New patients lead rise in claims for antidepressants

A company that manages pharmaceutical benefits for some seven million Canadians says it's seeing a dramatic increase in insurance claims for antidepressants such as Prozac, Celexa, Paxil and Zoloft.

Express Scripts Canada says claims for selective serotonin reuptake inhibitors, or SSRIs, increased by 17 per cent last year over 2019, and says the spike rose to 20 per cent around Thanksgiving.

The company says the increase is driven largely by first-time patients, and says the trend is expected to continue as the COVID-19 pandemic lingers.

• How to cope with winter isolation during the pandemic
• Pandemic driving more young people to seek mental health help

"It's going to be a very, very challenging period over the upcoming months," said Dr. Dorian Lo, a medical doctor and president of Express Scripts Canada, the largest private claims administrator in the country. "It's clear that folks are suffering."

Lo said he expects SSRI claims in 2021 to outpace pre-pandemic levels by as much as 25 per cent.

Medication 'can absolutely save lives'

The soaring number of prescriptions places added pressure on mental health services that support first-time patients who are going through what could be the darkest time in their lives, according to advocates.  

"To put it bluntly, people's lives are at stake. This far too often results in a suicide or suicide attempt," said Pharmacist Jen Baker, who owns Pharmasave Loyalist Pharmacy in Amherstview, Ont.

We need systems in place to support individuals who are suffering.- Jen Baker, Ontario Pharmacists Association

Baker, who also chairs the board at the Ontario Pharmacists Association, said SSRIs can bring people back from the brink. "Especially when symptoms are becoming unbearable ... medication in this case for mental health can absolutely save lives."

But she warned there needs to be proper mental health supports in place as well, particularly for patients being prescribed these drugs for the first time.

"We need systems in place to support individuals who are suffering," Baker said. 

Lack of support

Dr. Alykhan Abdulla, chair of the Ontario Medical Association's family and general practice section, said doctors are seeing more patients seeking help to deal with depression-like symptoms than ever before.

Not all of them end up on SSRIs, he said, but the lack of support for those who are prescribed antidepressants for the first time can affect their long-term recovery.

Abdulla said most patients will begin to recover within six to eight months of starting a new prescription, but without additional therapeutic support, what might have been an isolated episode could become a chronic mental illness.   

Abdulla said few physicians also provide therapy, and their patients can wait years to see a psychiatrist. Despite new investments by the province, publicly funded options are especially limited. Not all employers cover private therapy, and some of the patients who need it most have no private insurance, he said.

"The people that are in the greatest need for therapy for mental health are the ones the most challenged to get the help they need," Abdulla said. "This is unfair."

He said the spike in claims for SSRIs only tells part of the story: physicians have also been prescribing more sleeping aids and anti-anxiety medication, and have been treating more patients for other physical symptoms of stress.

"We're really seeing a lot of people being challenged for all kinds of reasons, so I would put the number closer to maybe 40 per cent with need for medication during this time of this pandemic," Abdulla said.

Need help? Here are some mental health resources:

• Ottawa Mental Health Crisis Line (EN/FR) : 613-722-6914, 1-866-996-0991 if outside Ottawa
• Distress Centre of Ottawa and Region (EN) : 613-238-3311
• Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)