The news
Prescriptions for drugs used to treat attention deficit hyperactivity disorder have increased during the coronavirus pandemic, particularly among women and patients aged 20 to 39. according to new research compiled by researchers affiliated with the US Food and Drug Administration.
The increase came as prescription rates remained relatively flat for other key classes of health drugs used to treat conditions such as depression and anxiety, according to the study, which was published Wednesday in JAMA Psychiatry.
The reasons are not entirely clear, the researchers found, and could include pandemic-related stress, recognition of undiagnosed cases, overprescribing and online drug trafficking.
Lisa Cosgrove, a clinical psychologist at the University of Massachusetts Boston, who was not involved in the study, said the results “seem unimaginable” because the pandemic was a time when most people were not in school or in the office, in environments where attention related issues often come to light.
The study’s authors noted that social media may have played a role in the increase in ADHD prescriptions, as telemedicine services “used social media services to advertise treatments for behavioral conditions, such as ADHD and eating disorders.”
Dr. Cosgrove, who studies psychiatric treatment practices, agreed. He speculated that online influencers and others who have spoken openly on platforms like TikTok about their own ADHD diagnoses may have prompted viewers to explore and “self-diagnose.”
“There are so many TikTok videos about people being diagnosed with ADHD and embracing the ADHD identity,” said Dr. Cosgrove.
Stephen Hinshaw, a professor of psychology at the University of California, Berkeley, and an expert on ADHD, said the “TikTok phenomenon” and other social media platforms almost certainly led to some overprescribing due in part to the “quick and dirty” self-diagnoses via online questionnaires, along with easier access to online stimulant prescriptions.
But one benefit, he said, is that social media may have enabled many people to recognize that they had untreated ADHD. This may be especially true for women, she added, as they understand that ADHD is not just a “boy’s disease.” as it has long been characterized.
The numbers
The study, conducted by scientists at the Center for Drug Evaluation and Research, a division of the US Food and Drug Administration, compared pre-pandemic drug prescriptions in five categories with prescriptions during the pandemic, which the study defined as the two-year period from April 2020 to March 2022. Compared to the previous two years, the pandemic period saw a drop in prescriptions for two classes of drugs: benzodiazepines, used to treat anxiety and other conditions, and buprenorphine, used to treat opioid use disorder . Benzodiazepine prescriptions fell by 9 percent and buprenorphine prescriptions fell by 2 percent.
Antidepressant prescriptions increased by 10% during this period. But the study authors note that the increases were consistent with similar patterns before the pandemic, so “changes in levels and trends were not significant for antidepressants.”
Instead, prescription rates for ADHD medications “increased significantly during the Covid-19 pandemic, exceeding pre-pandemic rates, particularly among young adults and women,” the study found.
Among 20- to 39-year-olds, prescriptions for Schedule II ADHD stimulants, which include Ritalin and Adderall, increased by 30 percent. Schedule II drugs have a “high potential for abuse that can lead to severe psychological or physical dependence.” according to the federal government. Prescriptions of non-stimulant drugs for ADHD increased by 81% among 20- to 39-year-olds and by 59% among women overall, the study found.
The study also revealed a change in drug prescribers. During the pandemic, prescriptions of ADHD stimulants by nurses increased by 57 percent compared to prescriptions by this group two years earlier, while prescriptions by psychiatrists decreased by 1 percent.
A similar pattern emerged with non-stimulant ADHD medications. Prescriptions by nurses increased by 74 percent during the pandemic, compared with a 12 percent increase by psychiatrists.
Behind the numbers
The results raised several questions, the researchers wrote: Specifically, to what extent were ADHD medications prescribed appropriately?
The spike in prescriptions during the pandemic highlighted the continued need to “determine the appropriateness of treatment,” as well as to explore “how marketing and prescribing practices have evolved,” the authors concluded.
Some evidence suggests that ADHD was overdiagnosed even before the pandemic. Dr Cosgrove also noted that behavioral and mental health information is being shared on TikTok and other platforms it was often misleadingand said there was a need for more rigorous diagnosis.