Northern Ireland has one of the world's highest prescription rates for antidepressant medicines, according to new research, but fresh questions have emerged over what may be driving the trend.
The analysis, carried out for Belfast-based investigative news website the Detail, examined 36 million prescription records from across the UK, including 3.5 million prescriptions written by GPs in the North. It is the first time such prescription records have been released and the raw data provided the basis for an international comparison to be carried out.
However, the research findings have questioned the conventional view that poverty and the legacy of the Troubles fully explain the high levels, prompting questions about the health service in the North and its prescription drug use.
The Detail's project, entitled The Script Report, found: Antidepressant prescription rates in the North far exceeded those of England and Wales, and were also higher than levels found in 23 countries featured in a global study. In the six-month period examined, GPs in the North prescribed enough antidepressants to give every man, woman and child a 27-day supply at the "defined daily dosage" limits. In England, GPs prescribed enough for 10 daily doses per patient. The figure in Wales was 19.
The North's prescription levels are higher than other UK regions with a similar economic profile, or similar or higher rate of depression. Doctors interviewed for The Script Report pointed to a problem among age groups too young to have directly experienced the Troubles. And, in addition to the findings on antidepressants, the report studied rates for more than 50 drugs that also included sedatives, painkillers and anti-anxiety medicines. In more than 40 of the drugs, Northern Ireland prescription rates exceed those of England.
“Coming out of the Troubles, people are beginning to talk about and recognise post-trauma anxiety, depression and stress,” said Tom McEneaney of Aware Defeat Depression, a mental health charity in Northern Ireland.
“Nobody’s shouting from the rooftops, but depression is sitting under the sofa, gathering momentum.”
Dr Tom Black, chair of the British Medical Association Northern Ireland GP Committee, said other factors were also playing a role.
He said public campaigns aimed at raising awareness of depression, as well as a health questionnaire introduced for patients, had led to some “self-diagnosing”, leaving GPs with less power to make decisions based solely on symptoms they observe.
“Politicians, the media and the public felt we were under-diagnosing, and they wanted to put the control in the patients’ hands,” said Dr Black.
But doctors also contend that longer periods of medication for patients have contributed to a rise in prescriptions. A further actor was access to alternative or additional therapies such as counselling.
The World Health Organisation’s defined daily dose system was used to make the drugs comparable in the study, but it is a unit of measurement and does not necessarily reflect what a doctor might prescribe to a patient, as this depends on individuals.
The study's methodology is explained in full in The Script Report, which can be accessed at The Detail’s website. The report was compiled by US data journalist Jon McClure. The findings add weight to calls for further examination of the issues fuelling Northern Ireland's prescription rates.
Responding to the findings, a spokesperson for the Department of Health for Northern Ireland said: "[When] primary care talking therapies hubs in each [health] trust area . . . are fully developed over the next three years, the hubs will improve access to low-intensity psychological care, promote a culture of early intervention and reduce reliance on pharmacological interventions."
More research needed
A spokesperson for the Health and Social Care Board said: “The HSCB recognises that much more needs to be done in order to provide alternatives to drug therapy for people who present with common mental health needs.”