Study Details Increase in Psychiatric Medications During COVID-19 Pandemic

Mukaila A. Raji, MD

A recent cohort study examining the implication of the COVID-19 pandemic on mitigation measures regarding psychiatric medications found that there was an increase in z-hypnotic and selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) prescriptions in both men and women.

An increase in benzodiazepine prescriptions in women was also reported, which suggested a substantial mental health impact of COVID-19-associated mitigation measures.

Investigators led by Mukaila A. Raji, MD, Department of Internal Medicine, The University of Texas Medical Branch, wrote of the unintended consequences of the lockdowns and other isolating practices that were adopted during the pandemic, as well as the anxiety related to fear of the virus and other factors such as loneliness, alcohol consumption, and suicidal ideation.

The team also acknowledged that the mental health impact of the COVID-19 pandemic and the following mitigation methods had disproportionately affected women and COVID-19 survivors.

In order to properly explore the effects of the pandemic on vulnerable patient populations, Raji and colleagues analyzed trends in the prescribing of 3 classes of drugs; namely, benzodiazepines, serotonergic, and Z-hypnotics.

The investigative team hypothesized that the start of the pandemic and the stay-at-home order issued in March 2020 were associated with increases in prescriptions of these drugs, especially for female patients.

The Methods

Raji and colleagues utilized data from Clinformatics Data Mart, considered one of the largest commercial databases in the US, to enroll patients who were 18 years and older for their study.

The enrollment period began in January 1, 2018, and concluded on March 31, 2021.

The records of 17,255,033 adults were examined in 2018, 17,340,731 adults in 2019, 16,916,910 adults in 2020, and 15,135,998 adults in 2021. Each examination was comprised of nearly an equal number of male and female patients.

From there, investigators used National Drug Code for each featured drug in the study to identify prescriptions of benzodiazepines, Z-hypnotics, and serotonergic drugs. They accounted for the date of prescription and the days of supply to assess whether an enrollee had at least 1 day of prescription of 1 of these drugs for the numerator for the given month and drug.

For each month from January 1, 2018, to March 31, 2021, Raji and colleagues calculated the percentage of patients with SSRI or SNRI, benzodiazepine, or Z-hypnotic prescriptions by sex. Metformin was included as a control drug to assess the general prescribing variance during the study period.

The Findings

Compared to male enrollees, investigators found that women had a higher rate of prescriptions for all 3 drug classes as well as larger changes in prescription rates over time.

Regarding benzodiazeprine, prescribing decreased from January 2018 (women: 5.61%; 95% CI, 5.60%-5.63%; men: 3.03%; 95% CI, 3.02%-3.04%) to March 2021 (women: 4.91%; 95% CI, 4.90%-4.93%; men: 2.66%; 95% CI, 2.65%-2.67%). The notable exception to this was a slight increase in April 2020 among women enrollees.

Z-hypnotic prescribing increased from January 2020 for women (1.39%; 95% CI, 1.38%-1.40%) and February 2020 for men (0.97%; 95% CI, 0.96%-0.98%) to October 2020 (women: 1.46%; 95% CI, 1.46%-1.47%; men: 1.00%; 95% CI, 0.99%-1.01%).

For women, SSRI and SNRI prescribing rates increased from 12.77% in January 2018 to 15.18% in October 2020, followed by a decrease to 14.75% in February 2021. For men, prescribing rates increased from 5.56% in January 2018 to 6.31% in January 2020, then increased to 6.73% in April 2020, followed by a decrease to 6.57% in February 2021.

Overall, investigators reported a substantial increase in prescriptions during the COVID-19, and with them substantial mental health implications. This was especially true of the women participants in the study.

“These findings suggest that mitigation measures, including social isolation and stay-at-home orders, might have negatively affected mental health, particularly among women,” the team said. “As data accumulate, examination of long-term consequences of these prescribing trends and how they relate to mental health outcomes, such as suicide and ED visits, is warranted.”

The study, “Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic,” was published online in JAMA Open Network.