Abstract

The COVID-19 pandemic has been associated with substantial adverse effects on mental health worldwide, contributing to increased prevalence of anxiety, depression, and sleep disturbances. These changes have influenced psychopharmacological treatment practices and psychotropic medication utilization across healthcare systems. Objective: To evaluate trends in outpatient prescribing of anxiolytics, hypnotics, and antidepressants in North Macedonia before, during, and after the COVID-19 pandemic and to explore psychotropic medication use and mental health-related behaviors among adults during the pandemic period. Methods: A mixed-methods study was conducted comprising a retrospective pharmaco-epidemiological analysis of national outpatient prescription data from 2018–2024 and a cross-sectional survey conducted in 2022. Prescription data were obtained from the national electronic prescription system and Health Insurance Fund reports. Temporal prescribing trends were assessed using Spearman’s rank correlation and Mann–Whitney U tests. The survey included 340 adults and assessed psychotropic medication use, reasons for use, prescribing practices, and perceptions of the pandemic’s impact on mental health. Results: Significant upward prescribing trends were observed for alprazolam (ρ=0.964, p<0.001), zolpidem (ρ=1.000, p<0.001), venlafaxine (ρ=1.000, p<0.001), and sertraline (ρ=0.964, p<0.001). Zolpidem showed the largest relative increase (+64.8%), followed by venlafaxine (+36.4%) and alprazolam (+28.2%). Diazepam remained the most frequently prescribed psychotropic medication throughout the study period. Survey findings showed that 71.2% of respondents initiated psychotropic medication use during the pandemic. Anxiety (52.7%), tension (31.2%), and insomnia (25.0%) were the most commonly reported reasons for use. Approximately one-third of participants reported dose escalation, while many reported feelings of reassurance when medication was available and discomfort when access was limited. Conclusion: Psychotropic medication prescribing increased substantially in North Macedonia following the onset of the COVID-19 pandemic. The findings highlight the need for continued monitoring of psychotropic medication utilization, rational prescribing practices, and strengthened mental health services to address the long-term consequences of public health crises.

Keywords

COVID-19, mental health, anxiolytics, hypnotics, antidepressants, psychotropic medications, prescription trends, pharmaco-epidemiology, outpatient prescribing