Psychotropic medications, such as antidepressants, antipsychotics and mood stabilisers are commonly prescribed to people with learning disabilities. However there is concern that these are being over-prescribed, often to manage problem behaviours, and in the absence of good quality evidence of their effectiveness in this context. Guidelines recommend that psychotropic medications and antipsychotics in particular, are withdrawn or reduced in the absence of severe mental ill health.
Health and medication data for 1,190 adults with learning disabilities who had agreed to be part of the study between 2002 and 2004 were compared with medication data for 3,906 adults with learning disabilities, living in the same health board area in 2014. A longitudinal cohort of 545 people, for whom data was available across the whole period, was also created to investigate changes in prescribing for the same group of people over a decade.
Analysis of the cross-sectional data in 2002/2004 showed that over 50% of adults with learning disabilities were prescribed at least one psychotropic medication. This reduced slightly to 48% in 2014. Almost a quarter of people with learning disabilities were prescribed antipsychotics in 2002/2004 and 16.7% in 2014. Antidepressants were prescribed to 11.2% of participants in 2002/2004 and to 19.1% in 2014. 30.0% of those prescribed antipsychotics in 2002/2004 had psychosis or bipolar disorder, 33.2% had no mental ill health or problem behaviours, and 20.6% had problem behaviours but no psychosis or bipolar disorder.
For the longitudinal cohort, with data at both time points, psychotropic increased from 47.0% (256/545) in 2002/2004 to 57.8% (315/545) in 2014 (p<0.001). Antipsychotic prescribing did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), but there was a significant increase in antidepressant (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytic (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptic (OR 1.40; 95% CI 1.06 to 1.84; p=0.017) prescribing. People who were identified as having mental health problems in 2002/2004 had increased levels of antipsychotic prescribing in 2014 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001). However for those identified with problem behaviours in 2002/2004 the increase in was even higher (OR 6.45; 95% CI 4.41 to 9.45; p<0.001).
Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by 2014 than in 2002/2004, people were not withdrawn from them had been prescribed. People with problem behaviours had increased levels of prescribing. There was also a striking increase in antidepressant prescriptions which requires further investigation. Adults with intellectual disabilities need frequent and careful medication reviews.
Project lead: Angela Henderson
Research team: Paula McSkimming, Deborah Kinnear, Colin McCowan, Alasdair McIntosh, Linda Allan, Sally- Ann Cooper
Angela was formerly the Director for Policy and Impact for the Scottish Learning Disabilities Observatory and remains an affiliate team member, having moved in 2024 to work with the Scottish Government leading the development of annual health checks and learning disabilities data. Angela is interested in how evidence is used in policy making and was involved in many projects at the Observatory. These included: Understanding the impact of Covid-19 on people with learning disabilities The Research Voices Project Helping to set up the SPIRE learning disabilities data project Analysing information about drug prescribing for people with learning disabilities
Deborah is the Director of the Scottish Learning Disabilities Observatory and Professor of Health and Neurodevelopmental Conditions, in the School of Health and Wellbeing, at the University of Glasgow. Deborah is passionate about her research which aims to improve the health of people with learning disabilities and their families. She has worked on many different projects about people with learning disabilities including: cancer incidence, cancer screening, multi-morbidity (having two or more health conditions), oral health and COVID-19, to name a few. She has also worked on projects about the physical and mental health of family members who support someone with a learning disability. Deborah is committed to conducting research that has impact and works closely with self-advocates with learning disabilities, family carers and third sector organisations who are pivotal in all of her work and who have a shared vision of ensuring the human rights of all people with learning disabilities are recognised, supported and upheld. Read more about Deborah here.
Anna set up the Scottish Learning Disabilities Observatory with funding from the Scottish Government. She wants the Observatory to make Scotland fairer and healthier for people with learning disabilities and their families, by: Finding out the health problems people have Finding out how good or bad health care is Telling people about health and health care problems Finding ways to make health and health care better Checking if health gets better or worse over time Helping the Scottish Government, and staff who provide health and social services, to get it right for people with learning disabilities Anna is a doctor. She has done a lot of studies on the health of people with learning disabilities. Anna’s full name is Professor Sally-Ann Cooper.
