Psychotropic drug prescriptions in adolescents before and after COVID-19 pandemic in Lombardy Region, Italy

Psychotropic drug prescriptions in adolescents before and after COVID-19 pandemic in Lombardy Region, Italy | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL British Journal of Clinical Pharmacology This is a preprint and has not been peer reviewed. Data may be preliminary. 15 November 2025 V1 Latest version Share on Psychotropic drug prescriptions in adolescents before and after COVID-19 pandemic in Lombardy Region, Italy Authors : Rita Campi , Ida Fortino , and Antonio Clavenna 0000-0001-5536-4192 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176323875.57821561/v1 Published British Journal of Clinical Pharmacology Version of record Peer review timeline 262 views 176 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aims To compare the pattern of psychotropic drug prescriptions in adolescents who started a drug therapy after the COVD-19 pandemic and in adolescents who began before the pandemic. Methods A healthcare database from Italy’s Lombardy region was analyzed to compare the prescription profiles of psychotropic drugs (N05 and N06 groups of the Anatomical Therapeutic Chemical classification system) and access to healthcare services among two cohorts of adolescents, aged 12–17. One cohort received their first psychotropic drug prescription in 2018 (pre-pandemic), and the other received theirs in 2021 (post-pandemic). The incidence, number of prescriptions within 12 months of the initial prescription, therapy persistence at the end of the observation period, and prevalence of polytherapy (prescription of more than one psychotropic class) were evaluated. Additionally, access to healthcare services was monitored before and after the initial prescription. Results The incidence increased from 3.01 per 1,000 in 2018 to 4.97 per 1,000 in 2021 (incidence rate ratio [IRR] 1.64; 95% CI 1.55–1.74), with the largest rise in girls aged 12–14 (IRR 2.35; 95% CI 2.01–2.77). Among girls, the mean number of prescriptions (+39%), prevalence of polytherapy (+57%), and persistence at 12 months (+38%) all increased post-pandemic, while no significant changes were observed among boys. Prior healthcare service use rose from 58.4% in 2018 to 65.7% in 2021. Conclusions The increase in incidence and intensity of psychotropic drug prescriptions in adolescent girls confirms the existence of gender differences in the pandemic’s impact on mental health. Psychotropic drug prescriptions in adolescents before and after COVID-19 pandemic in Lombardy Region, Italy Rita Campi 1 , Ida Fortino 2 , Antonio Clavenna 1 1. Laboratory of Child Health and Development Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; 2. Directorate General for Health, Lombardy Region, Milan, Italy Address correspondence to: Antonio Clavenna, Laboratory for Child Health and Development Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, via Mario Negri 2, Milan, 20156 Italy. e-mail: [email protected] , ORCID 0000-0001-5536-4192. Data availability The data that support the findings of this study are available from the Lombardy Region, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the Lombardy Region upon reasonable request. Funding This study is part of the Project EPIFARM funded by the Lombardy Region . Competing interest: The authors declare no competing interests. Ethical approval No ethics committee approval is required in Italy for epidemiological studies using healthcare administrative databases for research purposes and with individuals identified by an anonymous patient code. Patient consent statement Not applicable. Healthcare administrative databases were analysed and individuals were identified by an anonymous patient code Keywords: Adolescent, COVID-19, Mental Health, Psychotropic Drugs Word count: 2,524 Table count: 3 Figure count : 2 Aims To compare the pattern of psychotropic drug prescriptions in adolescents who started a drug therapy after the COVD-19 pandemic and