Psychotropic medication prescribing during the COVID-19 pandemic

Hirschtritt, Matthew E.; Slama, Natalie; Sterling, Stacy; Olfson, Mark; Iturralde, Esti

doi:10.1097/md.0000000000027664

Cited by 26 publications

(30 citation statements)

References 40 publications

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“…Our findings contrasted the results of a cross-sectional study where the investigators found no clinically meaningful differences in overall prescription rates of psychotropic medications in 2020, compared to 2019, using data from Kaiser Permanente Northern California electronic records ( Hirschtritt et al, 2021 ). After accounting for secular trends or prior year patterns, they found a small, but significant increase in the antidepressant trazodone and mood stabilizers/antipsychotics, and a small decrease in benzodiazepines and hypnotics, with no significant change in antidepressants and stimulants ( Hirschtritt et al, 2021 ). They also found a lower-than-expected trend in new fills for nearly all medications, including antidepressants, benzodiazepines, hypnotics, and mood stabilizers and antipsychotics ( Hirschtritt et al, 2021 ).…”

Section: Discussioncontrasting

confidence: 98%

“…After accounting for secular trends or prior year patterns, they found a small, but significant increase in the antidepressant trazodone and mood stabilizers/antipsychotics, and a small decrease in benzodiazepines and hypnotics, with no significant change in antidepressants and stimulants ( Hirschtritt et al, 2021 ). They also found a lower-than-expected trend in new fills for nearly all medications, including antidepressants, benzodiazepines, hypnotics, and mood stabilizers and antipsychotics ( Hirschtritt et al, 2021 ). This was consistent with our findings of a decline in incidence in antidepressants and anxiolytic/sedative-hypnotic use in the second quarter as their data were only limited to the first 13 weeks of the pandemic in California.…”

Section: Discussionmentioning

confidence: 99%

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Psychotropic Medication Use Before and During COVID-19: A Population-Wide Study

et al. 2022

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Background: The coronavirus disease 2019 (COVID-19) pandemic and public health measures that took place have led to concerns regarding mental health and receipt of psychotropic medications. We aimed to study the changes in psychotropic medication dispensation rates before and during the COVID-19 pandemic in the general population.Methods: Administrative health data from the Canadian province of Manitoba was used to describe the quarterly incidence and prevalence of antipsychotics, antidepressants, and anxiolytic/sedative-hypnotics from January 1, 2015 to December 31, 2020. Individuals who received at least one prescription within each quarter were considered exposed to the medication. The denominator was the total population within each quarter. Incidence was defined as no receipt of medication in the 3 years prior to the quarter of interest. Autoregression models for time series data plus indicator variables were used to compare each quarter of 2020 after public health measures were implemented in March 2020 in relation to the expected trend. Analyses were stratified by age and sex.Results: There were 1,394,885 individuals in the first quarter of 2020, with a mean (SD) age of 38.9 (23.4) years, 50.3% were female, and 36.1% had a psychiatric diagnosis in the previous 5 years. A significant decrease was observed for incident antidepressant use (p < 0.05 for both sexes and all age groups except for those 65 years and older) and anxiolytic use (p < 0.05 for both sexes and all age groups except 80 years and older) in the second quarter (April-June) of 2020 compared to the expected trend. Females and those aged 40 years and older had a significantly higher incidence of antidepressant and antipsychotic use in the final quarter of 2020 compared to the expected trend (p < 0.05).Conclusion: Our findings indicate a decrease in new prescriptions for antidepressants and anxiolytics in the 3 months after COVID-19 in-person restrictions were first implemented. We then observed an increase in the new use of antidepressants and antipsychotics at the end of 2020, in females and people aged 40 years and older, with the highest rates of use in the population 80 years and older.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Use Before and During COVID-19: A Population-Wide Study

et al. 2022

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“…Several explanations may be postulated including the drop in medical consultations in this age group during the pandemic for all health problems, including mental health (e.g. Hirschtritt, Slama, Sterling, Olfson, & Iturralde, 2021 ; ONS, 2021c ), despite the significant increase in mental health problems reported by older individuals (Tyler et al, 2021 ). For individuals aged 65 years or older, difficulties accessing telehealth may act as a substantial barrier (Lam, Lu, Shi, & Covinsky, 2020 ) because of unfamiliarity with the relevant technology.…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, our analyses were limited to one class of psychotropics (i.e. antidepressants) but there is some evidence that prescriptions of all psychotropics may have increased during the pandemic (Express Scripts, 2020 ; Hirschtritt et al, 2021 ). Further, we did not collect information on the different types of antidepressants prescribed or other forms of treatment such as psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

Increased incident rates of antidepressant use during the COVID-19 pandemic: interrupted time-series analysis of a nationally representative sample

Frangou

Travis-Lumer²,

Kodesh³

et al. 2022

Psychol. Med.

