(P-087) Impact of COVID-19 Outbreak on Antidepressants Utilization: A Real-word Drug-utilization Study Based on Tuscany Healthcare Administrative Databases

Background: The rapid spread of COVID-19 forced the countries to implement lockdown measures (LM) to prevent its diffusion. Several studies found increased incidence of mental disorders during outbreaks, but to date no data exist on antidepressants (ADs) utilization.

Objectives: To assess whether LM implementation affected prevalence and incidence of use of ADs. Secondary, potential change in treatment interruption (TI) among ADs users was investigated

Methods: Adults (≥18 years) with at least 1 dispensing of ADs (ATC: N06A*) within 01/01/2019-26/09/2020 were selected from the healthcare administrative database of Tuscany. The studied period was divided into 3 parts: pre-lockdown (01/01/2019-08/03/2020), lockdown (09/03/2020-14/06/2020) and post-lockdown (15/06/2020-26/09/2020). Patients with at least an AD dispensing in the year prior the first observation were considered as prevalent otherwise as incident. Prevalence and incidence per 10,000 inhabitants were computed using the regional resident population at January 1st of each year as reference. Among prevalent AD users, the incidence of TI (no refill of dispensing within 30 days by the end of its validity) was computed. Measures were computed on a weekly time unit and compared between the three periods.

Results: The weekly prevalence (mean of 552.3 per 10,000 pre-lockdown vs 505.5 lockdown phase; relative change: -9%) and incidence (5.2 vs 3.7; -29%) of ADs use decreased after LM. During the post-lockdown phase prevalence (505.5 vs 495.9; -2%) decreased whereas the incidence (3.7 vs 4.3; 16%) slight increased in relation to the lockdown period, the results were not statistically significant. Conversely, the incidence of TI among ADs users increased during both lockdown (344.7 vs 384.3; 12%) and post-lockdown (384.3 vs 394.2; 3%) periods.

Conclusions: Our analysis showed a reduction of ADs use during the early phase of lockdown followed by partial increase in the next phase. Several factors such as healthcare facilities re-organization, fear of contagion, and exacerbation of diseases’ symptoms might have caused the observed phenomenon. The findings might appear in contrast with previous studies highlighting higher incidence of mental diseases during outbreaks. However, it is plausible that although mental disorders diagnoses increased, the emergency situation made the patients less prone to start a new cycle and less compliant with it, and the physicians less confident to prescribe ADs choosing other options. This finding might help healthcare providers to update recommendations for patient’s management during future lockdown phases.