in adolescents who began before the pandemic. Methods A healthcare database from Italy’s Lombardy region was analyzed to compare the prescription profiles of psychotropic drugs (N05 and N06 groups of the Anatomical Therapeutic Chemical classification system) and access to healthcare services among two cohorts of adolescents, aged 12–17. One cohort received their first psychotropic drug prescription in 2018 (pre-pandemic), and the other received theirs in 2021 (post-pandemic). The incidence, number of prescriptions within 12 months of the initial prescription, therapy persistence at the end of the observation period, and prevalence of polytherapy (prescription of more than one psychotropic class) were evaluated. Additionally, access to healthcare services was monitored before and after the initial prescription. Results The incidence increased from 3.01 per 1,000 in 2018 to 4.97 per 1,000 in 2021 (incidence rate ratio [IRR] 1.64; 95% CI 1.55–1.74), with the largest rise in girls aged 12–14 (IRR 2.35; 95% CI 2.01–2.77). Among girls, the mean number of prescriptions (+39%), prevalence of polytherapy (+57%), and persistence at 12 months (+38%) all increased post-pandemic, while no significant changes were observed among boys. Prior healthcare service use rose from 58.4% in 2018 to 65.7% in 2021. Conclusions The increase in incidence and intensity of psychotropic drug prescriptions in adolescent girls confirms the existence of gender differences in the pandemic’s impact on mental health. What is already known An increase in psychotropic drug prescriptions for adolescents after the pandemic has been widely reported. The increase was greater among girls than boys. What this study adds An increase in the number of prescriptions, polytherapy, and persistence in psychotropic drug therapy at 12 months was observed in girls who began treatment after the pandemic, but not in boys. These findings may suggest that mental health problems are more severe in adolescent girls. 1. INTRODUCTION Disruptions and restrictions implemented in several countries during the period of the SARS-CoV-2 pandemic had an impact on the mental health of children and adolescents. 1 Several studies have documented an increase in emergency department (ED) visits, hospital admissions for mental health issues, and psychotropic drug prescriptions for children and adolescents during the pandemic compared to before the pandemic. 1–4 In particular, there was an increase in anxiety and depressive symptoms, self-harm episodes, and eating disorders. 1–4 The majority of studies reported gender differences, finding that girls were more likely than boys to experience mental health disorders. 1,2,5,6 An increase in the prescription of psychotropic drugs in adolescent girls living in the Lombardy region during the pandemic period was previously reported, with the prevalence of prescriptions increasing from 7.1 per 1,000 in 2019 to 10 per 1,000 in 2021, while no differences were observed in boys. 7 The number of girls receiving a psychotropic drug prescription in 2021 was greater than predicted based on the monthly trend in the pre-pandemic period, with a ratio of observed to predicted cases of 1.24. 7 Despite the widely described increase in psychotropic drug prescriptions, 8–15 a comparison is lacking between the prescription profile in adolescents who started a drug therapy after the COVD-19 pandemic and in adolescents who began before the pandemic. This study aims to compare the incidence of psychotropic drug prescriptions before and after the pandemic and evaluate differences in prescription profiles, particularly concerning the number of prescriptions and polypharmacy prevalence, as well as the care provided by healthcare services. 