The aim of this study was to determine the short-term impact of COVID-19 on use of psychotropic drugs in the pediatric population. The main finding was a significant increase in dispensing of psychotropics in the years affected by the COVID-19 pandemic, with a particularly strong increase in 2021. This observed increase in dispensing is likely to be correlated with a deterioration in the mental health of young people by the pandemic context as highlighted in a Finnish study which reports an increase in the incidence of primary care from 151.7 per 1000 adolescents in 2019 to 193.6 in 2020 and 306.7 in 2021 [30]. Again, the greatest impact is observed during 2021.

The analysis by therapeutic class shows.

For antipsychotics, another studies have reported an increase in the prevalence of patient using antipsychotics [5, 30]. An increase in the dispensation of antipsychotics may suggest an increase in the pathologies treated with these drugs, such as psychotic, thymic or behavioral disorders. The stability of consumption between 2019 and 2020 means that the effect of the health crisis is not immediate but rather distant.

Concerning anxiolytics, 351 additional youth patients received a reimbursement for this class of psychotropic drugs between 2018 and 2021. A study highlighted an increase of anxiety disorder with + 2% to + 20% of new diagnoses [31] depending on age. Other research has shown up to 39% of anxiety during lockdown in 2020 [32] and 25,7% in 2021 [33] versus 14,9% pre-pandemic anxiety level [34]. On the contrary, some studies find an important decrease in immediate reaction to the restrictions [35, 36] and put forward as hypotheses the closure of schools during this period and the reduction in medical consultations. However, we found no difference directly linked to the restrictions (Table 4). An increase in the number of primary care visits for anxiety diagnoses is observed in Finland with a difference 2019 vs 2020 of + 39% and 2019 vs 2021 of + 128%. An another French study found a high increase in the number of patients consuming anxiolytics (p-value = 0.02) [37]. All these works, including our study, confirms that the health crisis is one of the factors led to a significant increase in use of anxiolytics among youth.

The hypnotics and sedatives class is characterized by a very marked increase in dispensing from March 2020. These results are difficult to interpret because several phenomena may be associated: 1- new reimbursed melatonin-based medicine in France from March 2020, 2- non-reimbursed hypnotics (over the counter) not studied because not included in reimbursements, and 3- some anxiolytics (benzodiazepines), antipsychotics (cyamémazine) and antihistamines (alimemazine) prescribed for sleep disorders. Our hypothesis for this increase is the possible shift of off-label prescriptions to the new reimbursed melatonin-based drug or a greater need among young people. One study highlighted an increase in the number of primary care visits for sleep disorders compared to 2019 of + 79% in 2020 and + 224% in 2021 but found a parallel decrease in the use of hypnotics [30].

The depression generated among young people in connection with the COVID-19 has been widely suspected. Results from reimbursed data for this drug class among youth confirm an increase in dispensing between 2018 and 2021 (+ 58.9% reimbursed lines, + 33.9% patients, Table 2). Indeed, the number of new diagnoses of depression have increased by + 2% to + 32% depending on age according to a German study [31]. The same is true in Finland, with a higher number of consultations in town for depressive episodes, associated with an increase in the use of antidepressants [30]. A Finnish study found an increase in the use of antidepressants among 6–12 year old school children of + 14% in the year 2021 [38]. It should be remembered here that the prescription of an antidepressant is indicated for moderate to severe depressive syndromes but also used for generalized anxiety disorder. In view of all these results, the hypothesis that the context of the pandemic is at the origin of new diagnoses or of the aggravation of pre-existing depression or anxiety disorders (psychotherapy alone to combined with pharmacological treatment).

Contrasting results were observed between years for psychostimulants. A decrease of almost half in the incidence of psychostimulants was observed over the second quarter of 2020 in Canada [35]. A decrease of dispensing was observed in 2020 which we presume is related to the school’s closure for several weeks before the implementation of distance learning courses. Indeed, 16% of parents of children with ADHD said in an Australian survey that treatment is not necessary during school closures [39]. When the data were analyzed globally, i.e. comparing 2018–2019 versus 2020–2021, the difference was not significant (Table 3).

In general, a low period, with a decrease in the number of patients having had a reimbursement, is noted whatever the year in the periods correspond to the summer and autumn school holidays. This observation can be linked to a frequent practice in child psychiatry which consists of limiting the prescription of certain psychotropic drugs such as psychostimulants by reserving them for the school periods and to a lesser need for psychotropic drugs such as anxiolytics outside the school context.

When the impact of the health crisis was assessed by comparing the two periods 2018–2019 and 2020–2021 for the reimbursement of psychotropic drugs and for each drug class, it appeared that the average weekly dispensation of the pre-pandemic years was significantly lower than the average of the pandemic years. All classes of psychotropic drugs were increased except psychostimulants. These results show, in particular, the increase in the use of antidepressants and anxiolytics among youth in the ex-Limousin region during the COVID-19 pandemic.

Apart from the health crisis caused by the COVID-19 pandemic, there is a natural trend towards an increase in psychotropic drug prescriptions among children and adolescent, a process that has been underway for a decade. Between 2014 and 2018, among 0–20 year-olds in France, we observed an increase of + 17.0% for antipsychotics, + 14.0% for antidepressants and normothymics, and + 40% for psychostimulants. For hypnotics and anxiolytics, the trend was for a decrease of– 4.9% [40].

The results in Table 4 show that there is no direct increase because of the restrictions. The significant difference found for all the psychotropic drugs between the confinements and the curfews is certainly linked to the progressive increase in prescriptions of the new drug of melatonin. Indeed, we interpret it as this difference is no longer significant when the hypnotics class is withdrawn.

The progression of the prevalence of psychotropic drugs is significant when the pre-pandemic years were compared to the pandemic years and highlight a real increase in the number of reimbursements for psychotropic drugs in youth.

The impact of the COVID-19 crisis is assumed to be multi-factorial, with examples including the anxiety-provoking media presentation of the pandemic context [13], an imbalance in the parent–child relationship [13, 41, 42], social isolation [43, 44], fear of loss of a loved one/bereavement [13, 21] or intra-family violence/abuse [21, 26].

It is important to note that reimbursement data is derived from a medical prescription, but the fact that a medicine is reimbursed does not necessarily mean that it will be taken by the youth. Medication use is an indicator that we assume correlates with associated mental disorders, so this shortcut may be a source of bias.

The data provided by the health insurance is only considered complete 6 months after the date of care. Therefore, the results presented, when they include the year 2021, may be underestimated.

This study excludes the use of non-reimbursed drugs such as doxylamine indicated for the treatment of insomnia or self-medication. It also excludes psychotropic drugs found in the family pharmacy which can be given to minors without a prescription [45].

Finally, the limitations of the ATC classification must be borne in mind. Some drug has psychiatric indication like alimemazine, an antihistamine (R06) for insomnia, but non classified as a psychotropic drug and non-included in this study. Similarly, cyamemazine may be prescribed for its sedative properties to help people fall asleep, even though it is classified as an antipsychotic drug according to its ATC code. Same for benzodiazepines such as clonazepam which are indicated as anticonvulsants.