Mental Health Overview

1. Mental Health Overview

2. Introduction • Anxiety and mood (mainly depression) disorders affect around 1 in 6 people in Britain each year • Improving mental health remains one of the government’s top three funding priorities for the NHS (with CHD and cancer) • Labels such as ‘mentally ill’ can be highly stigmatising • Can deter many from seeking treatment • 90% of patients with mental health problems (including up to 30–50% with severe mental illness) are only seen in primary care • Mental health issues are the sole reason for attending 20–25% of consultations (and a feature of 40% to 70%) …the second most common reason for consulting • Co-morbid substance misuse is commonplace—29% of people diagnosed as mentally ill misuse alcohol or drugs (self-care for symptom control or drug-induced ill-health?)

3. Clinical evidence in mental health • Most trials are of short duration and lack adequate power to detect clinically significant differences between groups • Trial participants commonly highly selected and unrepresentative of ‘real world’ setting • Use of unpublished rating scales rather than gold standard ones can bias studies in favour of the intervention • In clinical trials of antidepressants, 80% of response seen is accounted for by the placebo effect • One third of trials of atypical antipsychotics are industry-sponsored. The reported outcomes of sponsored trials highly favour the manufacturer’s product • Available, non-drug therapies (exercise, self-help, psychological therapy) should be considered when deciding treatment. These may be more appropriate, particularly in mild to moderate mental illness

4. http://www.ppa.org.uk/news/pact-092005/drugs_used_in_mental_health.pdfTrends in spending on mental health drugs in General Practice in England COST

5. Some prescribing issues • Antidepressant prescribing rates are still growing • Many doctors and patients would prefer talking therapies for common mental health problems but waiting times are often prohibitive • Venlafaxine now requires specialist supervision only when dose exceeds 300mg/day • Caution in those with CHD history • Contra-indicated in ventricular arrhythmia, uncontrolled hypertension • Regular BP monitoring required • Overall hypnotic prescribing rates have not fallen despite CMO, NICE and CSM advice to restrict to short-term use only (2–4 weeks) • NICE recommend choosing a hypnotic with lowest purchase cost

6. What would happen to 100 people like you who take sleeping tablets for more than a week. ? ? ? ? ? ? ? K K K For 76 people the tablets do NOTHING, good or bad These 7 people sleep better, which means they get an extra 25 minutes sleep a night! They also wake up once less every 2 nights K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K K These SEVENTEEN people have side effects One of them may be serious, like a fall or car crash K K K K K K K K K K K K K K K K K K K K K K K L L L L L L L L L L L L L L L L L

7. Some prescribing issues (cont) • Risperidone and olanzapine should be avoided in dementia. Prescribers should consider ventricular arrhythmia risk before treating with other atypical antipsychotics • More recent evidence suggests atypical antipsychotics associated with increases mortality rate in elderly (NNH = 52) • No efficacy difference between atomoxetine and methylphenidate in ADHD. To be initiated only by an appropriately qualified healthcare professional with expertise in ADHD—Continued prescribing and monitoring of drug therapy may be performed by GPs, under shared care arrangements.