Has deprivation in Blackpool sparked the rise of antidepressants during lockdown?

New research has found Blackpool residents were prescribed more mental-health related medication during the beginning of lockdown than any other area in Lancashire or South Cumbria.
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Research by Echo, Lloyds Pharmacy’s online repeat prescription service, analysed prescription trends from England’s clinical commissioning groups (CCGs) to find out how demand for antidepressant, anti-insomnia and anti-anxiety medication compared across the country during the early period of the Covid-19 lockdown.

The analysis shows that, in March, the North West prescribed more antidepressants and anti-insomnia medication per 1,000 patients than any other CCG in England and NHS Blackpool prescribed more medication combined than any other CCG in the Lancashire and South Cumbria region.

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For the month of March, 122 antidepressants were prescribed per 1,000 CCG patients in the North West region, which is more than any other English region and the highest rate of any month analysed. The months of March and April combined also saw the North West prescribing at the highest rate - 233 antidepressants per 1,000 patients.

Anti-depressant use is higher in Blackpool than in neighbouring areasAnti-depressant use is higher in Blackpool than in neighbouring areas
Anti-depressant use is higher in Blackpool than in neighbouring areas

The region also prescribed the most anti-insomnia medication (11.9), as well as the second most anti-anxiety medication (9.3) per 1,000 patients in March 2020.

Data from NHS Digital shows there was an overall increase of 9.3 per cent in medicines prescribed in England in March 2020 compared to March 2019. This effect was seen to varying extents across most types of medicines.

NHS Blackpool, which has some of the highest levels of deprivation in England, prescribed more antidepressant, anti-insomnia and anti-anxiety medication combined than any other CCG in the Lancashire and South Cumbria region.

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In total, per 1,000 people, 205.2 prescriptions were made for people in Blackpool, made up from 7.5 for anti-anxiety, 188.6 antidepressant and 9.2 for insomnia.

Helen Barnard from the Joseph Rowntree TrustHelen Barnard from the Joseph Rowntree Trust
Helen Barnard from the Joseph Rowntree Trust

Alistair Murray, chief pharmacist at Echo, said that while the link between deprivation and mental health is ‘complex’, it has been a worrying time for areas like Blackpool.

He said: “A recent study by Public Health England showed an association where people in more deprived areas were prescribed more antidepressants per head of population and also were more likely to receive this treatment for longer periods of time.

“This link is complex but organisations such as the Joseph Rowntree Foundation have highlighted ONS data showing that people in more deprived areas are less likely to have the ability to work from home for their jobs. This situation means that during lockdown there are greater risks of a drop in income, or that if they have to go to work they may have worried about a greater risk of exposure to the virus.

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“We won’t know the long term effects of this on people’s mental health for some time but it’s clear that it has been a worrying time in areas with more deprivation.”

According to the Office for National Statistics, nearly half of UK adults reported high levels of anxiety between March 20 and 30, as the nation went into lockdown and measures of personal wellbeing for this period were described as being at their “worst levels” since the ONS began collecting this type of data in 2011.

The ONS also produced figures that showed that the age-standardised mortality rate of deaths involving Covid-19 in the most deprived areas of England was 55.1 deaths per 100,000 population compared with 25.3 deaths per 100,000 population in the least deprived areas.

Helen Barnard, the acting director of the Joseph Rowntree Foundation, an independent social change organisation working to solve UK poverty, said it was “vital” to end the correlation between low income and poor health.

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She said: “As a country we believe in protecting each other from harm, and this is especially apparent when we see people willingly disrupting their lives to abide by the current restrictions.

But even before coronavirus there were signs that our record on tackling poverty and health inequalities was unravelling. It can never be right that someone’s life chances are so profoundly affected by where they live or how much money their family has.

“It’s crucial that all aspects of the spread of this virus are carefully examined, but we know that people in more deprived areas are less likely to have jobs where they can work from home.

This means they may have to face a very significant drop in income or keep going to work, facing greater risks of catching the virus. They are also more likely to live in overcrowded homes, increasing the risk for whole families. This just is not right.

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“As well as dealing with the current crisis, it is vital to break the grip of poverty on the health of the nation in the long term. This means rethinking how we treat the lowest paid members of our society who have sustained us and kept us safe during this crisis. By doing so, we can help end the spiral of low income and poor health which may have had especially tragic consequences during this pandemic.”

Other figures through Echo’s research show that as a whole, Blackpool’s CCG saw an year-on-year increase in antidepressant prescriptions of 11.5 per cent for March 2019 to March 2020 (29,207 prescriptions compared with 32,578).

This fell to a 4.72 per cent increase for April 2019 to April 20 when 31,980 were prescribed.

Mr Murray explained that a lot of people ordered their next prescription early because there was “so much uncertainty” about how lockdown would work and people didn’t want to be left without medicines.

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He added: “This led to some short term supply issues across the country but wasn’t as marked as the panic-buying that we saw in supermarkets and the medicines supply chain returned to normal quite quickly.

“With antidepressants, we know that people can experience withdrawal symptoms if they stop taking them suddenly so it’s not surprising that people didn’t want to risk running out of their antidepressants.

“It’s unlikely that the increase at this stage is due to new prescriptions because there is normally a gap between initial contact with a GP and the time of first prescription while other options such as talking therapies are considered.

“However, we know from various surveys that many people have experienced a worsening of their mental health during Covid and lockdown so we will be revisiting the data for May and June once it becomes available as this will show some of the more lasting impact of lockdown on mental health.”

Has pandemic impacted our mental health?

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Mental health charity Mind said the country has hit a ‘mental health emergency’ following the pandemic and that new problems have arisen and existing problems have got worse.

A spokesman for the charity said: “The coronavirus (Covid-19) pandemic will leave a deep and lasting scar on the mental health of millions in this country. The devastating loss of life, the impact of lockdown and loneliness, and the inevitable recession that lies ahead will affect all of us.

“Prioritising mental health has never been more critical than it is now. New mental health problems have developed as a result of the pandemic, and existing mental health problems have gotten worse.”

More than 16,000 adults and teenagers shared their experiences of mental health during the pandemic as part of research by the charity. It said that more than two thirds of adults with mental health problems reported that their mental health got worse during lockdown.

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Mind also found that people living in social housing (a proxy for social deprivation) were more likely to have poor mental health and to have seen it get worse during the pandemic.

It said 52 per cent of people living in social housing said their mental health was poor or very poor ( compared to 38 per cent who said it was not poor or very poor) and more than two thirds (67 per cent) said that their mental health got worse during lockdown. Similarly, over half (58 per cent) of under-18s who have received free school meals said their mental health was poor or very poor (compared to 41 per cent not), with nearly three quarters (73 per cent) of this group saying that it got worse during lockdown.

The spokesman added: “Supported by these findings, we are urging the UK and Welsh Governments to put mental health at the very centre of their recovery plans.

“As we look to the future, those in power must make the right choices to rebuild services and support, and to ensure that the society that comes after the pandemic is kinder, fairer and safer for everyone experiencing a mental health problem.”

Where can you seek support?

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If you’re concerned about your mental health in general or as a result of the coronavirus lockdown, make an appointment with your GP.

They can advise you on the best course of action.

You can find local NHS support online at www.nhs.uk/service-search

You can also contact Mind on 0300 123 3393 for further information about mental health.