Change of antidepressant utilization in children, adolescents and young adults in Europe before and during the COVID-19 pandemic: a systematic review.

Background: In recent decades, antidepressant utilization among young persons in Western countries has increased, raising concerns about overprescribing and safety. The COVID-19 pandemic and respective restrictions might have impacted not only youth's mental health but also antidepressant prescribing. Our aim was to systematically investigate changes in antidepressant utilization during the pandemic compared to pre-pandemic periods in European young persons.

Methods: This systematic review was registered in PROSPERO (CRD42024559951). Observational studies with ≥ 100 European young persons (0-24 years) reporting prevalence or incidence data in antidepressant utilization before and during the pandemic (2018/2019 vs. 2021/2022) were included and percentage changes between two time periods calculated. MEDLINE (via PubMed), PsycINFO, and EMBASE were searched from January 1, 2021 to July 3, 2024 and supplemented by citation searching. Study quality was assessed using the Joanna Briggs Institute's tool.

Findings: We screened 4,416 records for eligibility and included eight studies covering data from Austria, Denmark, Finland, France, Italy, Norway, Spain, and Sweden (n = 4 from Nordic countries). The number of included young persons ranged from 1071 to 3,455,521 and all studies used secondary data, mostly from registries. All studies showed a relative increase in overall antidepressant use during the COVID-19 pandemic, with variability between countries ranging from 23 to 52%. Antidepressant utilization showed higher increases in adolescents (n = 3 studies) and females (n = 3 studies). Selective serotonin reuptake inhibitors were more common (73.9-90.9%; n = 3 studies) than other antidepressant classes.

Interpretation: During the COVID-19 pandemic, antidepressant utilization in young persons increased modestly in all studied European countries. This increase may mirror the surge in mental health problems in young persons during the pandemic, but may also reflect altered patterns of mental health services availability.