Increased Incident rates of antidepressant use during the COVID-19 pandemic: Interrupted time series analysis of a nationally representative sample

Background: The COVID-19 pandemic has been associated with increased levels of depression and anxiety with implications for the use of antidepressant medications. Methods: The incident rate of antidepressant fills before and during the COVID-19 pandemic were compared using interrupted time series analysis followed by comprehensive sensitivity analyses on data derived from electronic medical records from a large health management organization providing nationwide services to 14% of the Israeli population. The dataset covered the period from 1st January 2013 to 1st February 2021, with March 1st, 2020, onwards defined as the period of the COVID-19 pandemic. Forecasting analysis was implemented to test the effect of the vaccine roll-out and easing of social restrictions on antidepressant use. Results: The sample consisted of 852,233 persons with a total antidepressant incident fill count of 139,535.4 (total cumulative rate per 100,000 = 16372.91, 95% CI 16287.19, 16459.01). We calculated the proportion of antidepressant prescription fills for the COVID-19 period, and the counterfactual proportion for the same period, assuming COVID-19 had not occurred. The difference in these proportions was significant [Cohen's h=10^-30.16 95% CI = 10^-3. (-0.71, 1.03)] The pandemic was associated with a significant increase in the slope of the incident rate of antidepressant fills (slope change=0.01, 95% CI 0.00, 0.03; p=0.04) and a monthly increase of 2% in the relative risk of antidepressant fills. The increased rate was more pronounced in women, was not modified by lockdown on/off periods, socioeconomic or SARS-CoV-2 status. The rate of observed antidepressant fills was similar to that forecasted under the assumption of ongoing COVID-19 distress. Conclusion: These findings underscore the toll of the pandemic on mental health and inform mental health policy and service delivery during and after implementing COVID-19 attenuation strategies.