Canadian seasonal depression and COVID depression statistics collide: How Canadians are managing their mental health during the COVID-19 pandemic

Insights show use of antidepressant medications spiked during COVID-19 surges

By Dr. Dorian Lo
President of Express Scripts Canada

Canadians, especially women, are increasingly turning to antidepressants to help deal with the combined impacts of COVID-19 and the onset of seasonal depression. While this news is concerning, it is also a hopeful sign that growing numbers of Canadians are reaching out for help to deal with mental health issues, a once heavily stigmatized subject.

These are just some of the insights revealed by an analysis of Express Scripts Canada data, which compares trends seen in COVID’s first wave against drug claim data between September and mid-November, a period that aligns with the second wave. 

Among its findings, for example, our data shows an 11 per cent year-over-year increase in the number of people who made claims for antidepressants during the first week of September 2020.  This spike represents the highest number of claims seen since the end of the re-opening (recovery) period, when antidepressant claim volumes surged 32 per cent during the first week of July 2020, compared to the same period in 2019.

Conversely, summertime’s re-opening period saw antidepressant claims volume fall between two to five per cent of 2019 volumes, and ultimately two per cent by the end of August. As Public Health measures subsequently stepped up to address growing viral spread, antidepressant claims volume once again surged to hit a 19 per cent year-over-year rise by mid-October. This would suggest that Canadians were experiencing heightened incidences of depression during COVID surges.

Beyond the impacts and stresses associated with COVID-19, the rise in antidepressant claims also coincides with the arrival of seasonal depression.

What is seasonal depression?

Otherwise known as Seasonal Affective Disorder, or Seasonally Adjusted Depression the Canadian Mental Health Association describes seasonal depression as “a form of depression that appears at certain times of the year, usually beginning in the fall when the days get shorter.” For Canadians, winter is typically the worst season for depression.

According to Express Scripts Canada data, 2020’s particularly stressful back-to-school period in early September and Thanksgiving week proved to be trying, especially for women. For example, 13 per cent more claims for antidepressants occurred during this year’s challenging back-to-school week compared to 2019. Later, during Thanksgiving week – when many families faced pandemic restrictions that would curtail normally cherished holiday gatherings – antidepressant drug claims by women rose 22 per cent compared to the same period in 2019.

In fact, women were responsible for 3 per cent to 5 per cent more antidepressant claims than men during these emotionally challenging weeks.

COVID depression fluctuated widely between first and second waves

Other data also helps to explain 2020’s antidepressant roller coaster ride between the pandemic’s first and second waves. Among the contributing factors, a survey conducted late last April by Willis Towers Watson noted that, in response to COVID-19 impacts, 82 per cent of employers planned to prioritize messaging about Employee Assistance Programs to their staff. It seems that employees listened.

Varying geographical impacts, further affected by differences in dispensing limits, might also explain nuances in demand for antidepressants.

For example, some provinces implemented 30-day limits on prescriptions during the March to May period, but later lifted these limits as summer approached. The resulting return of citizens’ making drug claims for prescription orders covering up to 90-days supplies could partially explain the decrease in claims over the summer. It also sheds light on the subsequent surge in antidepressant claims value, which rose 13% between September 1 and November 14 compared to 2019. 

Medication adherence is another telling factor, one that deserves particular attention as it pertains to antidepressant usage.

During my years as a physician, I noticed, for example, that some people question their physician’s advice to take a prescription drug to help address anxiety or depression. Other patients forget that antidepressants take up to six weeks before they have an effect, and up to six months before the maximum benefit is felt. Some of these patients may therefore presume their issue is resolved as soon as they start to feel better. For these and other reasons, patients sometimes stop taking their medication contrary to their doctor’s advice.

Express Scripts Canada’s 2020 Drug Trend Report also shows the more medications a person takes, the more likely they are to be nonadherent to at least one. Additionally, 38 per cent of Express Scripts Canada members with depression are probably nonadherent.

Lastly, given the data and fluctuations seen in antidepressant usage between 2020’s first and second pandemic waves, it is possible that some patients stopped taking their antidepressants during the summer, but then restarted taking these medications when the second wave and seasonal depression emerged. 

Mental health during COVID-19 is a significant challenge for Canadians

While these insights help explain swings in antidepressant usage, other reports further confirm the pandemic’s undeniable impacts on Canadians’ mental health.

A recent study by the Canadian Mental Health Association and the University of British Columbia, for example, found that 40 per cent of those surveyed said their mental health has deteriorated since the COVID-19 outbreak began. For those with a pre-existing mental-health issue, that figure rose to 61 per cent.

A Leger Marketing study in late October also noted 24 per cent of Canadians report their mental health and stress levels were worse than they were last spring, when the pandemic’s first wave swept across Canada.

With Christmas fast approaching, employers can expect many staff members to be particularly anxious about how the pandemic will impact this normally festive time of year. Fortunately, more employers than ever are taking their employees’ mental health seriously. A survey conducted in September by Willis Timmins Watson noted, for example, that 53 per cent of employers are enhancing their wellbeing programs, and 60 per cent expect to prioritize mental health services and stress management.

A range of helpful solutions are available

For starters, insurance carriers offer various tools that employers can use to promote physical and mental health among employees.

Employers whose staff benefit from the Express Scripts Canada Pharmacy, and who take multiple medications, should be encouraged to consult with a member of our pharmacy team, who can confirm all prescribed drugs can be safely taken in combination with one another. Our pharmacists can also potentially recommend equivalent, cost-effective drugs that can help the patient and their drug plan save money.

Most importantly: employees should always be encouraged to seek guidance from their doctor, even if that means adhering to directions on how to safely reduce or eliminate a medication from their regime.

Despite these challenging times there is much to be optimistic about. Working together, we can all get through COVID-19, help employees deal with seasonal depression, and find ways to make the best of the holidays and the year ahead.