Tracking the rise in prescribing for anxiety in UK primary care

An increase in medication prescriptions for anxiety between 2003-2018 has been uncovered by new research from the University of Bristol. This increase is thought to be a result of new patients starting treatment, rather than increases in long-term use. Better detection of anxiety and patients being more accepting of medication could also be factors.

Anxiety disorders are common and usually managed through primary care. Talking therapy is recommended at first. However, in situations where psychological therapy doesn’t help improve the condition, a patient may be prescribed medications know as anxiolytics. These can include antidepressants, benzodiazepines, beta-blockers, anticonvulsants and antipsychotics.

Before this study, little was known about trends in prescribing anxiolytics for anxiety, other than the substantial increase in prescribing antidepressants over the past 20 years. To analyse these trends the team of researchers from the National Institute for Health Research Bristol Biomedical Research Centre (NIHR Bristol BRC), Applied Research Collaboration West (ARC West) and Centre of Academic Primary Care (CAPC), examined data from the Clinical Practice Research Datalink (CPRD).

They looked at differences over time and differences according to age and gender. They also looked at whether any changes in prescribing over time were due to new prescriptions or changes in the length of treatment.

They found increases in prescribing for most anxiolytic medications, not just antidepressants. The increases were substantial among young adults aged 18-34, with benzodiazepine prescribing also increasing for this age group.

The researchers concluded that several changes may have affected prescribing in recent years. This includes better detection of anxiety, patients being increasingly willing to accept medication, or an earlier unmet need.

Dr Charlotte Archer, Senior Research Associate in Primary Care Mental Health, said:

“The increases in the number of new patients starting anxiolytic treatment may reflect better detection of anxiety by GPs. The increase in new prescriptions was substantial in those aged 18-34, particularly in recent years, and this may also reflect an earlier unmet need for young adults.

“It is also important to consider that some of this prescribing is not based on robust evidence of effectiveness, such as the use of beta-blockers for anxiety, and some may contradict guidelines, such as the use of antipsychotics. There is also limited evidence on the effect of taking antidepressants long-term, so there may be unintended harm to those that are be being prescribed this medication for a long time.

“This information has allowed us to gain a better understanding of primary care prescribing for anxiety, and trends have changed over the study period. Going forward we need research to improve our understanding of why we are seeing this increase in prescribing, especially in young adults, and to provide interventions that can reduce the growing reliance on medication for this age group.”

Charlotte’s work on this study was funded by the NIHR School for Primary Care Research (SPCR).

Paper

Rise in prescribing for anxiety in UK primary care between 2003 and 2018: a population-based cohort study using Clinical Practice Research Datalink
Charlotte Archer, Stephanie J MacNeill, Becky Mars, Katrina Turner, David Kessler and Nicola Wiles
Published in the British Journal of General Practice