Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach

Estrela, Marta; Silva, Tania; Gomes, Eva; Piñeiro, María de las Mercedes Paíno; Figueiras, Adolfo; Roque, Fátima; Herdeiro, María Teresa

doi:10.1136/jech-2021-216732

Cited by 45 publications

(44 citation statements)

References 26 publications

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“…Namely, the COVID-19 pandemic was not associated with an immediate increase in antidepressant prescription fills, but it was associated with an increase over time and is expected to continue increasing in the near future. The increased incident rate of antidepressant fills during the pandemic in Israel is consistent with prior reports that used nationwide data from the Europe and the USA (Estrela et al, 2022 ; Express Scripts, 2020 ; Rabeea et al, 2021 ) and aligns with similar findings following other events producing population-level distress, such as terrorist attacks (Druss & Marcus, 2004 ) and earthquakes (Trifirò et al, 2013 ). The increased antidepressant fill rate during the pandemic was higher than that seen during the Gaza war, probably reflecting the greater length, morbidity, and mortality associated with the pandemic.…”

Section: Discussionsupporting

confidence: 88%

“…The use of antidepressant medication during the pandemic provides complementary information, focused on the intersection between help-seeking behavior and service provision. Studies of antidepressant use derived from large-scale nationwide datasets are few, but those from Europe and the USA provide convincing evidence of increased antidepressant prescription pharmacy claims during the pandemic compared to the pre-pandemic period (Estrela et al, 2022 ; Express Scripts, 2020 ; Rabeea, Merchant, Khan, Kow, & Hasan, 2021 ), and suggest significant moderating effects for sex and age (NHS Digital, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

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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“…With respect to the minor decline in the number of DHD for anti-depressants, similar results were found in a study carried out in Portugal ( Estrela et al, 2021 ). According to another study conducted in Aragon ( Mestre, 2021 ), the follow-up period used for our study (6 months following the end of the lockdown) may be insufficient for the detection of changes in the consumption of these drugs.…”

Section: Discussionsupporting

confidence: 86%

Analysis of Drug and Health Resource Use Before and After COVID-19 Lockdown in a Population Undergoing Treatment for Depression or Anxiety

et al. 2022

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IntroductionThe arrival of the COVID-19 pandemic modified the functions of Primary Care (PC) teams, which were forced to focus their resources on the diagnosis and treatment of SARS-CoV-2 infected patients. The disrupted healthcare of individuals with pre-existing mental disorders (depression or anxiety), as well as the psychological decompensation resulting from the lockdown caused by the COVID-19 pandemic, may have modified the use of drugs and health resources by these patients. The aim of this study is to determine the changes in these parameters, between the 6 months prior to the lockdown (09/14/2019 to 03/15/2020) and the 6 months following its end (05/03/2020 to 11/04/2020), in a population undergoing active treatment for depression or anxiety, according to the electronic clinical record.Materials and MethodsReal world data observational study of 110,694 individuals aged >16 years suffering from active or undergoing treatment for depression or anxiety according to the electronic medical records of the Aragon Regional Health Service (Spain). Pharmacological variables [daily dose per inhabitant (DHD) dispensed by pharmacies of: anxiolytics, hypnotics/sedatives, and antidepressants] and variables related to the use of healthcare resources (number of primary and specialized healthcare visits) were considered. Student’s T-tests for paired samples were performed to analyze differences between periods (pre–post). The level of significance was established at 5% (p < 0.05).ResultsThe use of anxiolytic drugs increased as compared to its use over the 6 months prior to the lockdown. In contrast, the consumption of antidepressants was found to decrease. The use of health resources continued to be below pre-pandemic levels, 6 months post-lockdown end.ConclusionChanges in the use of health resources could have a negative impact on the parameters of these diseases. The increase in drug use, especially benzodiazepines, may suggest a worsening of the symptoms during the lockdown and in the subsequent months. It is a worrying sign, which points to the growth of this public health problem and the need for its prevention.

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“…In Germany [25], a decrease in the prescription of drugs for mental disorders was identified. Interestingly, similarly to this study, research from Portugal found no impact of the pandemic on the increasing prescribing trends of drugs of interest [26].…”

Section: Discussionsupporting

confidence: 81%

Impact of COVID-19 Pandemic on the Use of Antidepressant and Antianxiety Pharmaceuticals as Well as Sick Leave in Poland

Krupa

Czech²,

Pinkas

et al. 2022

IJERPH

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The COVID-19 pandemic caused a major upheaval to the lives of people and placed a strain on societal mental health. The aim of this research is to estimate the impact of the pandemic on the mental condition of the Polish population measured through the consumption of relevant medication and medical leave of absence from the workplace. Methods: We analyzed national-level data on the consumption of pharmaceuticals used in clinical practice in Poland in the treatment of depression and anxiety alongside medical absence in the workplace using the Interrupted Time Series model to estimate the significance of the pandemic. Results: We found no significant change regarding the consumption of pharmaceuticals with the development of the pandemic. Conversely, medical leaves of absence for psychiatric reasons increased significantly with the onset of COVID-19. The influence was strongest in the diagnosis of anxiety or reaction to severe stress and weakest in recurrent depression. Conclusion: The pandemic had a significant influence on the ability to work for psychiatric patients in Poland but did not change pharmaceutical use. Physicians should consider the mental health of patients impacted by the anti-epidemic measures. Further study is needed to fully understand the long-term impact of the pandemic on mental health in Poland.

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Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach

Cited by 45 publications

References 26 publications

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

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

Analysis of Drug and Health Resource Use Before and After COVID-19 Lockdown in a Population Undergoing Treatment for Depression or Anxiety

Impact of COVID-19 Pandemic on the Use of Antidepressant and Antianxiety Pharmaceuticals as Well as Sick Leave in Poland

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