Post-pandemic trends in psychotropic medication use in Danish children, adolescents, and young adults

Abstract

Mental health among children, adolescents, and young adults deteriorated during the Covid-19 pandemic, leading to concurrent significant rises in utilization of psychotropics.^{1, 2} This escalation in psychotropic medication use raised concerns for potential long-term effects beyond the immediate aftermaths of the pandemic. We aimed to assess rates of incident psychotropic medication use in the post-pandemic period compared with pre-pandemic trends in Danish children, adolescents, and young adults.

In this population-based study, we used individual-level data from the Danish National Prescription Registry³ to identify all individuals aged 5–24 years who filled a prescription for psychotropic medication from January 1, 2015, to December 31, 2023. Prescriptions for the following psychotropic drug classes were included: antipsychotics (Anatomical Therapeutic Chemical [ATC] code N05A), anxiolytics (N05B), hypnotics and sedatives (N05C), antidepressants (N06A), and psychostimulants (N06B). For each month of the study period, we determined the number of incident users of each drug class and obtained the total number of 5–24-year-olds living in Denmark from the Danish Civil Registration System. Drug use was considered incident if there had been no prescription fill for the given drug in the previous 5 years.

Interrupted time series analysis was used to determine the monthly number of incident users of psychotropic medication in the post-pandemic period compared with the counterfactual pre-pandemic trend. Time-trends were modeled using Poisson regression with 105 data points. The model included three time segments: the pre-pandemic period (January 2015 to February 2020), the pandemic period (March 2020 to January 2022), and the post-pandemic period (from February 2022 until end of data availability). The end of the pandemic period was defined as January 2022, following the lifting of all Danish Covid-19-related restrictions. We modeled both the level and slope changes associated with each time segment and included Fourier terms and a scale parameter to account for seasonality and overdispersion (see Supplementary Methods).⁴ Using model predictions, we obtained the cumulative number of incident psychotropic drug users in the post-pandemic period compared with pre-pandemic predictions and estimated the number of excess cases of incident psychotropic use and corresponding risk ratios (RR) with 95% confidence intervals (CI). The analysis was repeated for each psychotropic drug class and stratified by sex and age groups (5–11, 12–17, 18–24 years).

From 2015 through 2023, 182,097 Danish individuals aged 5–24 years filled an incident prescription for a psychotropic medication (55% female, median age 18.8 years [interquartile range 14.7–22.0]). The yearly incidence rate (IR) of psychotropic medication use increased from 1166 new users per 100,000 person-years (PY) in 2015 to 2090/100,000 PY in 2023 (Figure 1). This was largely driven by incident psychostimulant and hypnotic use, which increased from 321 to 1007/100,0000 PY and from 545 to 1251/100,000 PY, respectively. Compared with the pre-pandemic forecast, the post-pandemic period was associated with an excess number of 13,620 (95% CI; 9158–18,081) incident psychotropic medication users, equivalent to a RR of 1.36 (1.20–1.51). Trends for incident hypnotic and psychostimulant use continued to increase during the post-pandemic period with 11,334 (8535–14,133) excess users of hypnotics, RR 1.59 (1.37–1.80), and 8409 (6246–10,572) excess users of psychostimulants, RR 1.56 (1.35–1.78). Although less pronounced, the use of antidepressants also increased with 4332 excess users (2222-6442) leading to a RR of 1.24 (1.10–1.38). No increases in use of antipsychotics or anxiolytics were observed compared to the expected trends.

The increase in incident psychotropic medication use was more marked for females than males. The RR for incident use of hypnotics was 1.84 (1.58–2.10) for females and 1.33 (1.14–1.52) for males in the post-pandemic period compared with the pre-pandemic forecast. Also, the RRs for incident use of psychostimulants and antidepressants in females were 2.24 (1.87–2.60) and 1.37 (1.20–1.53), whereas the corresponding RRs in males were 1.17 (1.01–1.33) and 1.04 (0.92–0.16).

The rates of new users of any psychotropic medication increased after the pandemic across all age groups. This was also the case for hypnotics, where incident use exceeded pre-pandemic trends in all age groups with RRs of 1.33 (1.08–1.57) for 5–11-year-olds, 1.74 (1.46–2.02) for 12–17-year-olds, and 1.60 (1.38-1-81) for 18–24-year-olds. For antidepressants, the number of incident users were also higher in all age groups (RR 1.60 [1.03–2.16] for 5–11-year-olds, RR 1.70 [1.44–1.96] for 12–17-year-olds and RR 1.16 [1.03–1.29] for 18–24-year-olds). The use of psychostimulants, however, only surpassed forecasts for 12–17- and 18–24-year-olds with RRs of 1.76 (1.50–2.01) and 1.92 (1.61–2.23), respectively.

This study documents a persistent rise in young Danish individuals using psychotropic medications that extends into the first 2 years after the Covid-19 pandemic. The rise was observed for psychostimulants, hypnotics, and antidepressants, and was particularly high for females.

Our findings expand previous reports of increasing psychotropic medication use among Danish youths during the pandemic that also showed an alarming female predominance.¹ The exact mechanisms driving this persistent surge remain unclear and are likely caused by multiple factors including consequences of the pandemic. Still, the pandemic seems to have catalyzed a more long-lasting change in psychotropic utilization patterns among youths, which is likely related to a deterioration of mental well-being above and beyond the trends in preceding years.⁵ The specific increase in psychostimulants, however, may also rely on increased recognition and broadening of diagnostic criteria for ADHD.

Strengths of the study include its nationwide coverage with recent update of data. Limitations include focus on the number of incident users only. Furthermore, filled prescriptions serve only as proxies for actual consumption. Finally, the interrupted-times series approach holds assumptions on seasonality, trends over time,⁴ and arbitrary definitions of start and end of the Covid-19 pandemic.

The alarming rise in psychotropic medication use observed among Danish children, adolescents, and young adults during the Covid-19 pandemic persists into the post-pandemic years. This adds to the growing concern about current mental health issues among youths, particularly females. Moreover, the continued rise in use of psychotropics in this young population is troubling due to potential adverse effects, insufficient long-term safety data, and the risk of misuse. Our findings underscore the need for further research into underlying causes and potential interventions.

The authors declare no conflict of interest.