2. METHODS The data sources were administrative health databases of the Lombardy Region, routinely used for reimbursement reasons. Lombardy is one of the largest Italian regions, in the northern area of the country, and one of the most prominent regions from the socioeconomic point of view. In particular, four databases were analyzed, collecting: – drug prescriptions dispensed by the retail pharmacies of the Lombardy Region and reimbursed by the Italian national health service (NHS); – prescriptions for diagnostic tests, specialist visits, and rehabilitation performed in outpatient clinics; – hospital discharge forms; – visits performed in the emergency departments (ED). The above databases have been previously described. 7,16 The study population consisted of adolescents living in the Lombardy Region who were between 12 and 17 years old on December 31, 2018, and on December 31, 2021 (575,576 and 592,413, respectively). The analysis included all pediatric prescriptions reimbursed by the health service and dispensed by the retail pharmacies in the Lombardy Region. Psychotropic drugs were defined according to the Anatomical Therapeutic Chemical (ATC) classification system and comprised the following subgroups: antipsychotics (N05A), antidepressants (N06A), and stimulants (N06BA). Anticonvulsants (N03 subgroup) were not considered in the psychotropic group because they are mainly used to treat epilepsy in children. Anxiolytics were also excluded because the Italian National Health Service does not reimburse them. Adolescents receiving at least one psychotropic drug prescription in the 1 January – 31 December 2018 (pre-pandemic) and 1 January – 31 December 2021 (pandemic) periods were identified. The 2018 cohort was selected because it was the last cohort with an observation period occurring entirely before the start of the pandemic. The 2021 cohort was selected because that year marked the beginning of an increase in psychotropic prescriptions. 7 Incident cases (i.e., new users) were defined as children who were treated with psychotropic drugs and had no psychotropic drug prescriptions in the previous 24 months. The date of the first psychotropic drug prescription was defined as the index date. We defined a 12-month observational period for each child starting from the index date. We collected all psychotropic drug prescriptions, outpatient child and adolescent mental health service (CAMHS) visits, emergency department visits, and hospitalizations due to a mental disorder occurring during the observation period. ICD-9 (International Classification of Diseases, Ninth Revision) codes from 290 through 319 recorded as primary diagnoses were used to identify ED visits and hospitalization due to mental health conditions. Codes 983* (Toxic effect of corrosive aromatics acids and caustic alkalis), V62.82 (Bereavement), V62.84 (suicidal ideation), and V40.3 (other behavioral problem) were also included. 17 The following outcome measures were used to evaluate the prescribing pattern: • Incidence of psychotropic drug prescriptions (number of incident cases/total number of residents aged 12-17 years) • Number of psychotropic drug prescriptions in the 12-month observation period • Psychotropic drug persistence at the end of the 12-month period. We defined persistent users as subjects with at least one prescription within the 90-day window from +270 to +360 days after the index date. We used a 90-day gap since a prescription may cover up to 90 days of therapy. • Percentage of cases with no psychotropic prescriptions after the index date (occasional users). • Prescription of more than one psychotropic class at the index date and/or during the 12-month observation period (polytherapy). Moreover, to monitor care pathways, we estimated the prevalence of access to healthcare services for mental disorders based on at least one of the following events: 1) a CAMHS visit, 2) an ED visit with a discharge diagnosis of mental disorders, or 3) a hospital admission with a discharge diagnosis of mental disorders. Prevalence was calculated for the 12 months before and after the index prescription (IP) date. Differences between the groups were assessed by t-test for continuous values, and by chi-squared test for percentages. We estimated the incidence rate ratios (IRRs) and 95% confidence intervals (CIs) with the Poisson regression model, comparing 2021 vs 2018, stratified by gender and age group and for sub-analysis by classes of psychotropic prescriptions. All p-values were two-sided, with p<0.001 or p<0.01 considered statistically significant. Data were analyzed using SAS Studio 9.4 (SAS Inc., Cary, NC, USA) and STATA/IC 11.2 (StataCorp LP, College Station, TX, US). Data were managed and analyzed using an anonymous patient code. Each patient was identified by the same alphanumerical anonymous code in all the aforementioned databases. No ethical committee approval is required in Italy for this kind of study. 3. RESULTS 3.1 Incidence of psychotropic drug prescriptions A total of 1,734 and 2,943 adolescents received their first psychotropic drug prescription in 2018 and 2021, respectively. The incidence rate increased from 3.01 to 4.97 per 1,000 between 2018 and 2021 (IRR 1.64; 95% CI 1.55–1.74; Table 1). The female-to-male ratio increased from 1.33 in 2018 to 2.31 in 2021. The highest incidence was recorded among 15-17-year-old girls (10.44 per 1,000 in 2021), and the greatest increase was observed among 12-14-year-old girls (IRR 2.35; 95% CI 2.01–2.77). No statistically significant increase was observed in 15-17-year-old boys (IRR 1.12; 95% CI 0.99–1.27; Table 1). Similar increases were seen for antipsychotics and antidepressants (IRR: 1.81 and 1.78, respectively), while the incidence of psychostimulants remained unchanged. The most commonly prescribed drugs in both cohorts were sertraline, aripiprazole, fluoxetine, and risperidone, covering 63.1% (in 2018) and 67.1% (in 2021) of total psychotropic prescriptions (Supplementary Table 1). The mean number of prescriptions per user increased from 4.4±5.2 in 2018 to 5.3±5.9 in 2021 (p<0.0001; Table 2). No differences were observed in boys (4.7 ± 5.3 vs. 4.5 ± 5.2; p = 0.43), whereas the greatest increase in the average number of prescriptions was found in girls aged 12–14 years (4.7 ± 4.7 vs. 6.5 ± 6.4; Table 2). The proportion of adolescents who received only the index prescription (occasional users) decreased from 28.1% to 22.4% (p < 0.0001). This decrease was significant in girls (31.3% to 20.9%; p < 0.0001), whereas the proportion remained unchanged in boys (24.2% to 25.4%; p = 0.62). The prevalence of persistent users increased from 36.9% in 2018 to 42.8% in 2021 (χ 2 =15.5; p<0.001). Differences were found between genders: the increase was observed in girls (from 32.6% to 44.9%; rate ratio: 1.36; 95%CI 1.22-1.50), while the percentage of persistent users decreased slightly in boys (from 42.3% to 38.4%; Figure 1). Co-prescription of antidepressants and antipsychotics at the index prescription was present in 2.5% of cases in 2018, increasing to 4.8% in 2021 (χ 2 =20; p<0.0001). This proportion increased among girls (2.1 to 5.6%; p<0.0001), but not among boys (3.1 to 3.2%; p=0.89). Similarly, the percentage of girls with polytherapy during the 12-month observation period increased from 16.1% in 2018 to 25.5% in the 2021 cohort (χ 2 =33; p<0.0001), whereas the proportion remained stable in boys (12.1% to 12.8%; p=0.64). 3.2 Access to the healthcare services The proportion of adolescents who had accessed healthcare services (CAMHS, ED or hospitalization) at least once in the 12 months prior to the index prescription increased from 58.4% to 65.7% (p<0.001). This increase was particularly notable among girls aged 12–14 (58.8% to 77.9%; p < 0.001), whereas no differences were observed among boys aged 15–17 (Table 3). The proportion of adolescents receiving psychotropic drugs with no access to healthcare services before or after the index prescription decreased from 27.8% to 22.0% (p < 0.001). In this case too, differences were statistically significant in girls, but not in boys. The prevalence of CAMHS visits before the IP increased from 50.8% to 61.0%. The rates of hospitalization (17.2% vs. 17.4%) and ED visits (14.5% vs. 15.8%) were similar in the 2018 and 2021 