Anxiety and depression are common mental health disorders (CMD) in the UK, and medication can be prescribed by GPs to help patients with their symptoms. Antidepressants are the main recommended drug treatment, although other drugs (such as benzodiazepines, anticonvulsants, antipsychotics or beta-blockers) may also be prescribed for anxiety. Prior to the COVID-19 pandemic, incident prescriptions for most of these drugs were increasing for patients with anxiety, and a substantial increase had also been seen in prescribing of antidepressants for patients with depression.
Recent research found a decrease in the number of patients prescribed antidepressants and benzodiazepines in the immediate period after the March 2020 phase 1 COVID-19 lockdown, with a corresponding decrease in GP recorded anxiety and depression. However, incidence of recorded CMDs and prescriptions started to return to pre-pandemic levels around six months later. However, antidepressants and benzodiazepines have indications beyond treating mental illness, and as the authors did not link prescriptions to a CMD Read code, we do not know with certainty if these prescribing events were for anxiety and depression. Additionally, we do not know how these trends may have been affected by the later phase 2 and 3 lockdowns during the pandemic, or the effect on trends in the prescribing of other psychotropic medication for CMDs.
Therefore, our aim is to examine trends in GP recorded anxiety and depression, and trends in psychotropic prescribing specifically for anxiety and depression, from the March 2020 ‘lockdown’ up to June 2021 (or to the most recent available date).
This study will investigate the effect of the COVID-19 pandemic on trends in GP recorded anxiety and depression, and trends in prescribing for anxiety and depression, in the UK from 1st March 2010 to 30th June 2021 (or most recent available date), and examine associated factors. The study will use a retrospective cohort design, including patients aged 18 or over. The number of patients with a new episode defined by an anxiety or depression code in each calendar month will be calculated, and the number of patients who started psychotropic medication in each calendar month will be calculated.
Using data from the 10years before March 2020, we will use negative binomial regression models to estimate expected monthly incidence counts. For each month, observed and expected counts will be converted to rates using the observed person-month denominator. Monthly expected rates (95%CIs) will be plotted against observed rates. Differences between expected and observed rates will be expressed as relative rate reduction (percentages with 95%CIs). Trends (recorded codes/prescribing) over time will be examined for: (1) anxiety and depression combined; (2) anxiety; and (3) depression. For prescribing, for each of these three groups, data will be plotted to examine patterns of prescribing over time for all medications combined (antidepressants, anticonvulsants, benzodiazepines, antipsychotics, beta-blockers (antidepressants, antipsychotics and anticonvulsants only for group 3)), and separately for SSRIs. Data will be stratified by age, gender, region and deprivation. Joinpoint analysis will be used to explore key timepoints in the data.
The study will provide valuable insight into trends in GP recorded anxiety and depression, and prescribing for these conditions, during the COVID-19 pandemic. Findings will inform further research on the impact of the pandemic and remote consulting on patients with anxiety or depression, and will identify areas to explore in terms of future treatment for these conditions.
The outcomes are trends in recorded anxiety and depression, and trends in prescribing for anxiety and depression, in the UK between 1st March 2020 and 30th June 2021 (or the most recent available date).
Charlotte Archer - Chief Investigator - University of Bristol
Charlotte Archer - Corresponding Applicant - University of Bristol
David Kessler - Collaborator - University of Bristol
Nicola Wiles - Collaborator - University of Bristol
Rupert Payne - Collaborator - University of Bristol
Stephanie MacNeill - Collaborator - University of Bristol
Practice Level Index of Multiple Deprivation