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Background The COVID-19 pandemic has been associated with increased levels of depression and anxiety with implications for the use of antidepressant medications. Methods The incident rate of antidepressant fills before and during the COVID-19 pandemic were compared using interrupted time-series analysis followed by comprehensive sensitivity analyses on data derived from electronic medical records from a large health management organization providing nationwide services to 14% of the Israeli population. The dataset covered the period from 1 January 2013 to 1 February 2021, with 1 March 2020 onwards defined as the period of the COVID-19 pandemic. Forecasting analysis was implemented to test the effect of the vaccine roll-out and easing of social restrictions on antidepressant use. Results The sample consisted of 852 233 persons with a total antidepressant incident fill count of 139 535.4 (total cumulative rate per 100 000 = 16 372.91, 95% CI 16 287.19–16 459.01). We calculated the proportion of antidepressant prescription fills for the COVID-19 period, and the counterfactual proportion for the same period, assuming COVID-19 had not occurred. The difference in these proportions was significant [Cohen's h = 10−3 (0.16), 95% CI 10−3 ( − 0.71 to 1.03)]. The pandemic was associated with a significant increase in the slope of the incident rate of antidepressant fills (slope change = 0.01, 95% CI 0.00–0.03; p = 0.04) and a monthly increase of 2% compared to the counterfactual (the estimated rate assuming no pandemic occurred). The increased rate was more pronounced in women, and was not modified by lockdown on/off periods, socioeconomic or SARS-CoV-2 status. The rate of observed antidepressant fills was similar to that forecasted under the assumption of ongoing COVID-19 distress. Conclusion These findings underscore the toll of the pandemic on mental health and inform mental health policy and service delivery during and after implementing COVID-19 attenuation strategies.

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“…Some recent studies suggested that selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, and the SARI classes of antidepressants drove this protective effect on COVID-19 infection risk [ 32 , 33 ]. Furthermore, it has been shown that during the COVID-19 pandemic—specifically in the 13 weeks following March 4, 2020—there were increased prescriptions in adult patients for trazodone, and decreased prescriptions for benzodiazepines and hypnotics [ 34 ]. This may reflect a shift in clinicians’ attitudes and increased awareness of trazodone’s actions.…”

Section: Discussionmentioning

confidence: 99%

Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

Mazza

Caroppo

Marano

et al. 2022

IJERPH

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(1) Background: During the SARS-CoV-2 (COVID-19) pandemic, cannabis use increased relative to pre-pandemic levels, while forced home confinement frequently caused sleep/wake cycle disruptions, psychological distress, and maladaptive coping strategies with the consequent appearance of anxiety symptoms and their potential impact on substance use problems. (2) Aim: Long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. The present work aims to investigate the effectiveness of trazodone in optimizing the condition of people with cannabis dependence under pandemic conditions. (3) Methods: All cases with cannabis use disorder were uniformly treated with long-acting trazodone 150 mg or 300 mg/day; their craving and clinical status were monitored through appropriate psychometric scales. Side effects were recorded as they were reported by patients. We described the cases of three young patients—one man and two women—who were affected by chronic cannabis use disorder and who experienced lockdown-related psychological distress and sought psychiatric help. (4) Results: The described cases highlight that the once-a-day formulation of trazodone seems to have a therapeutic role in patients with cannabis use disorder and to guarantee tolerability and efficacy over time. No significant side effects emerged. (5) Conclusions: The use of long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. Trazodone deserves to be studied in terms of its efficacy for cannabis use disorder.

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Psychotropic medication prescribing during the COVID-19 pandemic

Abstract: Supplemental Digital Content is available in the text

Cited by 26 publications

References 40 publications

Psychotropic Medication Use Before and During COVID-19: A Population-Wide Study

Psychotropic Medication Use Before and During COVID-19: A Population-Wide Study

Increased incident rates of antidepressant use during the COVID-19 pandemic: interrupted time-series analysis of a nationally representative sample

Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

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