cohorts. There was also an increase in CAMHS visits after IP, from 60.0% to 68.9%. Figure 2 reports the prevalence of CAMHS visits by gender and age groups in the two cohorts. The greatest increase was found in the 12–14 age group, particularly in the proportion of CAMHS visits before the IP. This increased from 46.2% to 72.6% in girls and from 52.4% to 68.5% in boys (p < 0.001). However, the percentage of 15-17-year-old boys with a visit before the IP did not change (55.3% vs 55.8%, p=0.90). As expected, a similar pattern was observed in the proportion of adolescents who attended CAMHS before and after the IP. The overall estimate increased from 42.6% to 54.3%, with the greatest increase seen in the 12–14 age group (girls: 42.5% to 66.6%; boys: 47.6% to 63.8%). No statistically significant differences were observed among 15-17-year-old boys (45.6% to 50.2%; p=0.14). 4. DISCUSSION In the year following the onset of the pandemic, there was an increase in psychotropic drug prescriptions. The impact differed by gender, being more pronounced in girls and less relevant in boys. Notably, the increase was not statistically significant among 15-17-year-old boys. The increase in incidence appears to be greater than in other countries; in Denmark, for example, the IRR was 1.37, 8 whereas in our study it was 1.64. The increase affected antidepressant and antipsychotic prescriptions in a similar manner, which is consistent with the findings of other studies. 8–14 Conversely, the incidence of psychostimulant prescriptions remained unchanged in the two cohorts. Several studies have reported an increase in ADHD symptoms during the pandemic, 18 but results concerning the prescription of stimulants during this period are conflicting. An increase has been observed in some settings (e.g. Australia), 11 but not in others (e.g. France). 13,14 It should be noted that, as in France, the prevalence of ADHD medication in Italy is quite negligible, particularly among adolescents. This may explain why no differences were observed in the incidence of stimulant use. One of the most significant findings of our study is that the differences in the prescription profile were almost exclusively observed in adolescent girls. In 2021, girls were more likely to receive a higher number of prescriptions and polytherapy, and were more likely to persist with psychotropic therapy in the first 12 months after the initial prescription. No differences were found for the same indicators in boys, while a decrease in persistence was observed. These results suggest that girls requiring drug therapy for a mental disorder in 2021 experienced more severe symptoms than those receiving pharmacological treatment prior to the pandemic. A higher level of symptom severity was observed in adolescents admitted to inpatient psychiatric units during the pandemic compared to those with similar characteristics admitted before the pandemic, but these studies did not specifically investigate gender differences. 19–21 Several studies have documented gender differences in the impact of the pandemic on mental health. 5,17,22–26 Adolescent females were found to be more affected by the consequences of the pandemic and related lockdown measures than males, resulting in symptoms of anxiety and depression. 2,5,25,27 This finding is consistent with the greater prevalence of internalizing mental disorders in women compared to men. 28 Although a decrease in help-seeking behavior and difficulties in accessing healthcare services were reported in the early months of the pandemic, 29 it is reassuring that this was not the case for those starting psychotropic drug therapy in 2021. In fact, the majority of incident cases were cared for by a child psychiatrist, particularly among younger adolescents: almost two out of three attended a CAMHS both before and after the IP, with only slight gender-based differences. Among 15-17-year-olds, the proportion was lower (1 in 2), and the prevalence in boys was not significantly different to that in 2018. The increase in CAMHS attendance when comparing the pre- and pandemic periods suggests that the pandemic did not affect access to healthcare services. Overall, the data suggests that, following the pandemic, more adolescent girls required psychotropic drug therapy, and their condition appears to have been more severe than that of peers treated with psychotropic drugs prior to the pandemic. 