Prescription of psychotropic medications in primary care: a cross-sectional study of general practice computer records

Background Mental health problems are common in England, and new medications potentially offer equal or greater efficacy with increased patient safety and fewer side-effects. Objective To examine the use of psychotropic medications in primary care, in particular the use of more modern drug therapies. Subjects and setting Using routinely collected computer data from 12 general practices with a combined list size of 117 000. Method We collected anonymised data from general practice computer systems using MIQUEST (Morbidity Information Query and Export Syntax – a Department of Health-sponsored data extraction tool). Data were aggregated, cleaned and processed using an established methodology, then imported into a statistical package for analysis. Results The use of psychotropic medication increased with age. Over one-third (35%) of women and one-quarter (23.8%) of men of the study population aged over 85 years were prescribed at least one psychotropic medication in the last year (P < 0.001). At all ages, women are twice as likely to be prescribed psychotropic medication, though no more likely to be prescribed multiple therapies. One-quarter of those with a diagnosis of severe and enduring mental illness (SMI) were not taking any psychotropic medication. Over half of those with SMI on medication are taking more than one medication. The proportion of people prescribed atypical anti-psychotics has risen from 30% to 50%, with a corresponding fall in the use of older anti-psychotics. Twenty-one percent of females have been prescribed antidepressants, 14% in the last year. In contrast to anti-psychotics, the proportion of people prescribed more modern antidepressants has increased slightly. Conclusions Females and older people are much more likely to receive psychotropic medications. Further research is needed to explore why the pattern of prescribing differs from what is known about the pattern of mental health problems.