There’s a surprisingly simple reason for England’s high antidepressant use: lots of people need them | Dean Burnett

A new NHS report has revealed the highest ever levels of antidepressant use recorded in England, with roughly one in seven people prescribed an antidepressant item in 2025-26. This has resulted in a swathe of media coverage expressing alarm over the increase, with questions about what could, or should, be done to reverse the trend.

Such a high level of antidepressant use should, of course, prompt concern and reflection. But the popular claim that has taken hold is that antidepressant use is too high because of “overprescribing”, as Dr John Read, a professor of clinical psychology, says in the Daily Mail. This is the idea that patients are being prescribed antidepressants when they shouldn’t be, or when better, safer alternatives are available.

This idea is worth challenging – but first it’s important to consider how we got here. The increase in antidepressant use is strongly correlated with a rise in diagnoses in common disorders including depression and anxiety. Much of this is the afterlife of the Covid-19 pandemic and its associated lockdowns: according to ONS data, across Britain, the rate of depressive symptoms in adults doubled during the crisis to almost one in five. As of April 2025, the figures remain almost as high. This surge has particularly affected young people in England, with one in four having a mental health condition, according to NHS data.

So with this rise, an increase in antidepressant use is predictable. Lockdown, however necessary for public health, has had lasting implications for the country’s wellbeing.

But it’s not only the consequences of the pandemic. What this data also indicates is that persistent regional inequalities have a worsening effect on mental health outcomes, and therefore antidepressant use. The most dramatic increases in antidepressant use are found in the most impoverished regions of England, while more affluent regions report modest levels of antidepressant use.

The highest rate of antidepressant use was seen in patients treated under the North East and North Cumbria integrated care board, with 200 in every 1,000 people prescribed antidepressant medication. Consider that this ICB contains some of the country’s most deprived areas, which have “faced longstanding inequalities and poor health for decades”, and you have further proof of something that has long been clear: poverty is inextricably linked to poorer mental health outcomes. One key element that underpins many cases of depression, anxiety and related disorders is chronic stress. It’s our brain’s achilles heel. And a guaranteed source of chronic stress is a life of constant poverty.

The argument presented against wide antidepressant prescription, as laid out in the Daily Mail, is that “doctors [are] increasingly being expected to treat wider social and life problems with medication”. Such a position assumes that a neat division can be drawn between these social problems and the mental health conditions they produce.

These socioeconomic factors also explain why antidepressants are used more and more as a first-line treatment. It’s all well and good to argue that less severe cases of depression should be treated with talking therapies such as cognitive behavioural therapy, but these involve regular one-one-one sessions with trained counsellors, and the wait for such interventions on the NHS regularly lasts months, if not years.

In the most deprived areas, access to such services is even more difficult, whereas for the most part, antidepressants are accessible straight away. It should also be said that GPs follow strict clinical guidelines for prescribing antidepressants, as set out by the National Institute for Health and Care Excellence. These state that practitioners should “not routinely offer antidepressant medication as first-line treatment for less severe depression unless that is the person’s preference”. So it is clear that GPs are not simply handing out pills, but rather responding to legitimate patient demand.

Of course, antidepressants can’t be a magic bullet – mental health services are evidently in need of deep reform and increased funding. We have already heard pledges to improve services, including with the government’s announcement in May this year of a new mental health strategy in England to drive a shift from crisis intervention to preventive care. And there are already technological interventions being recommended, including digital therapies for depression and anxiety that “could free up thousands of NHS therapist hours”.

The government’s callout for frontline workers, clinicians and mental health experts to share views on transforming mental health care shows that there are likely several creative solutions to tackle this crisis, without the need for medication. Still, there should be no doubt about the simple reality: more people than ever are taking antidepressants because they genuinely need them.

So the point here is not that the record rates of antidepressant use in England isn’t a problem. It undoubtedly is. But to determine that this is due to “overprescription” is to mistake a symptom for a much deeper social and economic crisis as its cause.

• Dean Burnett is a doctor of neuroscience and the author of The Idiot Brain and Emotional Ignorance