03. Psychotropic Prescriptions in Youth During COVID-19 Pandemic

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Hi! David Rosenberg here for the Psychopharmacology Institute. In this CAP—or Child and Adolescent Psychiatry—Smart Take, we will examine psychotropic medication prescriptions during the COVID-19 pandemic among children and adolescents in the United States receiving mental health services. Even in the pandemic’s aftermath, we still feel the impact and fallout from a nearly 3-year pandemic. Global lockdown, social distancing and isolation, and extended school closures resulted in virtual learning and a new normal. Behaviors that once would have been considered to be OCD became the new normal: We wore masks everywhere; we used sanitizers as much as possible.

Is it any wonder psychiatric sequelae exploded in children, adolescents, and young adults, with unprecedented levels of depression and anxiety? In this study, the authors examined monthly prescribing trends of psychotropic medications in nearly 8,900 privately insured youth in the United States from 2–17 years of age. So, what did they find? Well, psychotropic prescriptions increased dramatically shortly after the onset of the pandemic and nationwide lockdowns in April 2020 and then gradually decreased in the months following through September 2020. The increase in prescriptions in 2020 compared with 2019 was most remarkable for antidepressants, antipsychotics, and mood stabilizers.

However, antidepressant and antipsychotic prescriptions remained significantly higher in September 2020 than in September 2019, so their increase after the pandemic did not return to baseline. Antidepressant and antipsychotic prescriptions were similar in children 6–17 years of age, underscoring an especially striking impact on elementary, middle, and high school students. Increased antidepressant and antipsychotic prescriptions were also more pronounced in females than in males. Overall, this is an excellent, well-done study. As the authors note, the data examined was available through September 2020, so they could not examine changes throughout the pandemic and its aftermath. They also could not compare and contrast patients with 1 psychotropic prescription and those receiving more than 1 psychotropic.

Nonetheless, this is a well-done and informative study for those in the trenches treating children and adolescents in the aftermath of the pandemic. Moreover, I want to emphasize that we are likely to experience an even greater wave as the pandemic hopefully continues to recede. I liken this to the PTSD we see in veterans in combat. Many can focus on the task and hold it together during acute stress and trauma.

However, when they return to “normal civilian life,” they can experience significant and debilitating PTSD and other symptoms. I suspect that we may be in for a similar wave of psychopathology in school-age children, perhaps also their parents, as we leave the once new but now old normal of the pandemic and go into another new normal of the pandemic’s aftermath. Those working with school-age children are likely to be increasingly busy in the months and years ahead.

Abstract

Psychotropic Prescriptions During the COVID-19 Pandemic Among U.S. Children and Adolescents Receiving Mental Health Services

Alejandro Amill-Rosario, Haeyoung Lee, Chengchen Zhang, Susan dosReis

Objective: Increased mental health problems among children and adolescents during the COVID-19 pandemic may have impacted psychotropic medication use. This study describes trends in monthly psychotropic medications before and early in the COVID-19 pandemic among 2- to 17-year-old children and adolescents with mental health disorders.

Methods:  A cross-sectional study design using the 2019-2020 IQVIA™ prescription and medical commercial claims data to estimate the proportion of children and adolescents with any psychotropic prescription in the month out of all with any mental health-related medical or prescription services in the month and the year-over-year percent change. We assessed monthly proportions of youth who filled a psychotropic prescription overall and by psychotropic class, stratified by age and gender.

Results: Of the 8,896,713 children and adolescents in the sample, 24.7% received psychotropic medication during the study period. The proportion of the cohort prescribed a psychotropic medication in a given month averaged 27%-28% from January 2019 to February 2020, peaked at 36.9% in April 2020, and gradually declined to 28.7% in September 2020. The largest year-over-year percent change was in April for antipsychotic (41.9%) and antidepressant (37.9%) medication, which remained higher in September 2020 compared to September 2019, particularly among ages 6 years or older and females.

Conclusion: The proportion of youth with a psychotropic prescription increased at the onset of the COVID-19 pandemic, later returning to prepandemic levels. However, antipsychotics and antidepressants remained higher than prepandemic, highlighting the need to further understand the long-lasting effects of the pandemic on children and adolescents.

Reference

Amill-Rosario, A., Lee, H., Zhang, C., & DosReis, S. (2022). Psychotropic prescriptions during the COVID-19 pandemic among U.S. children and adolescents receiving mental health services. Journal of Child and Adolescent Psychopharmacology, 32(7), 408-414.