Prescribing for Anxiety Has Increased in Those Under Age 35

Summary: Study reveals a significant uptick in the prescription of anxiolytics and benzodiazepines in people under the age of 35.

Source: University of Bristol

Researchers from the University of Bristol have found that there have been increases in incident prescribing of most anti-anxiety medications (called anxiolytics) in recent years, which have been substantial in young adults (aged under 25).

This may reflect better detection of anxiety, increasing severity of symptoms, increasing acceptability of medication, or an earlier unmet need. While overall incident benzodiazepine prescribing has fallen over time, prescribing has increased in those aged under 35. In 2017, 44% of benzodiazepine prescriptions were longer than the NICE recommended maximum of four weeks.

Some of this prescribing is not based on robust evidence of effectiveness, such as the use of beta-blockers, some may contradict guidelines, such as anti-psychotics, and there is limited evidence on the effect of taking antidepressants long-term. As such, there may be unintended harm.

Prior to this research, previous studies had found substantial increases in the prescribing of antidepressants for any indication, and for depression, over the past two decades. However, little was known about trends in the 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.

Dr. Charlotte Archer, an NIHR-funded Senior Research Associate in Primary Care Mental Health at Bristol Medical School (PHS), 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 and some may contradict guidelines. 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.

“The information from this study has allowed us to gain a better understanding of primary care prescribing for anxiety, and how 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.”

Abstract

Rise in prescribing for anxiety in UK primary care between 2003 and 2018: a population-based cohort study using Clinical Practice Research Datalink

Background

Little is known about trends in prescribing of anxiolytics (antidepressants, benzodiazepines, beta-blockers, anticonvulsants, and antipsychotics) for 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 and 2018.

Design and setting

A population-based cohort study using Clinical Practice Research Datalink (CPRD) data.

Method

Analysis of data from adults (n = 2 569 153) registered at CPRD practices between 2003 and 2018. Prevalence and incidence rates were calculated for prescriptions of any anxiolytic and also for each drug class. Treatment duration was also examined.

Results

Between 2003 and 2018, prevalence of any anxiolytic prescription increased from 24.9/1000 person-years-at-risk (PYAR) to 43.6/1000 PYAR, driven by increases in those starting treatment, rather than more long-term use. Between 2003 and 2006, incidence of any anxiolytic prescription decreased from 12.8/1000 PYAR to 10.0/1000 PYAR; after which incidence rose to 13.1/1000 PYAR in 2018. Similar trends were seen for antidepressant prescriptions. Incident beta-blocker prescribing increased over the 16 years, whereas incident benzodiazepine prescriptions decreased. Long-term prescribing of benzodiazepines declined, yet 44% of prescriptions in 2017 were longer than the recommended 4 weeks. Incident prescriptions in each drug class have risen 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 overall impact associated with taking antidepressants long term. As such, there may be unintended harm.