Update on America’s State of Mind – 4 Key Takeaways
A full-year analysis reveals a sustained increase in the use of antidepressants as Americans coped with the impact of the COVID-19 pandemic.

Last spring, just after we reached the one-month mark of stay-at-home orders and social distancing, we examined prescription claims for mental health medications – those used to treat depression, anxiety and insomnia – and observed a dramatic increase in use during the earliest weeks of the pandemic.

As part of our 2020 Drug Trend Report research, we conducted a full-year analysis of mental health medication utilization, which gives us a full view of the toll 2020 has taken on our mental well-being. This analysis is based on prescription medication claims for more than 27 million commercially insured Americans.

Below are four key mental health trends from our analysis.

1) There was a sustained increase in use of antidepressant medication prescriptions, especially among people with no previous prescription history.

While use of other mental health medications stabilized after a spike in use at the start of the COVID-19 pandemic, overall use of antidepressant medications increased 7.9% between 2019 and 2020.

More than 11% of commercially insured Americans had at least one prescription for an antidepressant in 2020, a 4.6% increase from 2019. Nearly one-third (32.1%) of people taking antidepressants in 2020 had no history of use six months prior to their  first antidepressant prescription in 2020.

2) Women and girls continue to receive treatment with mental health medications at higher rates than men and boys across all ages.  

Historically, women have had a higher prevalence of use of medications for mental health compared to men. That is a trend that continued last year, with our claims data showing that women were more likely than men to receive prescriptions for antidepressant, anti-anxiety and sleep medications. For use of antidepressants, the percentage of women and girls was near double, or more than double, the percentage of men and boys each age group.  For anxiety and sleep medications, use was almost entirely in adults.

Percent of commercially insured patients with at least one Rx for an antidepressant



Percent of commercially insured patients with at least one Rx for an anti-anxiety medication



Percent of commercially insured patients with at least one Rx for a sleep medication



Research shows the COVID-19 pandemic has disproportionally affected women in relationships and upset their work/life balance, particularly women with children at home, which may contribute to higher rates of treatment with medications used for depression, anxiety and insomnia. It is also important to consider that men may be struggling as much as women with their emotional health, but may be seeking treatment at lower rates, or finding other ways to cope.

3) Teens and young adults are struggling.

Social isolation and uncertainty about school, college and early career development has taken a toll on teens and young adults in the past year, contributing significantly to an accelerating trend in mental health medication use among this age group.

In the 13-19 age group, 11% of girls had at least one prescription for an antidepressant in 2020, an increase of 10.4% from 2019. Nearly 6% of boys 13-19 had at least one prescription for an antidepressant in 2020, a 2.6% increase from 2019, the lowest increase observed over the last five years. Again, as seen among adults, it may be that boys and young men experience issues with emotional health, but may be less likely to seek treatment, or be helped by adults to obtain treatment, and even less so as learning environments went virtual. 

Over the past five years, use of antidepressant medications has increased more than 55% among teen girls, and nearly 38% among teen boys.

Percent increase in the number of commercially insured patients with at least one Rx for an antidepressant



4) Certain types of employers saw higher increases in employees using antidepressants.

While the COVID-19 pandemic added pressure and stress to all professions, the education, hospital, legal and technology sectors had the biggest increases in the number of people with at least one prescription for an antidepressant medication in 2020. The pandemic disproportionally affects these sectors, and as such, there is much to do to ensure employees in these sectors have affordable and easy access to high quality care and ongoing support.

Prevalence of antidepressant use by employer type, 2020



As we have seen during other serious and traumatic events in our nation’s history, behavioral and emotional concerns will persist even as we make progress in building immunity to COVID and returning to a more normal life. Digital health tools and virtual care are removing barriers to access to reach people with behavioral health care like never before. It is critical for employers to offer ongoing support to employees and to make sure employees know about available resources and use them.

At Evernorth, solutions like InMynd and non-drug solutions for depression, anxiety and insomnia on our Digital Health Formulary provide plans with many options that create an affordable and simple ways for patients to connect to care, in a setting that is most comfortable for them, to ensure they get the care they need to stay healthy.

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