Psychotropic drug prescribing before and during the COVID-19 pandemic among people with depressive and anxiety disorders: A multinational network study

Abstract

Background: People with mental health conditions were potentially more vulnerable than others to the neuropsychiatric effects of the COVID-19 pandemic and the global efforts taken to contain it. The aim of this multinational study was to examine the changes in psychotropic drug prescribing during the pandemic among people with depressive and anxiety disorders. Methods: This study included electronic medical records and claims data from nine databases in six countries (France, Germany, Italy, the UK, South Korea, and the US) of patients with a diagnosis of depressive or anxiety disorders between 2016 and 2021. The outcomes were monthly prevalence rates of 1) antidepressant, 2) antipsychotic, and 3) anxiolytic drug prescribing. The associations between the pandemic and psychotropic drug prescribing were examined with interrupted time series analyses for the total sample and stratified by sex and age group. People with lived experience were not involved in the research and writing process. Outcomes: Between 2016 and 2020, an average of 16,567,914 patients with depressive disorders (10,820,956 females [65.31%]; 5,746,958 males [34.69%]) and 15,988,451 patients with anxiety disorders (10,688,788 females [66.85%]; 5,299,663 males [33.15%]) were identified annually. Ethnicity data were not available. Two distinct trends in prescribing rates were identified. The first pattern shows an initial surge at the start of the pandemic (e.g., antipsychotics among depressive disorders in the US Medicaid database: rate ratio [RR], 1.077; 95% CI, 1.055-1.100), followed by a gradual decline towards the counterfactual level (RR, 0.990; 95% CI, 0.988-0.992). The second pattern, observed in four databases for anxiolytics among people with depressive disorders and two for antipsychotics among people with anxiety disorders, demonstrates an immediate increase (e.g., antipsychotics among anxiety disorders in the UK: RR, 1.467; 95% CI, 1.282-1.675) without a subsequent change in slope (RR, 0.985; 95% CI, 0.969-1.003). In two US databases, the anxiolytic prescribing rate continued to increase at a greater rate among people aged under 25 for both conditions. Interpretations: The study reveals persistently elevated rates of psychotropic drug prescriptions beyond the initial phase of the pandemic. These findings underscore the importance of enhanced mental health support and emphasis the need for regular review of psychotropic drug use among this patient group in the post-pandemic era.