National level prescribing of psychotropic medication in primary care during the COVID-19 pandemic in England: potential implications for cardiometabolic health : Cardiovascular Endocrinology & Metabolism

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National level prescribing of psychotropic medication in primary care during the COVID-19 pandemic in England: potential implications for cardiometabolic health

Waheed, Unaizaa; Stedman, Mikeb; Davies, Markb; Walther, Andreasc; Solomon, Emmad; Ollier, Bille; Heald, Adrian H.a,f

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Cardiovascular Endocrinology & Metabolism: December 2022 - Volume 11 - Issue 4 - e0270
doi: 10.1097/XCE.0000000000000270
  • Open

The COVID-19 (SARS-CoV-2) pandemic has had a global impact on healthcare provision. Changes in prescribing of commonly used medications can be used as a marker for diagnoses of new patients as well as measuring service levels for patients in primary care [1].

The consequences of the COVID-19 pandemic in relation to incident cases of depression and other mental health issues are well documented [2–4]. How much the prescribing of specific psychotropic medications was impacted by the pandemic has been less explored. This is relevant from a cardiovascular point of view as untreated depression and untreated psychosis are associated with a signficantly elevated cardiovascular event rate [5,6].

We here compare prescribing data for psychotropic medication with common physical health medications in England before/during the COVID-19 pandemic.

Primary Care Prescribing data for different major national formulary classes of drug from March 2017 to February 2022 (5 years) were considered [7]. In order to capture the impact during periods of social restriction of access to health services for new diagnoses/existing conditions, repeat prescriptions and episodic prescribing were included with account taken of historical trend.

The prepandemic prescriptions issued each month from March 2017 to February 2020 were linearly extrapolated forward to give estimates over the pandemic period to give an expected annual growth (EAG). From this the monthly average expected prescriptions for the pandemic period March 2020–February 2022 were calculated and compared to the actual average. The change in share of total prescriptions of the main antidepressantant medications was evaluated to show relative change.

As comparative baseline, it was found that physical health medications had lower monthly prescription during the pandemic with antibiotic (which are episodic) −12.2% (EAG −1.4%), and the most repeat prescriptions for bronchodilators −1.8% (EAG 0%), hypertension and heart failure −1.3% (EAG 1%), and lipid regulating minimally less at −0.1% (EAG 2.3%). Mental Health monthly prescribing increased with hypnotics/anxiolytics by 0.6%(EAG −2.4%), antipsychotics by 0.5% (EAG 2.7%), and antidepressants up by 0.3% (EAG 4.9%) The profile of the three main antidepressant medications was: sertraline increased from 22.7 to 24.6% (+8%), mirtazapine increased from 13.0 to 13.6% (+5%), and venlafaxine stayed at 6.3% (0%).

The pandemic effect on psychotropic prescribing was not as large as might be expected, possibly impacted by limited access to services [8]. The fall in antibiotic prescribing may similarly reflect the impact of reduced access to services, limiting episodic prescribing.

The increase in anxiolytic/hypnotic and antidepressant prescribing above trend links to pandemic effects on anxiety/worry [2–4]. However, the increase is far from what might be expected, on the basis of what is known about the way that the COVID-19 pandemic resulted in increased rates of anxiety and depression in the UK population as elsewhere in the world [2,3.4]. The slight increase in antipsychotic prescribing likely relates to the use of antipsychotics in care home settings [9] and is additive to the trend before the pandemic for increased prescribing of antipsychotic medication in England [10].

Should our assertion that the increase in antidepressant prescribing be much less than anticipated, the inference is that depression has been underdiagnosed in England and possibly elsewhere. If untreated, depression is associated with an adverse cardiovascular profile [5,6] and poorer life/socioeconomic/health outcomes overall [11]

Going forward, an evaluation of individuals’ experiences might illuminate why we have observed these prescribing trends. It is hoped that we can use the opportunity created by the COVID-19 pandemic to enable sustained, efficient, and equitable delivery of mental healthcare with attendant benefits for cardiovascular outcome in those affected by enduring mental health conditions [12].

Acknowledgements

All authors contributed equally and substantially to the cocreation and writing of this paper.

Data availability statement: the data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of interest

There are no conflicts of interest.

References

1. Heald AH, Stedman M, Davies M, Livingston M, Taylor D, Gadsby R. Antidepressant prescribing in England: patterns and costs. Prim Care Companion CNS Disord 2020; 22:19m02552.
2. COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet 2021; 398:1700–1712.
3. Mansfield KE, Mathur R, Tazare J, Henderson AD, Mulick AR, Carreira H, et al. Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study. Lancet Digit Health 2021; 3:e217–e230.
4. Jacob L, Smith L, Koyanagi A, Oh H, Tanislav C, Shin JI, et al. Impact of the coronavirus 2019 (COVID-19) pandemic on anxiety diagnosis in general practices in Germany. J Psychiatr Res 2021; 143:528–533.
5. Halaris A. Inflammation-associated co-morbidity between depression and cardiovascular disease. Curr Top Behav Neurosci 2017; 31:45–70.
6. Hayes JF, Marston L, Walters K, King MB, Osborn DPJ. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. Br J Psychiatry 2017; 211:175–181.
7. OpenPrescribing.net, Bennett Institute for Applied Data Science. University of Oxford. [Accessed 22 July 2022]
8. Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, Khunti K. Impact of COVID-19 on routine care for chronic diseases: a global survey of views from healthcare professionals. Diabetes Metab Syndr 2020; 14:965–967.
9. Howard R, Burns A, Schneider L. Antipsychotic prescribing to people with dementia during COVID-19. Lancet Neurol 2020; 19:892.
10. Heald AH, Stedman M, Farman S, Khine C, Davies M, De Hert M, Taylor D. Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection. BMC Psychiatry 2020; 20:528.
11. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370:851–858.
12. Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, et al. How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiatry 2020; 7:813–824.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.