cost of drugs, dressings or appliances before the deduction of any discount that the dispenser may receive from a supplier.  It excludes any dispensing or fitting fees.
 
The British National Formulary (BNF) is a bi-annual publication produced jointly by the British Medical Association and Royal Pharmaceutical Society of Great Britain.  The BNF aims to provide prescribers, pharmacists and other healthcare professionals with sound up-to-date information on medicines and their use.
 
Cardiotoxicity - Having a deleterious or poisonous effect upon the function of the heart through damage to its muscle or conduction system.
 
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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

The Scottish Government
Chief Executives of each NHS Board
Chief Prescribing Advisers of each NHS Board
 
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HISTORY OF THIS PUBLICATION:

Last Published: 19 December 2006
Next Due: 23 December 2008
Data Avaliable Since: 16 December 2005


Main contact: Email Margaret Conway