Use of Psychotropic Drugs during the COVID-19 pandemic in Minas Gerais, Brazil

To describe the profile of dispensation of mental health drugs by analyzing trends in use before and during the COVID-19 pandemic within the Unified Health System (Sistema Único de Saúde [SUS]).

Methods:

Pharmacoepidemiological study based on the retrospective analysis of records regarding the dispensation of psychotropic medicines in the SUS database in the state of Minas Gerais between 2018 and 2021, considering the periods before (2018–2019) and during the COVID-19 pandemic (2020–2021). A database with the records of dispensation of municipalities was created, and the consistency of releases was verified using the Analysis of Variance (ANOVA) test. Medicine consumption was measured in a defined daily dose (DDD) per 1,000 inhabitants/day for SUS, and the difference between periods was evaluated using Student's t-test.

Results:

During the COVID-19 pandemic, there was an increase in the consumption of psychotropic drugs in SUS-MG. The most consumed medicines were fluoxetine hydrochloride, diazepam and phenobarbital sodium (DDD=5.89; 3.42; 2.49) in the Basic Pharmaceutical Services Component(CBAF), and olanzapine, risperidone and quetiapine hemifumarate (DDD=0.80; 0.47; 0.38) in the Specialized Pharmaceutical Services Component (CEAF). The highest percentage increase in consumption was attributed to clonazepam (75.37%) and lithium carbonate (35.35%), in CBAF, and levetiracetam (3,000.00%) and memantine hydrochloride (340.0%) in CEAF.

Conclusion:

The change in the psychotropic drug dispensation profile during the COVID-19 pandemic highlights the need to produce more studies to complete, confirm or rule out this profile and monitor the use of psychotropic drugs by the population in the post-pandemic context.

Keywords:
Psychotropic drugs; Mental health; COVID-19; Pharmacoepidemiology; Pharmaceutical services; Database

Active ingredient	DDD/1000 inhabitants/day/SUS
Active ingredient	2018	2019	2020	2021	Mean	Median	Before the COVID-19 pandemic (2019)	During the COVID-19 pandemic (2020–2021)	Absolute variation	Percentage variation (%)
Amitriptyline	0.06	1.61	1.43	1.55	1.16	1.49	1.61	1.49	-0.12	-7.35
Biperiden	0.00	0.38	0.40	0.42	0.30	0.39	0.38	0.41	0.04	9.26
Carbamazepine	0.90	1.00	1.03	1.15	1.02	1.02	1.00	1.09	0.09	8.47
Clomipramine	0.01	0.16	0.20	0.22	0.15	0.18	0.16	0.21	0.05	29.56
Clonazepam	0.00	0.41	0.43	0.99	0.46	0.42	0.41	0.71	0.31	75.37
Chlorpromazine	0.08	0.33	0.38	0.41	0.30	0.35	0.33	0.40	0.07	21.54
Diazepam	0.03	2.97	3.41	3.44	2.46	3.19	2.97	3.42	0.46	15.41
Phenytoin	0.04	0.36	0.36	0.39	0.29	0.36	0.36	0.37	0.02	4.20
Phenobarbital	0.23	2.29	2.60	2.37	1.87	2.33	2.29	2.49	0.19	8.33
Fluoxetine	0.10	5.19	5.64	6.15	4.27	5.41	5.19	5.89	0.71	13.63
Haloperidol	0.01	1.37	1.72	1.80	1.23	1.55	1.37	1.76	0.39	28.50
Lithium carbonate	0.32	0.63	0.38	1.32	0.66	0.50	0.63	0.85	0.22	35.35
Midazolam	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Nortriptyline	0.03	0.52	0.61	0.70	0.46	0.56	0.52	0.65	0.13	25.10
Sodium valproate	0.50	0.60	0.73	0.85	0.67	0.66	0.60	0.79	0.19	31.72

Active ingredient	DDD/1000 habitantes/dia/SUS
Active ingredient	2018	2019	2020	2021	Mean	Median	Before the COVID-19 pandemic (2018-2019)	During the COVID-19 pandemic (2020–2021)	Absolute variation	Percentage variation (%)
Clobazam	0.05	0.11	0.03	0.13	0.08	0.08	0.08	0.08	0.00	5.26
Clozapine	0.28	0.32	0.34	0.32	0.31	0.32	0.30	0.33	0.03	11.11
Donepezil	0.34	0.35	0.31	0.26	0.31	0.32	0.34	0.28	-0.06	-18.31
Ethosuximide	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	50.00
Gabapentin	0.05	0.06	0.08	0.08	0.07	0.07	0.05	0.08	0.03	46.30
Galantamine	0.07	0.08	0.08	0.07	0.08	0.08	0.08	0.08	0.00	0.00
Lamotrigine	0.04	0.09	0.20	0.17	0.12	0.13	0.06	0.19	0.12	198.39
Levetiracetam	0.00	0.00	0.01	0.05	0.02	0.01	0.00	0.03	0.03	3000.00
Memantine	0.00	0.01	0.02	0.03	0.01	0.01	0.01	0.02	0.02	340.00
Olanzapine	0.75	0.89	0.76	0.84	0.81	0.80	0.82	0.80	-0.02	-2.68
Primidone	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
Quetiapine	0.29	0.33	0.38	0.37	0.34	0.35	0.31	0.38	0.07	22.08
Risperidone	0.27	0.41	0.44	0.50	0.40	0.42	0.34	0.47	0.13	37.06
Rivastigmine	0.10	0.15	0.19	0.19	0.16	0.17	0.12	0.19	0.07	56.91
Topiramate	0.14	0.13	0.17	0.17	0.15	0.16	0.14	0.17	0.03	21.01
Vigabatrin	0.01	0.01	0.02	0.02	0.01	0.02	0.01	0.02	0.01	90.00
Ziprasidone	0.12	0.13	0.13	0.11	0.12	0.13	0.13	0.12	0.00	-3.17

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E-mail: revbrepi@usp.br

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[1] CORRESPONDING AUTHOR: Sarah Nascimento Silva. Avenida Augusto de Lima, 1715, Barro Preto, CEP 30190-002, Belo Horizonte (MG), Brazil. E-mail: sarah.nascimento@fiocruz.br