New figures I have obtained under freedom of information paint a troubling picture of the mental well-being of people in part of Wales and northern England.
It may be the recession, but I suspect the statistics showing very high levels of anti-depressant use in those regions have more complex origins.
The new numbers also show yet another increase in prescribing pills like Prozac, despite national guidance advocating alternative treatments - up 3.15% in Wales and 3.64% in England during 2008.
The previously unpublished data, given to me by the Prescription Pricing Authority in England and the Prescribing Services Unit in Wales, focus on January this year. If one looks at the number of prescriptions for anti-depressants issued in that month per thousand patients, a startling story emerges.
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The top seven are all Welsh Local Health Boards (LHBs) in a small area in the south of the country. Of the top thirty prescribers, 12 are in Wales and 10 are Primary Care Trusts (PCTs) in the north-east of England.
We even see a local health authority prescribing at a rate greater than one prescription for 10 patients. In Torfaen, the area around Pontypool in south Wales, GPs handed out 104 prescriptions per 1,000 patients during January. This appears to be an astonishing level of anti-depressant use. GPs we have contacted blame a shortage of counselling for the high prescribing levels.
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Both south Wales and the north-east of England are areas with high levels of people not in work, but deprivation cannot explain what one sees as the other end of the table. Of the 30 PCTs which have the lowest levels of anti-depressant prescribing, all but two are in Greater London. And these areas include some of the most deprived in England.
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The figures also show how January 2009 compares with January 2008, and I wondered whether this might reveal the effects of the recession. The map shows a less obvious regional picture.
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The biggest year-on-year increases in prescribing are both in south Wales: Torfaen has seen a rise of over eight prescriptions per 1,000 patients in twelve months, consolidating its position at the top of the table.
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Blaenau Gwent, Bridgend and Neath/Port Talbot have also seen very large rises. Six of the top 20 places ranked by the increase in prescribing anti-depressants are in Wales. Have free prescriptions made a difference? If so, why do figures for the Vale of Glamorgan and Wrexham show falls in anti-depressant use?
In England, Swindon and Sunderland, which have both recently seen big job losses and lay-offs as a result of the economic downturn, have seen anti-depressant prescriptions rise by more than five prescriptions per 1,000 patients.
Tameside and Glossop sees the largest increase in the past 12 months in England with at least one local doctor saying that the recession is having a serious effect on the area's mental health.
Dr Kailash Chand, a GP in the area told his local paper:
I have no doubt that the threat and impact of recession is having a psychological effect upon many people in the UK - but anti-depressant prescribing has been rising for years and, in fact, the rate of increase is falling. Comparing Jan 2007 with Jan 2008, the increase in England was 8.3%, and it was 9% in Wales.Job insecurity, redundancy, debt and financial problems are all proven to contribute to mental distress. For the last few months I've seen at least one or two more patients per week who are unable to cope with financial difficulties.
Do let me know what conclusions you draw from the data