Increasing Use of Antidepressants, Hypnotics and Psychostimulants During the COVID-19 Pandemic Among Danish Children, Adolescents, and Young Adults

Background: Mental well-being of youths has been negatively affected by the COVID-19 pandemic, however, little is known about its impact on the use of psychotropics.

Objectives: To examine incident psychotropic drug use in Danish children, adolescents, and young adults during the pandemic.

Methods: We conducted a drug utilization study of all Danes 5-24 years between January 1, 2017 and March 31, 2022, using individual-level data from Healthcare registries, including information on all filled prescriptions for antipsychotics (Anatomical Therapeutic Chemical code N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), antidepressants (N06A), and psychostimulants (N06B). Incident drug use was defined as the first prescription filled within the specific drug class during the last five years.
We calculated overall incidence rates (IR) of psychotropic drug use per month by age group and the total dispensed drug quantity (in Defined Daily Doses (DDD)) per month overall and by drug class. We calculated the proportion of users naïve to all other psychotropic drug classes 180 days prior to their incident prescription from March 1, 2020 to March 31, 2022.
Using an interrupted time series approach we modelled the monthly number of incident users of psychotropic drugs, stratified by drug class and age group before the COVID-19 pandemic using Poisson regression and modelling seasonality using Fourier terms.

Results: There was an increase in incident use of psychotropics among all age groups from the first Danish lockdown in March 2020 through March 2022. This was most prominent among 12-17-years-olds (IR from 165 to 278/100,000 inhabitants) and 18-24-years-olds (IR from 323 to 516/100,000). Adjusting for pre-pandemic time trends, this corresponded to a relative increase of 32% (RR 1.32, 95% CI 1.31-1.34) and 17% (RR 1.17, 95% CI 1.16-1.18) from expected numbers. The increase exceeded expected numbers for all drugs except anxiolytics, with rate ratios of 1.37 (CI 1.36-1.38) for hypnotics and sedatives, 1.17 (CI 1.15-1.18) for psychostimulants, 1.11 (CI 1.09-1.12) for antidepressants and 1.08 (CI 1.06-1.10) for antipsychotics.
The increase in incident use was also reflected in the total dispensed quantity of psychotropic drugs, but only for hypnotics and sedatives (0.5 to 1.0 million (m) DDD per month), antidepressants (0.9 to 1.2 m DDD) and psychostimulants (0.9 to 1.1 m DDD). Of all new users, 65% were naïve to other psychotropic drug classes 180 days prior to initiation.

Conclusions: Danish youths have experienced an increase in mental problems that required psychotropic treatment during the COVID-19 pandemic. These new young users likely need psychiatric care and treatment in the future, emphasizing a potential strain on healthcare systems that reach beyond the pandemic period.