The World Health Organization reported that, following the COVID-19 pandemic, there was a 25% increase in the prevalence of anxiety and depression worldwide. Mental health crises following months and years of social isolation and other effects of the pandemic have renewed national interest in mental health care access. Understanding how mental health services, including medications used to treat mental illness, are being used provides important context for improving care in the future.
HCCI used our commercial claims dataset, Medicaid, Traditional Medicare, and Medicare Advantage (MA) claims data to look at the prescription fill patterns for several drug classes used to treat depression, one of the most common mental health conditions in the U.S. Our data show that the rate of days supplied for antidepressants increased slightly, by nearly 5%, across the entire study population from 2018-2021. That increase was driven by a 29% increase among people enrolled in employer-sponsored insurance and a 15% increase among people enrolled in Medicaid.
Looking at the most commonly prescribed antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs), our data show:
Use was the highest among adults aged 45–64, but use among young adults aged 18–34 grew the fastest from 2018–2021.
Women used SSRIs at twice the rate of men, and rates of use from 2018-2021 grew slightly faster among women than men.
Among Medicare and Medicaid enrollees (the only population for which we have race and ethnicity data), communities of color had the lowest rates of SSRI use. From 2018-2021, rates of use grew fastest among Hispanic, Asian and Pacific Islander, and Indian and Alaska Native people.
People with ESI and Medicaid residing in zip codes categorized as the least socially vulnerable areas of the U.S. had the highest rates of SSRI use while those in zip codes categorized as most socially vulnerable had the lowest rates of use.
The increase in use of antidepressants from 2018-2021 we observe in the data suggests an increase in the treatment of mental illness over that period and is consistent with reports of the increased prevalence of anxiety and depression.
We observe different rates of use by age, sex, race and social vulnerability, some of which may be due, in part, to differing prevalence of mental health conditions. Some of the disparities highlighted by our data likely reflect structural and systemic inequities that inhibit access to antidepressants, such as mental health provider shortages, stigma associated with mental illness that may discourage diagnosis and treatment, structural racism, and financial barriers.
The data available in the Health Care Vitals dashboard can help policymakers and health care providers better understand mental health treatment disparities with the goal of increasing equitable access to appropriate care.
We calculated monthly fill rates for prescriptions of three types of antidepressant drug classes using the RX Norm NDC categorization: selective serotonin reuptake inhibitors, non-selective monoamine reuptake inhibitors, and other antidepressants. We used prescription drug claims data from the HCCI Commercial Claims dataset, the Medicare RIF, and TMSIS to identify fills. We did not restrict fills to individuals with a particular diagnosis. Rates were calculated as total days supplied divided by the total enrolled population and multiplied by 100,000 to get a rate of use per 100,000 enrollees.