(V) Trends in Psychotropic Prescriptions Dispensed to US Children Early in the COVID-19 Pandemic

Publication Number: 1021

Background: COVID-19 caused an unprecedented disruption to healthcare access and daily interactions that have greatly affected the mental health of children and adolescents. Assessing the impact on pediatric psychotropic medication use and potential regional variations would provide insight into the magnitude of effect in this population.

Objectives: To examine trends in, and geographic variability of, psychotropic prescriptions to US children before and in the early months of the COVID-19 pandemic.

Methods: We utilized IQVIA’s US Longitudinal Prescription dataset from Jan 2019 to Sept 2020, which captures approximately 90% of prescriptions dispensed across the US. Data was provided under the IQVIA Institute Human Data Science Research Collaborative. We examined prescriptions dispensed to children aged 5-17 years by therapeutic class: antidepressants, antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medications (stimulants, alpha agonists), and sedatives/anxiolytics. We measured total prescriptions dispensed per month overall and stratified by ten US geographical regions (as defined by US CDC). We estimated the year-over-year percent change in number of prescriptions dispensed in 2020 vs. 2019 overall and by month for Mar through Sept.

Results: In the study period, 95.6 million pediatric psychotropic prescriptions were dispensed in the US. More antidepressant, antipsychotic, and sedative/anxiolytic prescriptions were dispensed to children in Mar 2020 compared to Mar 2019 (% increase by medication class: 4-12%), followed by a sharp decline in May 2020 compared to May 2019 (% decline: 7-13%). By Sept 2020, counts were similar to Sept 2019. ADHD medications were similar in Mar of 2020 vs. 2019 but by May 2020 dropped 21% (2.3 million dispensings in May 2020 vs. 2.9 million in May 2019); by Sept 2020, prescriptions remained below 2019 levels.

Trends observed in pediatric psychotropic prescriptions in 2020 vs. 2019 were similar by US region however, regional variation was observed in the magnitude of change and extent of rebound of prescription counts by Sept 2020. In New England and Pacific regions, fewer antipsychotics (-5%, -8%, respectively) and antidepressants (-4%, -3%) were dispensed from Mar-Sept 2020 vs. Mar-Sept 2019, while in the West North Central region, more antipsychotics (+3%) and antidepressants (+4%) were dispensed.

Conclusions: Overall, there were fewer psychotropic prescriptions dispensed for US children early in the COVID-19 pandemic compared to the pre-pandemic period. While some regions rebounded to pre-pandemic numbers by Sept. 2020, this varied by psychotropic class and region. Examining the pandemic's immediate and lasting effects on pediatric mental health and mental health care utilization remains a priority.