Psychiatric prescriptions up during pandemic, especially among women

Prescriptions for Z-hypnotics, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and benzodiazepines have increased during the COVID-19 pandemic.

These increases point to significant mental health effects of COVID-19-related mitigation measures, particularly among women, researchers noted in a cohort study published in JAMA Network Open.

“Most health care resources were focused on non-psychiatric aspects of COVID-19,” Sadaf Arefi Milani, PhD, MPH, of the department of internal medicine-geriatrics and palliative medicine at the University of Texas Medical Branch, told Healio Psychiatry. “We were interested in seeing if the mental health impact of the COVID-19 pandemic and associated mitigation measures exacerbated the already higher rates of mental health conditions and psychiatric prescriptions among women.

“We hope that this study highlights the substantially higher effect of the ongoing COVID-19 pandemic on women, sex as a priority in research on the COVID-19 pandemic and the need for interventions to address these sex disparities in the consequences of the pandemic,” Milani added.

Milani and colleagues analyzed data from a large commercial health insurance database in the U.S. They included enrollees aged 18 years or older who had complete enrollment in a given month during the study period of between January 2018 and March 2021 to be included for that month. Specifically, they included data of 17,255,033 adults (mean age, 51.7 years; 51.3% women) for 2018, 17,340,731 adults (mean age, 52.5 years; 51.6% women) for 2019, 16,916,910 adults (mean age, 53.7 years; 51.9% women) for 2020 and 15,135,998 adults (mean age, 56.2 years; 52.5% women) for 2021. Main outcomes included prescription of a benzodiazepine, Z-hypnotic (nonbenzodiazepine drugs, such as zolpidem, zaleplon and eszopiclone), selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI). The researchers calculated the percentage of patients with these prescriptions for each month by sex.

Results showed a higher rate of prescriptions for the three drug classes and more significant changes in prescription rates over time for women compared with men. Milani and colleagues noted a decrease in benzodiazepine prescribing between January 2018 (women = 5.61%; men = 3.03%) and March 2021 (women = 4.91%; men = 2.66%), aside from a small increase for women in April 2020. Further, they noted an increase in Z-hypnotic prescribing between January 2020 of 1.39% for women and in February 2020 of 0.97% for men and to October 2020 (women = 1.46%; men = 1%). SSRI and SNRI prescriptions increased between January 2018 (women = 12.77%; men = 5.56%) and April 2020 for men (6.73%) and October 2020 for women (15.18%).

“Practicing clinicians and decision-makers in the health systems across all settings with medical contacts with women (eg, primary care, perinatal care and acute care visits) should strongly consider incorporation of a validated screening process for mental health conditions in their routine practice and EMR,” Milani said. “This is especially critical in moments of natural disasters (infectious pandemics and extreme weather events, such as hurricanes), as our study suggests that those disasters exact a higher mental and psychological toll on women than men.

“Our study also suggests that providers recognize that anxiety, depression, sleep and other mental health disorders may manifest differently in men and women, and not just dismiss a woman’s mental health concern as just ‘nerves’ or ‘stress’,” Milani added. “Additionally, providers and/or patients should exercise caution with long-term use of Z-drugs (eg, Zolpidem), and they should strongly consider non-pharmacologic and behavioral approaches as safer and effective alternatives for insomnia and other sleep disorders.”