Impact of COVID-19 on Psychotropic Medication Use Among Children and Adolescents Receiving Mental Health Services

Background: Increased mental health problems among children and adolescents during the COVID-19 pandemic may have impacted psychotropic medication use.

Objectives: To describe trends in psychotropic medication use before and during the COVID-19 pandemic among commercially insured children and adolescents.

Methods: A population-based, cross-sectional study was conducted using 2019-2020 IQVIA prescription and medical claims data for 2 to 17 years old children and adolescents with mental health disorders. We evaluated psychotropic medication use before and during the COVID-19 pandemic, and four psychotropic-therapeutic classes were included; ADHD medication (stimulants and non-stimulants), antidepressants, antipsychotics, and mood stabilizers. We estimated (1) monthly psychotropic medication use defined as the number of children and adolescents with any psychotropic prescription claim in the month divided by the total number of children and adolescents with any record of a claim for service or medication in the same month and (2) year-over-year percent change in psychotropic medication use to account for seasonal variations.

Results: Of the 8,896,713 children and adolescents in the sample, 24.7% received psychotropic medication during the study period. Monthly psychotropic use averaged 27%-28% January 2019-January 2020, peaked at 36.9% in April 2020, and gradually declined to 28.7% in September 2020. The year-over-year percent change in psychotherapeutic class use shows 26.9% higher use in April 2020 relative to April 2019 and 10% higher use from March to July 2020 relative to the same months in 2019. The largest year-over-year percent change was in April for antipsychotic and antidepressant use; 41.6% and 37.9%, respectively, and remained higher in September 2020 compared to the same period pre-pandemic, particularly among those 6 years or older and females.

Conclusions: Increased psychotropic use at the onset of the COVID-19 pandemic was most pronounced for antipsychotic and antidepressant medication. While overall psychotropic use returned to the pre-pandemic levels, antipsychotic and antidepressant remained higher than pre-pandemic, highlighting the need to further understand the long-lasting effects of the pandemic on children and adolescents.