Little change in antipsychotic prescribing in decade despite withdrawal recommendations, study finds

A study published in BMJ Open has also found a “striking” increase in antidepressant prescriptions in the decade between 2004 and 2014 in the Greater Glasgow area.

Drugs tablets

Prescriptions of antipsychotic drugs for adults with intellectual disabilities did not change significantly in the decade between 2004 and 2014 in the Greater Glasgow area, despite concerns and guidelines recommending their withdrawal, a study published in BMJ Open
 has said.

The study also described a “striking” increase in antidepressant prescriptions in the same ten-year period.

For the study, the researchers carried out a comparison of two cross-sectional cohorts by way of a primary care intellectual disabilities register of adults in the NHS Greater Glasgow and Clyde area: 1,190 adults in 2002–2004, which was referred to as T1, and 3,906 adults in 2014, which was referred to as T2.

They found that 50.7% of adults in T1 and 48.2% of adults in T2 were prescribed at least one psychotropic drug.

Rates of prescribing of antipsychotic medicines did appear to be lower in T2 than in T1, at 16.7% and 24.5%, respectively, although the authors said that the rate was “still high”.

However, a significant increase was seen in prescriptions for antidepressants, which rose from 11.2% in T1 to 19.1% in T2.

Overall, prescriptions for psychotropics increased from 47% in T1 to 57.8% in T2.

The authors said that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced, and that people with “problem behaviours” had increased prescribing.

“Despite numerous calls and guidelines in the UK for the withdrawal of antipsychotic drugs from people with intellectual disabilities who do not have psychosis/bipolar disorders, our longitudinal, linked cohort analysis shows no progress over a decade,” the authors wrote.

“Adults with intellectual disabilities need frequent and careful medication reviews,” they concluded.

The research was published as the NHS Business Services Authority (NHSBSA) released its annual and quarterly summary statistics on medicines used in mental health, which revealed that the number of prescriptions for medicines used in mental health in England increased between 2015/2016 and 2019/2020. 

The findings in the NHSBSA annual report showed that between 2015/2016 and 2019/2020, there was increased use of prescription medicines in four drug groups: drugs for psychoses and related disorders; antidepressant drugs; central nervous system stimulants and drugs used for attention deficit hyperactivity disorder; and drugs for dementia. The only drug group that saw a reduction in this time period was hypnotics and anxiolytics.

In contrast, the quarterly report highlighted that, during the height of the COVID-19 pandemic from April 2020 to June 2020, four of the five drug groups saw a fall in levels of prescribing in quarter one of 2020/2021 compared to the previous quarter. Drugs used in psychoses and related disorders was the only group to see an increase.

David Branford, an independent pharmacy advisor on learning disabilities and mental health, said that in recent years there had been a “massive move” away from antipsychotics to other psychotropic drugs, such as antidepressants and antiepileptics. 

Branford said that a number of reviews of prescribing have taken place since the ‘Stopping over medication of people with a learning disability, autism or both’ (STOMP) campaign was launched in England in 2016. 

“The main findings are that STOMP is incredibly good at raising the profile of the issue, but in terms of people systematically reviewing people and taking them off the medicines, there hasn’t been a massive change,” he said. 

“We need some kind of CQUIN [Commissioning for Quality and Innovation framework], some kind of payment, or legal framework that requires people to be reviewed or taken off [these medicines]; just having campaigns where you raise the issue along doesn’t do it — you need significant incentives and support.” 

Last updated
Citation
The Pharmaceutical Journal, September 2020;Online:DOI:10.1211/PJ.2020.20208355