Female Teens Took More Antidepressants During COVID-19, Male Teens Took Less

Kao-Ping Chua, MD, PhD

Credit: University of Michigan, Institute for Healthcare Policy & Innovation

An uprise of adolescents and young adults started taking antidepressants during the COVID-19 pandemic, particularly among females, reported investigators at Michigan Medicine.¹

Although a high and growing number of adolescents and young adults aged 12 – 25 years received antidepressants before the pandemic, the antidepressant dispensing rate rose nearly 64% faster after March 2020.

“Our findings suggest these trends accelerated during the pandemic,” said lead investigator Kao-Ping Chua, MD, PhD, from the University of Michigan Health C.S. Mott Children's Hospital and the Susan B. Meister Child Health Evaluation and Research Center, in a press release.²

Research in 2021 found 25% of global children and adolescents (age range: 4.1 – 17.6 years) experienced elevated depression symptoms since the beginning of the pandemic (95% CI, 21.2% - 29.7%).³ Additionally, 20% of global youth experienced clinically elevated anxiety symptoms (95% CI, 17.2% - 24.4%). The prevalence significantly rose from the pre-pandemic rates of 11.6% and 12.9% for depression and anxiety, respectively.

Not only did rates of depression and anxiety increase for adolescents during the pandemic, but hospitalizations for psychiatric conditions, including anxiety, depression, and suicidality increased since the start of the pandemic for adolescents.⁴ A 2022 study estimated a 0.60% increase overall in the monthly proportion of mental health-related hospitalizations following the pandemic onset compared to the pre-pandemic period.

In the new study, Chua and colleagues analyzed data from the national IQVIA Longitudinal Prescription Database (2016 – 2022) reporting 92% of prescriptions dispensed in US pharmacies.¹ The database included 221,268,402 individuals (mean age: 19.2 years) with 64.4% female, 35.8% male, and 0.3% unknown sex. More than half of the sample (64.7%) were aged 18 – 25 years old, and 67.3% of the individuals who had dispensed antidepressant prescriptions took selective serotonin reuptake inhibitors, with the most common sertraline (24.1%), fluoxetine (18.5%), and escitalopram (16.3%).

Investigators found females drove the rise in the antidepressant dispensing rate during the pandemic. The pandemic was linked to a slope increase of 10.8 per month in the dispensing rate (95% CI, 4.9 – 16.7)—but not a level change (37.4, 95% CI, - 153.4 to 78.7).

Before March 2020, the dispensing rate increased by 17 per month (95% confidence interval [CI], 15.2 – 18.8). From January 2016 – December 2022, the monthly antidepressant dispensing rate increased 66.3% from 2575.9 to 4284.8.

Compared to before the pandemic, after March 2020 the monthly antidepressant rate increased 63.5% faster. Subgroup analyses found after March 2020, the rate increased 130% faster among female adolescents aged 12-17 years and 60% faster among female young adults aged 18 – 25 years.

“Multiple studies suggest that rates of anxiety and depression among female adolescents increased during the pandemic,” Chua said.² “These studies, coupled with our findings, suggest the pandemic exacerbated a pre-existing mental health crisis in this group.”

In contrast, the antidepressant dispensing rate had little change for male young adults and declined for male adolescents.

“It’s hard to believe this decline reflects improved mental health,” Chua said.

Chua suggests the reduced dispensing rate could be due to male adolescents skipping yearly physicals or other healthcare appointments during the pandemic and perhaps missed opportunities to diagnose and treat anxiety and depression. With the switch to online learning, teachers or nurses also may not have detected mental health problems in male adolescents as they had pre-pandemic.

However, women might not only have increased antidepressant dispensing rates due to worsened mental health—long waitlists for psychotherapy could have impacted this.

“In my primary care clinic, I often heard from patients and families that they were facing 6-9 month wait lists for therapy during the pandemic,” Chua said. “In those situations, it didn’t make sense to withhold antidepressants and recommend a therapy-only approach.”

Chua concluded by saying future studies should identify the best treatment options to improve the mental health of adolescents and young adults.’’

Investigators highlighted several limitations.¹ For instance, the database lacked data, not including what condition the antidepressant was treating, whether the prescription was prescribed in person or during telehealth visits, if prescriptions were privately or publicly insured, if people were taking multiple antidepressants, and changes in other psychotropic drugs. Another limitation was the uncertainty of whether the findings can be generalized past 2022, not knowing if the dispensing rate will slow over time.

“Future research should investigate the degree to which this increase was driven by changes in mental health, changes in access to mental health care, and changes in treatment patterns for mental health conditions,” investigators wrote.

^References

1. ^{Chua KP, Volerman A, Zhang J, Hua J, Conti RM. Antidepressant Dispensing to US Adolescents and Young Adults: 2016-2022. Pediatrics. Published online February 26, 2024. doi:10.1542/peds.2023-064245}
2. ^{Antidepressant Dispensing to Adolescents and Young Adults Surges During Pandemic. News Wise. February 21, 2024. https://www.newswise.com/articles/antidepressant-dispensing-to-adolescents-and-young-adults-surges-during-pandemic. Accessed February 23, 2024.}
3. ^{Walter, K. Pediatric Depression, Anxiety Rates Doubled During COVID-19. HCPLive. August 11, 2021. https://www.hcplive.com/view/pediatric-depression-anxiety-rates-doubled-covid-19. Accessed February 23, 2024.}
4. ^{Walter, K. COVID-19 Pandemic Increased Risk of Hospitalization for Mental Health Reasons. HCPLive. December 14, 2022. https://www.hcplive.com/view/covid-19-pandemic-increased-risk-hospitalization-mental-health-reasons. Accessed February 23, 2024.}