Postpartum women received more benzodiazepine prescriptions during the pandemic

New research from the University of Georgia suggests the COVID-19 pandemic may have had an unexpected side effect for postpartum women: more benzodiazepine prescriptions. The findings are published in the diary Archives of Women’s Mental Health.

The new study found that the pandemic did not lead to an increase in postpartum depression or anxiety diagnoses. But it did lead to a 15% increase in the number of privately insured new mothers filling prescriptions for anti-anxiety medications such as Valium, Xanax, Ativan and Klonopin.

However, the researchers found no increase in the prescription of SSRIs.

SSRIs, or selective serotonin reuptake inhibitors, are the gold standard for treating both depression and anxiety disorders. But these drugs, which include medications like Zoloft, Prozac and Lexapro, take time to work.

Benzodiazepines, also called benzos, are sometimes used as a stopgap during the month or two it takes for an SSRI to kick in. But they are not a replacement for SSRIs. And they carry significant risks of dependence and abuse.

“What concerns me most is not what we found, but what we didn’t find,” said Grace Bagwell Adams, lead author of the study and an associate professor in UGA’s College of Public Health. “You can’t tell me that there wasn’t more depression and anxiety in this population during the pandemic. And historically, even before COVID, postpartum depression and anxiety have been underdiagnosed. But we didn’t find an increase in diagnoses.”

Postnatal depression, anxiety largely underdiagnosed. The pandemic didn’t help.

One in ten women experience postpartum depression or anxiety in the first six months after giving birth. The majority are not properly diagnosed or treated for their conditions.

The researchers analyzed data from more than 518,000 privately insured women after giving birth from January 2016 through December 2020. Despite reported increases in anxiety and depression in general after the start of the pandemic, the researchers found no evidence of an increase in diagnoses of postpartum depression or postpartum anxiety.

According to the researchers, this suggests that the underdiagnosis and undertreatment of these conditions was exacerbated by the health care crisis caused by the pandemic.

Many insurers will only cover one postpartum visit, usually about six weeks after delivery. Providers are expected to screen for depression and anxiety during these visits.

But during COVID, it’s likely that many women didn’t have that appointment, Bagwell Adams said. Or if they did, it was via telehealth, which isn’t always ideal for discussing difficult mental health issues.

“One of the biggest causes of maternal death is suicide,” said Bagwell Adams. “If these women are not diagnosed and not treated properly, they die.

“And it’s not that postpartum women don’t go to their doctors on time. It’s that they’re not being listened to.”

Benzos are not a replacement for SSRIs when it comes to depression

After giving birth to her son during the pandemic, Bagwell Adams experienced this lack of communication firsthand during her postpartum checkup.

“We had a conversation and I told him that I was basically paralyzed by anxiety and depression,” she said. “He was like, ‘Let’s give you something to calm you down.’ I thought he was going to send me home with an SSRI.”

Instead, her doctor prescribed a benzodiazepine.

As someone who has dealt with anxiety for years, Bagwell Adams knew that wasn’t going to be enough. After some back and forth with her doctor, she was prescribed Lexapro. But many patients wouldn’t know to fight back like she did.

“What I find really troubling is that this is what we found for the crème de la crème of insurance coverage,” Bagwell Adams said. “The women in this sample have private insurance. This is the best-case scenario for the United States, and it doesn’t look good.”

Combining opioids with benzos has probably increased. That combination can be deadly.

Another concerning side effect of the increased prescription of benzodiazepines is interactions with other medications, particularly opioids.

More than seven in 10 women who deliver by cesarean section and one in four who deliver vaginally are prescribed opioids for pain management. And previous research shows that opioid prescriptions for postpartum women have increased during the COVID-19 pandemic.

But combining opioids with benzos can be deadly. And the likelihood that some women who filled benzodiazepine prescriptions were taking painkillers at the same time is high, the researchers said.

“To me, this study raises more questions than it answers,” Bagwell Adams said. “There’s something bigger going on here that’s really troubling when it comes to the treatment of women in general and postpartum women in particular.”