Christine Leong, an assistant professor in the college of pharmacy, is the first author of a recently published research letter in JAMA Pediatrics, published by the American Medical Association, comparing psychotropic drug use among children and adolescents prior to and during the COVID-19 pandemic. Psychotropic drugs are any medication that can be used to treat a psychiatric condition. Leong published the letter alongside six other researchers from the University of Manitoba.

Leong graduated from the University of Manitoba with a bachelor of science degree and the University of Toronto with a doctorate in pharmacy, before returning to Winnipeg as a hospital pharmacist at the Health Sciences Centre and later as an assistant professor.

The study found a nearly twofold decrease in stimulant and anxiolytic or sedative-hypnotic use among children in a Manitoba population immediately following the public health closures in the spring in 2020. However, the study also found a marked increase in antidepressant use near the end of 2020.

“The majority of the stimulant use represents ADHD medications, and so we did expect that finding,” Leong said.

The researchers explain the decrease in stimulant use among children as in part due to school closures and restrictions on in-person physician visits. Leong said in the case of stimulant use, there is a decrease in prescriptions being filled by patients and fewer new prescriptions being made.

Leong explained during the summer months when school is out, there is a “drug holiday” of reduced usage among people who take ADHD medications, and it could be the case that this established phenomenon is occurring during pandemic-caused school closures as well. This could explain the decrease in prescriptions being filled, while fewer opportunities for in-person physician visits may why explain fewer prescriptions are being made.

“It’s difficult to pinpoint exactly what could be causing the rise in antidepressant use,” Leong said.

“Antidepressants can be used for both anxiety or depression, and so it’s hard to decipher if it’s one or the other.”

The increase in antidepressant use could be explained by an increase in new-onset depression or anxiety among children in Manitoba in 2020, the researchers explained. The hypothesis that public health closures and social isolation may have led to an increase of depression or anxiety supports more inquiry into the health effects of pandemic measures.

Leong is interested in following up on this study with an analysis of the 2021 data to see if the partial re-opening of certain activities affected the use of psychotropic drugs. Ultimately, it will be impossible to know the full extent of how the pandemic affected psychotropic drug use in Manitoba until the pandemic is over.

Leong suggested that if there is a significant rise in anxiety and depression among children, then policy makers should take into account the risks versus the benefits of things like school closures.

“During this time, I think it’s just an additional piece of information that could be useful in terms of improving the mental health of children,” Leong said.

Manitoba is uniquely able to conduct research on population-based health outcomes because of their access to data.

“We use the administrative data from the Manitoba Centre for Health Policy,” Leong said.

“What’s unique is that in Manitoba we have pretty much access to data not restricted by age or income or drug coverage, whereas there is some data that’s available in other jurisdictions [where] you’ll only have patients that are of a certain age or are able to be covered.”

This unrestricted data allows researchers to examine target populations to reveal underlying patterns.

The study was funded by Research Manitoba’s COVID-19 Rapid Response Grant Competition. In total, the University of Manitoba received $3.8 million in research funding from the competition.

Leong’s interest in psychiatric pharmacy will now turn to a pilot program to make mental health resources more accessible through pharmacists. Leong has received a grant from the Canadian Foundation for Pharmacy’s 2021 Innovation Fund to support a study examining the impact of mental health first-aid training for pharmacists, hypothesizing that pharmacists who are properly trained in mental health first-aid will be better able to assist their patients. The study will train 25 pharmacists and collect data to determine if the training improves care and reduces stigma surrounding mental health.

“I do hope that patients will feel comfortable enough to speak to a pharmacist and that pharmacists would be well-prepared to direct them to the services that they need,” Leong said.