4.1 Strengths and Limitations This study evaluated the incidence of psychotropic drug prescriptions, prescribing patterns, and care pathways in a large population in an area severely affected by the pandemic. Integrating data on drug prescriptions with details concerning CAMHS outpatient visits enables us to estimate whether the psychotropic prescription was part of an integrated care approach. This study has some limitations. No information is available regarding why drugs were prescribed, so it is not possible to evaluate whether there was an increase in specific mental disorders. We had the opportunity to monitor outpatient visits and drug prescriptions that were reimbursed by the Italian NHS. Private visits and medicines paid for privately were not evaluated. Furthermore, anxiolytics and sedatives are not reimbursed by the NHS in Italy, so it is likely that the incidence of psychotropic drug use has been underestimated and that the observed increase in girls during the pandemic period is greater than reported. Incident cases were defined as those without antidepressant, antipsychotic or stimulant prescriptions in the 24 months prior to the index prescription. However, we cannot exclude the possibility that subjects had previously been prescribed an anxiolytic or sedative drug. Finally, while it is possible to monitor the prescription and dispensing of drugs, it is not possible to monitor their actual use or subjects’ adherence to therapy. The fact that the average number of prescriptions per individual was between four and five suggests that, in most cases, there was an overlap between the prescription and the assumption of the drug. 5. CONCLUSIONS In conclusion, our findings confirm that adolescent girls were most impacted by the mental health effects of the pandemic: there was a twofold increase in the incidence of psychotropic prescriptions, as well as an increase in the mean number of prescriptions, the rate of polypharmacy, and the persistence of therapy 12 months after the start of treatment. This suggests that the symptoms experienced by girls requiring drug therapy after the pandemic were more severe. Acknowledgements The authors would like to acknowledge Dr Chiara Pandolfini for the assistance in language editing. Conflict of Interest The authors have no conflicts of interest to disclose. Funding: This study is part of the Project EPIFARM funded by the Lombardy Region . Data availability The data that support the findings of this study are available from the Lombardy Region, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the Lombardy Region upon reasonable request. Author Contribution A.C. conceptualized and designed the study, and drafted the initial manuscript. R.C. participated in the conceptualization and design of the study, and carried out the statistical analyses. I.F. participated in the conceptualization and design of the study, and reviewed and provided input into data analysis. 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Boyd A, Van de Velde S, Vilagut G, et al. Gender differences in mental disorders and suicidality in Europe: results from a large cross-sectional population-based study. J Affect Disord . 2015;173:245-254. doi:10.1016/j.jad.2014.11.00229. Yonemoto N, Kawashima Y. Help-seeking behaviors for mental health problems during the COVID-19 pandemic: A systematic review. J Affect Disord . 