Psychotropic Medication use before, during, and after the Covid-19 pandemic in Danish Children, Adolescents, and Young Adults – an interrupted time series.

Background: The Covid-19 pandemic has been associated with deterioration in mental health among children and adolescents, leading to increased use of psychotropic drugs. Whether this increase in use persists beyond the pandemic is unknown.

Objectives: To examine changes in rates of incident prescriptions for psychotropic drugs before, during, and after the Covid-19 pandemic in Danish children, adolescents, and young adults.

Methods: Using Danish nationwide individual-level prescription data, we identified all incident prescriptions for antipsychotics, anxiolytics, hypnotics, antidepressants, and psychostimulants filled by individuals 5 through 24 years of age from January 1, 2015, to December 31, 2023. The onset of the pandemic was defined as March 2020, and the end as January 2022 when all restrictions were lifted in Denmark. Interrupted time-series analysis was used to model the monthly number of incident users of psychotropic drugs comparing predictions based on the pre-pandemic trend to the pandemic and post-pandemic trend.

Results: The study included 182,097 incident users of psychotropic medications (55% female, median age 15 years [IQR, 15-22]). From 2015 through 2023, the yearly incidence rate (IR) of psychotropics increased by 79% from 1166 new users per 100,000 in 2015 to 2089 users per 100,000 in 2023. This was largely driven by increased rates of psychostimulant and hypnotic use, which increased by 214% and 129%, respectively, during the period. Compared to the expected number of incident users of psychotropic medication derived from the pre-pandemic trend, the pandemic period was associated with an overall increase in the rate of new users of psychotropic medication with an incidence rate ratio (IRR) of 1.16 (95% CI, 1.15-1.18). In the post-pandemic period, this increasing tendency in psychotropic medication use continued with an IRR of 1.36 (1.30-1.43) compared to the pre-pandemic trend. The largest relative deviations from the expected trends were observed for psychostimulants and hypnotics. The pandemic was association with IRRs of 1.14 (1.12-1.17) for psychostimulant and 1.38 (1.35-1.41) for hypnotic use. In the post-pandemic period, incident use of both drugs remained markedly higher than expected with IRRs of 1.56 (1.46-1.69) for psychostimulants and 1.59 (1.50-1.71) for hypnotics.

Conclusions: The rates of psychotropic medication use among Danish youths continue to rise and exceed what is expected from pre-pandemic trends. Specifically, the marked increase in new young users of psychostimulants and hypnotics call for caution and in-depth analyses of potential explanations.