Steep rise in antidepressant use noted in young people during COVID, especially among teen girls


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The COVID-19 pandemic likely exacerbated a growing mental health crisis among US teens and young adults, as evidenced by the sharp increase in antidepressant prescriptions written after March of 2020.

These prescriptions are the focus of a study published today in Pediatrics, which shows that, after the pandemic began, prescriptions increased 130% among female adolescents ages 12 to 17 years and almost 60% among female young adults ages 18 to 25 years compared to rates seen in 2016 to 2019.

"Multiple studies suggest that rates of anxiety and depression among female adolescents increased during the pandemic," said first study author Kao-Ping Chua, MD, PhD, a pediatrician and researcher at University of Michigan Health in a press release from the University of Michigan. "These studies, coupled with our findings, suggest the pandemic exacerbated a pre-existing mental health crisis in this group."

Less prescribing found in boys, men

The study was based on antidepressant prescriptions dispensed to US individuals aged 12 to 25 years from 2016 to 2022 and included in the IQVIA Longitudinal Prescription Database, an all-payer national database covering 92% of the prescriptions dispensed in US pharmacies.

From January 2016 to March 2020, the monthly prescription rate increased by 17.0% per month (95% confidence interval [CI], 15.2% to 18.8%), suggesting antidepressant use (most commonly selective-serotonin reuptake inhibitors, or SSRIs) was on the rise prepandemic. Beginning in March 2020, the authors found an increase of 10.8% per month for prescriptions.

"The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand," the authors said.

The monthly antidepressant dispensing rate increased 63.5% faster from March 2020 onwards compared with beforehand.

But the trend was seen only in females, not males. Monthly prescription rates rose 129.6% and 56.5% faster from March 2020 onwards compared with beforehand among females aged 12 to 17 years and 18 to 25 years, respectively, the authors said, but prescribing rates for males the same age dropped after the pandemic began.

Before March of 2020, prescriptions for male teens were increasing steadily at 8.7% per month, but the pandemic was associated with a decrease in prescriptions.

"In December 2022, the antidepressant dispensing rate among male young adults was 0.1 (0.0%) higher than predicted by the counterfactual trend, compared with 403.8 (6.2%) higher among female young adults," the authors said.

Cultural norms could be at play

In a commentary in Pediatrics, experts from the University of Nebraska Medical Center and Creighton University School of Medicine write that the study further illuminates the mental health crisis experienced by US teens. They said the difference seen between boys and girls in the study is likely due to cultural norms.

"Cultural norms often socialize girls toward expressing internalizing behaviors such as anxiety and depression, whereas boys may exhibit more externalizing behaviors such as antisocial actions and substance abuse," they wrote.

"This pattern could affect how mental health disorders present and are recognized in males, suggesting the need for more research and training to identify expressions of emotional distress."

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