Researchers Find Increase in Benzodiazepine Prescriptions Among Postpartum Women During Pandemic

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Recent research published in the Archives of Women’s Mental Health shows that the COVID-19 pandemic is associated with an increase in benzodiazepine prescriptions among postpartum women with private insurance. Despite this finding, the investigators note that there was not an observed increase in postpartum depression or anxiety diagnoses.^1,2

Benzodiazepines—such as diazepan (Valium; Hoffman-La Roche), alprazolam (Xanax; Viatris), or lorazepam (Ativan; Bausch Health Companies)—are often prescribed as a stopgap during the month or 2 it can take for a selective serotonin reuptake inhibitor (SSRI) to take effect; however, these medications are not substitutes for SSRIs, and the authors warn that they can carry a significant risk of dependence or abuse.¹

About 1 in 10 women are reported to experience either postpartum depression or anxiety within the first 6 months after giving birth; however, most women are not diagnosed properly and do not receive treatment for their conditions. Lead study author Grace Bagwell Adams, PhD, MPA, associate professor at the College of Public Health at University of Georgia, noted that the study was inspired by her own experience with postpartum. Following the birth of her son during the pandemic, she expressed that she experienced a lack of communication with her provider at a postpartum check-up.¹

“[My provider and I] had a chat, and I told him I was basically crippled by anxiety and depression,” said Bagwell Adams in a news release. “He was like, ‘Let's get you something to help calm you down.’ I thought he was going to send me home with an SSRI [but he prescribed me a benzodiazepine.]”¹

For this study, a retrospective pooled cross-sectional design was utilized to gather a sample of over 518,000 privately insured women with postpartum in the US. Claims data were pulled from January 1, 2016, to December 31, 2020, and changes in diagnoses of anxiety and depression were measured. Additionally, the investigators assessed changes in prescription fills and days supplied of classes of medication that are used to treat anxiety and depression, such as antidepressants, z-drugs, and benzodiazepines.²

The investigators observed an approximate 15.2% increase in women who received benzodiazepine prescriptions during the pandemic. Interestingly, there were no significant increases in either depression or anxiety in postpartum women.²

“What concerns me the most is not what we found but what we didn’t find. You can't tell me there wasn't more depression and anxiety in this population during the pandemic. And historically, even pre-COVID, postpartum depression and anxiety has always been underdiagnosed. But we didn’t find an increase in diagnoses,” said Bagwell Adams in the news release.¹

The investigators stress that the study findings can be an indicator of the continuous trend of underdiagnosis and undertreatment of these conditions in women. They suggest that the lack of care for postpartum women could have been exacerbated by the health care crisis that occurred during the pandemic. Commonly, insurers cover only 1 postpartum visit—often at around 6 weeks following birth—in which health care providers screen for anxiety and depression.¹

“One of the top causes of maternal mortality is suicide. When these women don’t get diagnosed and they don’t receive proper treatment, they die. And it’s not that postpartum women didn’t see their doctor in time. It’s that they aren’t being listened to,” explained Bagwell Adams in the news release. “The thing I get really worried about it is that this is what we found for the cream of the crop in terms of insurance coverage. The women in this sample have private insurance. This is the best-case scenario for the US, and that doesn’t look good.”¹

Because of the lack of observed anxiety and depression diagnoses, the study authors urge that additional research should be conducted to assess this further. They note that prior evidence presented an increase in depressive and anxiety symptoms among postpartum women during the pandemic, and they believe that their findings suggest an increase in barriers to appropriate diagnosis and treatment in this population.²

“For me, this study highlights more questions than answers,” explained Bagwell Adams. “There’s something bigger happening here that is really disconcerting when it comes to treating women in general and postpartum women in particular.”¹

REFERENCES

1. University of Georgia. Postpartum women filled more benzodiazepine prescriptions during pandemic. News release. September 12, 2024. Accessed September 12, 2024. https://www.eurekalert.org/news-releases/1057773

2. Adams, GB, Steuart, S, Lawler, EC, Shone, H, Abraham, AJ. Increases in benzodiazepine prescribing for postpartum anxiety during COVID-19. Arch Womens Ment Health (2024) doi:10.1007/s00737-024-01488-4