A shortage of non-pharmacological options and alternative treatments may be one reason that anti-depressant prescription rates in Northern Ireland (NI) are significantly higher than the rest of the UK, suggests researchers following a two-year study of prevalence and variation in anti-depressant prescribing across Northern Ireland. 

Anti-depressant prescription rates in the UK are among the highest in Western Europe. In Northern Ireland, the rates are yet higher, says lead researcher Professor Mark Shevlin of Ulster University. Working with the award-winning NI charity, Aware Defeat Depression (Aware), the research team linked returns from the 2011 NI Census with NI prescribing records to map the socio-economic and geographic landscape of anti-depressant prescribing.

Findings show that anti-depressants were prescribed to 12% of NI's population in 2011 with this rate rising to 14% by 2015. "Over the entire five-year period 24% of the population were prescribed anti-depressants," Professor Shevlin points out. "Existing figures for 2013 show that NI was prescribed proportionately more anti-depressants than 23 other countries worldwide and that, overall, GPs in NI prescribed enough anti-depressants to give every member of the population a 27-day supply; the same statistics for England and Wales were 10 days and 19 days respectively."

While prescription rates in NI are climbing annually, rates of depression are not changing. Moreover, existing evidence reveals the rate of anti-depressant prescribing (15% in 2015) to be higher than household survey estimates of the proportion of the NI population that suffers low mood (9%) and clinical depression (7%). "We suspect that this disparity is occurring because some GPs are prescribing anti-depressants for non-clinical depression because they do not have access to alternatives as the infrastructure for 'social prescribing' in NI is poor," Professor Shevlin explains. 

Study findings show a clear association between self-reported poor physical health and the likelihood of being prescribed anti-depressants. Hence, more resources aimed at encouraging patients to improve their physical health through education on diet and exercise could ameliorate the effects of low mood without pharmacological intervention. Other alternatives to anti-depressants, say researchers, range from psychological treatments such as counselling to greater social interaction and taking steps to combat loneliness. 

Based on these findings, project partner Aware Beat Depression aims to identify geographical areas of high anti-depressant prescribing and particularly vulnerable groups such as young people and those aged 40-54 which it will target with support, education and information on alternatives to anti-depressant use.