2023;323:85-100. doi:10.1016/j.jad.2022.11.043 Table 1. Incidence (per 1,000 inhabitants) of psychotropic drug prescriptions in 2018 versus 2021 cohort, by gender and age groups N. Cases Incidence* N. Cases Incidence* All F 12-14 221 1.55 (1.35- 1.76) 530 3.66 (3.35-3.97) 2.35 (2.01-2.77) 15-17 742 5.44 (5.05-5.83) 1485 10.44 (9.92-10.97) 1.92 (1.76-2.10) 12-17 963 3.46 (3.24-3.67) 2015 7.02 (6.71-7.33) 2.03 (1.88-2.19) M 12-14 286 1.89 (1.67-2.11) 362 2.35 (2.11-2.59) 1.24 (1.06-1.45) 15-17 485 3.32 (3.03-3.62) 566 3.74 (3.43-4.04) 1.12 (0.99-1.27) 12-17 771 2.60 (2.41-2.78) 928 3.04 (2.84-3.23) 1.17 (1.06-1.29) M+F 12-17 1734 3.01 (2.87-3.15) 2943 4.97 (4.79-5.15) 1.64 (1.55-1.74) AD F 12-14 138 0.97 (0.81-1.13) 365 2.52 (2.26-2.78) 2.60 (2.13-3.18) 15-17 585 4.29 (3.94-4.64) 1176 8.27 (7.80-87.4) 1.93 (1.75-2.13) 12-17 723 2.60 (2.41-2.78) 1541 5.37 (5.10-5.64) 2.07 (1.89-2.26) M 12-14 104 0.69 (0.56-0.82) 131 0.85 (0.71-1.00) 1.24 (0.95-1.61) 15-17 265 1.82 (1.60-2.04) 335 2.21 (1.97-2.45) 1.22 (1.03-1.43) 12-17 369 1.24 (1.12-1.37) 466 1.53 (1.39-1.66) 1.23 (1.07-1.41) M+F 12-17 1092 1.90 (1.79-2.01) 2007 3.39 (3.24-3.54) 1.78 (1.66-1.92) AP F 12-14 100 0.70 (0.57-0.84) 271 1.87 (1.65-2.09) 2.66 (2.11-3.38) 15-17 263 1.93 (1.70-2.16) 619 4.35 (4.01-4.70) 2.26 (1.95-2.62) 12-17 363 1.30 (1.14-1.39) 890 3.10 (2.90-3.31) 2.39 (2.11-2.69) M 12-14 147 0.97 (0.82-1.13) 203 1.32 (1.14-1.50) 1.35 (1.09-1.69) 15-17 228 1.56 (1.36-1.77) 281 1.86 (1.64-2.07) 1.19 (0.99-1.42) 12-17 375 1.26 (1.14-1.39) 484 1.58 (1.44-1.73) 1.25 (1.10-1.44) M+F 12-17 738 1.28 (1.19-1.38) 1374 2.32 (2.20-2.44) 1.81 (1.65-1.98) ADHD F 12-14 9 0.06 (0.02 -0.11) 8 0.05 (0.02-0.09) 0.87 (0.29-2.56) 15-17 5 0.04 (0.005-0.07) 9 0.06 (0.02-0.11) 1.73 (0.52-6.56) 12-17 14 0.05 (0.02-0.08) 17 0.06 (0.03-0.09) 0.89 (0.40-0.75) M 12-14 64 0.42 (0.32-0.53) 61 0.40 (0.30-0.50) 0.94 (0.65-1.35) 15-17 50 0.34 (0.25-0.44) 33 0.22 (0.14-0.29) 0.64 (0.40-1.01) 12-17 114 0.38 (0.31-0.45) 94 0.31 (0.25-0.37) 0.80 (0.65-1.05) M+F 12-17 128 0.22 (0.19-0.26) 111 0.19 (0.15-0.22) 0.84 (0.65-1.09) * per 1,000 inhabitants. AD=Antidepressants; AP=Antipsychotics; IRR= Incidence Rate Ratio Table 2 – Mean number (and standard deviation) of psychotropic drug prescriptions per incident user in the 12 months after the index date F 12-14 4.7 (4.7) 6.5 (6.4) 38 <0.001 15-17 3.9 (5.3) 5.4 (6.0) 38 <0.001 12-17 4.1 (5.1) 5.7 (6.1) 39 <0.001 M 12-14 5.1 (5.1) 4.9 (5.3) -4 0.32 15-17 4.5 (5.4) 4.3 (5.1) -4 0.27 12-17 4.7 (5.3) 4.5 (5.2) -4 0.22 M+F 12-17 4.4 (5.1) 5.3 (5.9) 20 <0.001 Table 3 – Prevalence of access to healthcare services in the 12 months prior the index prescription 2018 2021 F 12-14 58.8 77.9 <0.001 15-17 55.4 61.3 0.007 12-17 56.2 65.7 <0.001 M 12-14 63.3 74.0 0.003 15-17 60.0 60.4 0.89 12-17 61.2 65.7 0.05 M+F 12-17 58.4 65.7 <0.001 FIGURE LEGENDS Figure 1 - Prevalence (%) of persistent users by gender and age groups *p=0.01 **p<0.001 Figure 2 - Prevalence (%) of child and adolescent mental health service (CAMHS) attendance in the 12 months before and after the index prescription (IP) by gender and age groups APPENDICES Supplementary Table 1 – The 10 most commonly prescribed psychotropic drugs in 2018 and 2021 Information & Authors Information Version history V1 Version 1 15 November 2025 Peer review timeline Published British Journal of Clinical Pharmacology Version of Record 15 Apr 2026 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection British Journal of Clinical Pharmacology Authors Affiliations Rita Campi Istituto di Ricerche Farmacologiche Mario Negri View all articles by this author Ida Fortino Regione Lombardia View all articles by this author Antonio Clavenna 0000-0001-5536-4192 [email protected] Istituto di Ricerche Farmacologiche Mario Negri View all articles by this author Metrics & Citations Metrics Article Usage 262 views 176 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Rita Campi, Ida Fortino, Antonio Clavenna. Psychotropic drug prescriptions in adolescents before and after COVID-19 pandemic in Lombardy Region, Italy. Authorea . 15 November 2025. DOI: https://doi.org/10.22541/au.176323875.57821561/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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