Prescribing of central nervous system (CNS) stimulants and drugs used for attention deficit hyperactivity disorder (ADHD) has increased by almost two-thirds since 2015, according to calculations based on the latest figures released by the NHS Business Services Authority (NHSBSA). Over the same period, the number of users increased by over four-fifths.
Most prescriptions were issued to young males, and prescriptions were more common in areas of the highest deprivation.
Statistics for Medicines used in mental health cover prescriptions in England that were dispensed in the community (ie, excluding hospitals, prisons, and private prescriptions) for five British National Formulary (BNF) drug groups. They showed that between October and December 2022, CNS stimulant and ADHD drug prescriptions accounted for 650,000 items dispensed – up 6% on the previous quarter and the largest increase of all the groups. It brought the total number of such prescriptions for the year 2021/22 to 2.13 million, up 16.4% from 1.83 million items in the previous year, and a 63.3% increase from 1.31 million items in 2015/16.
The BNF category of CNS stimulants and drugs used for ADHD items includes:
- Caffeine and caffeine citrate
- Dexamfetamine sulfate
- Methylphenidate hydrochloride
- Atomoxetine hydrochloride
- Dexmethylphenidate hydrochloride
- Lisdexamfetamine dimesylate
- Pitolisant hydrochloride
For the whole year 2021/22, 191,000 identified patients received at least one prescription item for CNS stimulants and drugs used for ADHD – 18.0% up on the 162,000 identified patients in the previous financial year and 80.1% compared with the 106,000 identified patients in 2015/16. However, NHSBA noted that increases in identified patient numbers were likely to be over-estimated, as the proportion of patients who could be identified also increased – from 80.0% in 2015/16 to 87.6% in 2021/22.
Prescriptions Twice as Common for Males as Females
Unlike the other drug groups, in which females comprised the largest proportion of identified patients, over twice as many males as females were prescribed CNS stimulants and ADHD drugs.
Over the course of the 2021/22 year, 133,000 (69.6%) patients were male versus 58,000 (30.4%) female. This represented a decrease of 6.30 percentage points in the proportion of male identified patients since 2015/16, with a corresponding increase in the female proportion.
The most common group to be prescribed CNS stimulants and drugs used for ADHD in 2021/22 was male patients aged 10-14 (43,100 identified patients, 22.6%), followed by males aged 15-19 (27,700, 14.6%), and boys aged 5-9 (15,200, 7.98%).
Prescription Rates Linked with Deprivation
Based on the English Indices of Deprivation, those prescribed CNS stimulants and drugs used for ADHD were more likely to attend practices in more deprived areas – 28,000 patients in 2021/22 were from the most deprived areas in England, compared with 15,400 from the least deprived areas, representing 81.4% more patients hailing from deprived areas.
Tony Lloyd, chief executive of the ADHD Foundation, said : "ADHD has been significantly underdiagnosed in the UK at less than 2% of the population, when World Health Organisation states prevalence is at least 5.9%.
"It is particularly challenging in childhood; however most adults [with ADHD] choose careers and lifestyles that play to their cognitive strengths.
"The increase in adult diagnosis – estimated at approximately 400% in the past 3 years – is a rebalancing of the significant historical underdiagnosis. Approximately 180,000 adults in the UK use ADHD medications – a fraction of those who have ADHD – though many adults do not even know they have ADHD and the majority of children missed are girls."
He pointed out that more than half of all new diagnoses in adults were in women, in contrast to three boys to every girl diagnosed by children's health services.
Antidepressant Prescriptions Also Increased
Other full year statistics for 2021/22 capable of compilation as a result of the last quarter's figures included those for antidepressants, with 83.4 million items prescribed, up 5.07% from 79.4 million in 2021/22 and 34.8% increased compared with 61.9 million items in 2015/16. The category includes tricyclic and related drugs, selective serotonin re-uptake inhibitors (SSRIs), and monoamine-oxidase inhibitors (MAOIs).
The number of recipients of antidepressants, 8.32 million identified patients in 2021/22, represented a 5.72% increase over the previous year and an increase of 21.6% from 6.84 million patients in 2015/16. NHSBA commented: "Both the number of items issued and patients receiving antidepressants increased for the sixth consecutive year."
This was despite current advice that antidepressant drugs not be prescribed for routine treatment of mild depression, with psychological therapy recommended initially.
Of the total recipients of antidepressants, 5.47 million (65.8%) were female and 2.85 million (34.2%) male. These proportions have stayed broadly the same since 2015/16, commented NHSBA. The most common age distributions among female patients were: ages 50-54 (544,000 or 6.54% of all patients), 55-59 (530,000 or 6.38%), and 45-49 (459,000 or 5.52%).
'Keen Interest' in Antidepressant Prescribing in Children
In addition: "There is a keen interest in the prescribing of antidepressant drugs in children," said NHSBA. Although children accounted for just 0.86% of all identified patients in 2021/22, there were 71,300 aged 17 and under who received at least one antidepressant prescription item in 2021/22, 9.17% up on the 65,300 the previous year.
Again, in 2021/22, antidepressants were more likely to be prescribed to patients attending practices in areas of higher deprivation - more than doubled at 1.29 million, compared with 589,000 in the least deprived areas.
Also increased last year were drugs for dementia, with an estimated 4.07 million items prescribed in 2021/22, up 0.46% on 2020/21's figures, and 277,000 identified patients, a 0.52% increase from the previous year. The largest group of recipients of these drugs was female patients aged 85-89.
One-Fifth Increase in Anti-Psychotics Since 2015
While all five drug categories were prescribed more often to patients living in more deprived areas, the largest disparity was for drugs used in psychoses and related disorders, which saw almost three times as many patients receiving prescribing from practices in the most deprived areas of the country compared with the least deprived.
In total, 13.2 million antipsychotics were prescribed in 2021/22, 1.46% up from the 13.0 million items in 2020/21 and a 19.7% increase from 11.0 million in 2015/16.
The increase was mostly accounted for by the 11.7 million items in the BNF category antipsychotic drugs – up by 24.7% from 9.39 million in 2015/16 – as against antipsychotic depot injections and drugs used for mania and hypomania, which both decreased, by 22.6% and 7.04%, respectively.
Prescriptions for hypnotics and anxiolytics (a BNF category that includes barbiturates) overall reduced in 2021/22, with the 14.0 million items prescribed representing a 1.88% decrease from 14.3 million in 2020/21 and a 12.0% decrease from 15.9 million in 2015/16. Specifically, since 2015/16, hypnotics decreased by 11.4% (9.17 million to 8.13 million); anxiolytics by 12.7% (6.77 million to 5.91 million), and barbiturates by 74.4% (5510 to 1410 items).