The impact of the COVID-19 pandemic on Antidepressant Prescribing with a focus on people with learning disability and autism: An interrupted time-series analysis in England using OpenSAFELY-TPP
Authors: Cunningham Christine , Macdonald Orla , Schaffer Andrea L , Brown Andrew , Wiedemann Milan , Higgins Rose , Bates Chris , Parry John , Fisher Louis , Curtis Helen J , Mehrkar Amir , Hart Liam C , Bacon Seb , Hulme William , Speed Victoria , Ward Thomas , Croker Richard , Wood Chris , Walker Alex , Andrews Colm , Butler-Cole Ben , Evans Dave , Inglesby Peter , Dillingham Iain , Davy Simon , Bridges Lucy , O’Dwyer Tom , Maude Steve , Smith Rebecca , Goldacre Ben , MacKenna Brian 
Published: May 2024

Background

COVID-19 lockdowns led to increased reports of depressive symptoms in the general population and impacted the health and social care services of people with learning disability and autism. We explored whether the COVID-19 pandemic had an impact on antidepressant prescribing trends within these and the general population.

Methods

With the approval of NHS England, we used >24 million patients’ primary care data from the OpenSAFELY-TPP platform. We identified patients with learning disability or autism and used an interrupted time series analysis to quantify trends in those prescribed and newly prescribed an antidepressant across key demographic and clinical subgroups, comparing pre-COVID-19 (January 2018-February 2020), COVID-19 lockdown (March 2020-February 2021) and the recovery period (March 2021-December 2022).

Results

Prior to COVID-19 lockdown, antidepressant prescribing was increasing at 0.3% (95% CI 0.2% to 0.3%) patients per month, in the general population and in those with learning disability, and 0.3% (95% CI 0.2% to 0.4%) in those with autism. We did not find evidence that the pandemic was associated with a change in trend of antidepressant prescribing in the general population (RR 1.00 (95% CI 0.97 to 1.02)), in those with autism (RR 0.99 (95% CI 0.97 to 1.01)), or in those with learning disability (RR 0.98 (95% CI 0.96 to 1.00)).

New prescribing post lockdown was 13% and 12% below expected if COVID-19 had not happened in both the general population and those with autism (RR 0.87 (95% CI 0.83 to 0.93), RR 0.88 (95% CI 0.83 to 0.92))), but not learning disability (RR 0.96 (95% CI 0.87 to 1.05)).

Conclusions and Implications

Pre-COVID-19, antidepressant prescribing was increasing at 0.3% per month. While we did not see an impact of COVID-19 on overall prescribing in the general population, prescriptions to those aged 0-19, 20-29, and new prescriptions were lower than pre-COVID-19 trends would have predicted, but tricyclics and new prescriptions in care homes were higher than expected.

What is already known on this topic

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The prescribing of antidepressants in the UK has been increasing for more than a decade.

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Studies globally have found differing impacts of COVID-19 on mental health outcomes in the general population, by age, sex, socio-economic status, and care home status.

What this study adds

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This study describes the impact of COVID-19 on antidepressant prescribing in England with additional follow-up through December 2022, with a focus on people with a learning disability or autism.

How this study might affect research, practice, or policy

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This study demonstrates how the pandemic did not lead to an increase in antidepressant prescriptions in the general population, but more is needed to ensure that antidepressants are used appropriately within vulnerable populations.

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Improvements are needed in the documentation of diagnosis when prescribing medicines.