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