Twenty-five year trend in antipsychotic medication prescribing in England: challenges and opportunities

Antipsychotics are primarily indicated for psychotic disorders. There is increasing concern regarding their potential overuse for other conditions.

To examine the change in the number of community prescriptions and corresponding costs for antipsychotics per head of population over 25 years (1998-2022) in England.

The data for 1998-2022 were obtained from two separate resources from the OpenPrescribing database: from 1998 to 2016 from their long-term trends data-set; and for 2017-2022 from the monthly medication prescribing data. The relevant British National Formulary subcategories 4.2.1 'antipsychotic drugs' and 4.2.2 'antipsychotic depot injections' were selected. The annual differences in prescriptions and the mean average annual increase were calculated. Scatter plots to visualise the yearly trend and Spearman testing to assess the strength of the correlations were done. The total annual costs of these medications were calculated for this time period.

The annual mean increase in the number of prescriptions was 287 548 in raw numbers and 4.27 per 1000 population. There is a statistically significant and strong positive relationship between time and the prescriptions of antipsychotics per 1000 population (Spearman correlation coefficient 0.995, P ≤ 0.001). This increasing trend is driven by the increase in oral antipsychotic drug prescriptions over time (Spearman correlation coefficient 0.995, P ≤ 0.001). Antipsychotic drug costs increased until 2011, reduced until 2016 and rose again during 2020-2022.

This analysis suggests a worrying increasing trend in antipsychotic medication prescribing. Potential causal factors include off-licence use. Clinical practice and research implications are discussed.