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Non-pharmaceutical prescribing for Depression & Anxiety

This Project takes ~3-6 months for a practice with 10,000 patients

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)

On this page

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

  • 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.   
  • This project outlines how to use a ‘Wellbeing Toolkit’ to encourage non-pharmaceutical prescribing for less severe depression and GAD (see disclaimers).  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. 
  • You might like to create SMARTS goal for this project e.g. Within the next 6 months, tailor the Wellbeing Toolkit for your practice, run an online training session for clinicians and reduce new SSRI prescriptions by >5%. 

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

    Search for any new prescriptions of the 3 most common SSRIs (sertraline 25 + 50mg, citalopram 10mg + 20mg and fluoxetine 20mg) in your practice for a 2-month period.  The search excludes higher dose SSRIs and continuing prescriptions i.e. patients already taking SSRI.   

    We hope to provide downloadable IT searches for EMIS & System 1 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, F2F 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 2-3 months after the intervention has been implemented.   

  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.   

Have you completed this QIP?

Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost and carbon savings and other benefits. This project may help with CQC evidence submission (see disclaimers).  

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