Abstract
Background: Little is known about trends in prescribing of anxiolytics (antidepressants, benzodiazepines, beta-blockers, anticonvulsants, antipsychotics) for the treatment of anxiety. Several changes may have affected prescribing in recent years, including changes in clinical guidance. Aim: To examine trends in prescribing for anxiety in UK primary care between 2003-2018. Design and Setting: Population-based cohort study using Clinical Practice Research Datalink (CPRD) data. Methods: Analysis of data from adults (n=2,569,153) registered at CPRD practices between 2003-2018. Prevalence and incidence rates were calculated for prescriptions of any anxiolytic, and each drug class. Treatment duration was also examined. Results: Between 2003-2018, prevalence of any anxiolytic prescription increased from 24.9/1000 person-years-at-risk (PYAR) to 43.6/1000PYAR, driven by increases in those starting treatment, rather than more long-term use. Between 2003-2008, incidence of any anxiolytic prescription decreased from 12.8/1000PYAR to 9.3/1000PYAR; after which incidence rose to 13.1/1000PYAR in 2018. Similar trends were seen for antidepressant prescriptions. Incident beta-blocker prescribing increased over the 16-years, whilst incident benzodiazepine prescriptions decreased. 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. Conclusion: Recent 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 effect of taking antidepressants long-term. As such, there may be unintended harm.
| Original language | English |
|---|---|
| Pages (from-to) | e511-e518 |
| Number of pages | 8 |
| Journal | British Journal of General Practice |
| Volume | 72 |
| Issue number | 720 |
| Early online date | 31 Jan 2022 |
| DOIs | |
| Publication status | Published - 21 Mar 2022 |
Bibliographical note
Funding Information:This study was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project reference: CA2017), as part of Charlotte Archer’s doctoral studentship, and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Becky Mars is supported by a Vice Chancellor’s fellowship at the University of Bristol.
Publisher Copyright:
© 2022 Royal College of General Practitioners. All rights reserved.
Keywords
- mental health
- depression
- anxiety
- research methods
- epidemiology
- cohort study