Anti-depressants: Cost, Risks and Ramifications

Question

15:00:00

Asked by

To ask His Majesty’s Government how many individuals have been prescribed anti-depressants by the NHS in England in the past 10 years, at what cost, and what assessment they have made of the risks and ramifications.

My Lords, we are still waiting for the Minister, my noble friend Lady Merron, to arrive to answer the first Question, which I am very sorry about. I did tell people that we were not starting this afternoon with Prayers, so I am somewhat embarrassed to be standing here to tell the House that we shall have to wait a few moments for my noble friend to arrive. [Interruption.] Thankfully, I have no information, so I shall keep talking on the basis that at some point my noble friend Lady Merron will arrive and answer the Question before us.

Filibustering.

Absolutely.

May I express my gratitude to the Chief Whip for reminding me that there were no Prayers?

My noble friend Lady Merron is now here.

I apologise to your Lordships’ House and am grateful to my noble friend the Chief Whip, as ever. In 2023-24, 8.7 million identified patients were prescribed anti-depressants at a cost of £220 million, compared with 2015-16, when the cost was £270 million for prescriptions to 6.88 million people. The NHS Business Services Authority reports patient prescribing data on an annual basis rather than a running total. All licensed anti-depressants meet robust standards of safety, quality and efficacy, constantly reviewed by the MHRA.

My Lords, I thank the noble Baroness, Lady Merron, for her reply and for facilitating and attending our meeting with the Medicines and Healthcare products Regulatory Agency. Has she had the chance to read the correspondence I shared with her from the bereaved family of Thomas Kingston, who, like Olivia Russell, committed suicide while using anti-depressants? Has she noted that the coroner intends to issue a prevention of future death report to the MHRA? In the light of this tragedy, what can the Minister do to create a more rigorous approval regime, including greater definition of risk? Given that hundreds of millions of these drugs are issued, at a cost of hundreds of millions of pounds, will the Government establish a longer-term inquiry to ask searching questions about root causes—what is leading to endless repeat prescriptions and driving such widespread reliance on anti-depressants?

I extend my deepest sympathies to the family of Thomas Kingston after his very tragic death earlier this year. We await the findings of the inquest and will act on any recommendations by the coroner as appropriate. While there has been an increase in prescribing, as the noble Lord observes, anti-depressants, for example, are often prescribed for a wide range of reasons—not just for the treatment of depression but for migraine, chronic pain, and ME, among other conditions. The other possible reason for the increase is because of the stigma associated with seeking mental health treatment, but prescribing anti-depressants is never the first port of call—it is just one of the tools in the box to assist people. There are no current plans to conduct a review.

My Lords, the noble Lord, Lord Alton, did not mention whether we were discussing specific anti-depressants, but the case he mentioned does refer to a group of anti-depressants called selective serotonin reuptake inhibitors. They treat the patient by increasing serotonin levels, but they run the risk of patients having suicidal ideation—the feeling of wanting to commit suicide. In a meta-analysis carried out using 29 research reports, it was found that they are beneficial in the early phase of the treatment of depression, but in later phases the data is less reliable. Are the MHRA and the NIHR working together to look at the evidence available and to produce the appropriate guidance? To avoid a high risk of suicide in people using this group of drugs, it is important to have proper monitoring, which means controlled visits to appropriate health specialists.

I assure the noble Lord that NICE keeps all its clinical guidance under active surveillance to ensure that it can respond to any new evidence that is relevant, including relevant clinically related literature, that could possibly impact on its recommendations. More broadly, guidance recommends that suicidal ideation should be monitored in people with depression who are receiving treatment, particularly in the early weeks of treatment. That includes specific recommendations on medication for people at risk of suicide.

My Lords, a study in 2019 found that a third of women were prescribed anti-depressants by their GP to combat symptoms of the menopause. What are the Government’s current assessment of this situation and of adherence to NICE guidance in this area? If the Minister does not have full details to hand, perhaps she can write to me.

I would be very pleased to write further to the noble Baroness. This is a very important point about support for women during the menopause. However, a prescription is made only after discussion with the patient about it and other alternatives, and the clinician has to follow and comply with the guidelines. Patient choice is absolutely key here. Every individual is an individual, and only what is appropriate should be prescribed—if needed.

My Lords, as the Minister pointed out, SSRIs can be the right choice for some patients, but for there to be patient choice, there has to be the capacity for those therapeutic options. In April 2024, around 1 million people were recorded as waiting for mental health services, 340,000 of whom were children, and over 100,000 had waited for more than a year. The Government have pledged to provide an additional 8,500 mental health staff. Can the Minister say what she will do to increase patient choice and build that capacity?

We have already made a number of commitments, but the noble Baroness is quite right to observe the excessive numbers on the waiting list. We are deeply aware of the distress and continuing difficulty that this causes for many. The noble Lord, Lord Darzi, in his independent investigation, confirmed that about 1 million people are waiting for mental health support as of April 2024. Moving to the 10-year plan will be an opportunity to put mental health services in a different place. In addition to the commitments that the noble Baroness has mentioned, we are providing access to a specialist mental health professional in every school and providing open-access Young Futures hubs.

My Lords, I am grateful to the noble Lord, Lord Alton, for organising a recent meeting with the Minister, the MHRA and some psychiatrists, who raised the issue of SSRIs and their side-effects. One concern was that patients need to be aware that one side-effect of SSRIs is to have suicidal thoughts. Therefore, I was surprised to see on the NHS website’s page on the side-effects of anti-depressants that you have to scroll down four or five pages before seeing the warning signs about suicidal thoughts. While we await the review from the MHRA which it discussed with us, will the Government and the NHS look at the advice on the website so that those who are prescribed SSRIs are clearer about the risk of suicidal thoughts?

I would be happy to look at that. However, there have been warnings on the leaflets accompanying medication for some 20 years. It is always a cause to review to ensure that it is most effective. There are at least two sides to this. One is the clinician doing their job to discuss side-effects, including on withdrawal from the medication, but it is important that patients understand it as well.

Is my noble friend the Minister aware of the work of the Charlie Waller Trust, whose directive is to apply awareness among teachers, tutors and so forth of the danger of suicide in the work that they perform?

I am not specifically aware, but I will be glad to look into this.

My Lords, I want to raise the issue of dependency on anti-depressants. As the Minister will know, a lot of people have great difficulty coming off these anti-depressants. It is striking that for those using drugs illegally or with substance abuse, there are many services, but there are no services in the NHS for those seeking to withdraw from anti-depressants. This is a major problem. With that in mind, I ask two questions. First, will the Government consider the delivery of a helpline, which has been called for in a number of reviews, so that people can have some access to help? Secondly, will they support an NHS project designed to introduce withdrawal services within the NHS?

The noble Lord makes an important point about the effects of withdrawal from any medication. I am not sure that this is an exact answer but there is the 111 helpline, which has been expanded to refer to mental health services, so people can ring and ask those questions. However, I take his point about withdrawal. We may wish to consider this as we go towards the 10-year plan.