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Non-pharmaceutical prescribing for Depression & Anxiety

Estimated timings:
2-4 weeks to set up & run the project (steps 1-3)
3-6 months if including re-audit & review (steps 4-6)

Can be done by a GP, Pharmacist, Trainee or Student

Green Impact for Health Toolkit area: Prescribing & Quality Improvement

CQC Areas

  • Effective (Delivering Evidenced Based Care)
  • Well-led (Learning, Improvement & Innovation)
  • Well-led (Environmental Sustainability)

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The benefits of this project

Project benefits for Your Patients

Benefits for Your Patients

  • Improved health + quality of life
  • Reduced reliance on medication
  • Greater empowerment with increased self-care
Project benefits for Your Practice

Benefits for Your Practice

  • Reduced prescribing leading to lower side effects, appointment demand & administration for prescriptions
  • £993/year per 100 patients prescribed wellbeing toolkit instead of SSRI - medicines spend savings - based on average cost of 3 commonly prescribed SSRIs (sertraline 50mg tablet, citalopram 20mg tablet & fluoxetine 20mg capsules) Feb 25
Project benefits for The Planet

Benefits for The Planet

  • Reduced prescribing means lower environmental impact

Opportunity for improvement

  • Important: This is a quality improvement resource only and not clinical guidance. Users must follow local and national guidelines and review disclaimers and carbon footprint methodology before starting. Clinical responsibility lies with the user.
  • This project outlines how to use a ‘Wellbeing Toolkit’ to encourage non-pharmaceutical prescribing for less severe depression and generalised anxiety disorder.  NICE guidance advises against routinely offering medication first line in these cases.  Instead, it recommends guided self-help and talking therapies such as Cognitive Behavioural Therapy. The Wellbeing Toolkit provides clinicians with a useful resource for patients which outlines self-help and talking therapy options. 
  • Depression and Generalised Anxiety Disorder (GAD) are common disabling conditions which can both cause significant harms including reduced quality of life for patients and their loved ones. These include increased risk of substance misuse, suicide, functional impairment (including ability to work), greater service use and many associated economic costs.   
  • When the costs of health care, lost earnings, informal care, lower productivity, and other public sector costs are factored in, the estimated cost of depression in England is £20.2 billion - £23.8 billion a year.   
  • Selective Serotonin Reuptake Inhibitors (SSRIs), for example, sertraline, have an important role when used appropriately but are often not needed to manage less severe depression and GAD. They often cause side effects and withdrawal symptoms as well as having a carbon impact. 
  • In 2023/24, ~89 million antidepressant prescriptions were issued, and this figure has risen year on year. Inappropriate antidepressant prescribing is such a significant issue that NHS England has included it as one of its national medicines optimisation opportunities and Scotland has produced a guide for quality prescribing for antidepressants.   
  • You might like to create SMARTS goal for this project e.g. Within the next 2 months, tailor the Wellbeing Toolkit for your practice and run a training session about the toolkit for clinicians.

How to carry out this project

  1. Tailor the Toolkit

    Adapt this Wellbeing Toolkit (thanks to Dr Shaba Nabi who created it) to suit your local area and create a text message to send to patients. 

    You might like to include details of local support groups and other self-help links.

    Consider adding a code to the text message (ask practice IT team) so that you can later measure how many patients were sent it.  

    Resource: Wellbeing Toolkit SMS

    Experiencing depression or anxiety can be very difficult. But there are steps you can take to help yourself. You might find this Wellbeing Toolkit a helpful way to get started. It includes the details for talking therapies which can also be beneficial. Some of these ideas may not feel helpful or possible right now. Try a few different things and see which works best for you.

  2. Baseline data

    You might like to look at SSRI prescribing rates for your practice before and after the introduction of the Wellbeing Toolkit to see if SSRI prescribing reduces.

    If you work in a practice that uses SystmOne or EMIS and have access to Ardens, you could use this search and adjust the timings to suit your project:

    SystmOne: Review appropriateness of prescribing in last 1m – issue of SSRIs

    EMIS: Ardens -> 2.30 Prescribing – Environmental -> Greener Practice -> Review appropriateness of prescribing in last 1m – issue of SSRIs

    We hope to provide downloadable IT searches for EMIS & SystmOne for practices without Ardens soon.  In the meantime, you could use our EMIS and SystmOne search guides to create your own.

  3. Make the Intervention

    Advertise the Wellbeing Toolkit and text message to all clinicians at the practice e.g. clinical meeting, in-person conversations, email, staff newsletter.   

    Advise staff on how to use the toolkit in line when NICE guidance. GPs and other clinicians seeing new presentations of less severe depression and GAD are most likely to find this toolkit helpful and may like to give it to patients during initial consultations (could be via SMS or a printed copy).

    It should be highlighted that it would be inappropriate for the toolkit to be used alone for more severe depression or anxiety, significant risk of self-harm, suicide or harm to others, psychotic symptoms etc.   

    Consider holding a training session for clinicians on GAD and depression and introduce the Toolkit as part of this.  

  4. Post Intervention data collection

    Add this project to the Project Monitoring form so you know when to re-run the search.  Re-run the search 1-2 months after the intervention has been implemented to see if SSRI prescribing rates have changed.   

  5. Check Toolkit Use

    You might like to also search for how many patients were sent the toolkit (if coded).  This would help indicate if any correlation with toolkit use and SSRI prescribing.  

  6. Study

    Study the data to see if things have improved i.e. reduced number of new SSRI prescriptions.  If not, explore why and adjust accordingly. 

    Summarise learning, share with practice team + decide if any changes are needed to improve the process. 

    Decide when to re-audit again to ensure the change has lasted e.g. 3-6 months and use the Project Monitoring form to keep track.  Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.  

Top tip

Chat to your local Social Prescribing Team about the Wellbeing Toolkit. 

They will probably know of some great local resources for patients which you could include in the toolkit e.g. a local website listing volunteering opportunities

How to scale this project up or down

Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members.

You could ask your local medicines team and wider healthcare organisations e.g. ICB, Health Boards, to include the Wellbeing Toolkit in their Depression and Anxiety guidelines and to promote it to all practices.  

Explore the idea of an IT pop-up when an SSRI is initiated to remind clinicians of the Wellbeing Toolkit.  

This project focuses on initial prescribing for depression and anxiety.  You could also explore deprescribing of long-term antidepressants such as in this Yorkshire pilot programme.   

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