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. 2021 Jun 2;140:346–349. doi: 10.1016/j.jpsychires.2021.05.073

What have we learned in the past year? A study on pharmacy purchases of psychiatric drugs from wholesalers in the days prior to the first and second COVID-19 lockdowns in Germany

Louis Jacob a,b,c, Jens Bohlken d, Karel Kostev e,∗
PMCID: PMC9749835  PMID: 34139456

Abstract

No study has yet investigated how the second coronavirus disease (COVID-19) lockdown has impacted the consumption of psychiatric medications in Germany. Therefore, the goal of this study was to analyze weekly pharmacy purchases of psychiatric drugs from wholesalers in this country in 2019 and 2020 using data from the IMS RPM® (Regional Pharmaceutical Market) Weekly Database. The outcome was the number of pharmacy purchases of psychiatric drugs per week from wholesalers between Calendar Week 2 and Calendar Week 52 in 2019 and 2020. Calendar Weeks 12 and 51 in 2020 corresponded to the days prior to the first and second German COVID-19 lockdowns, respectively. Descriptively, compared with 2019, the number of weekly pharmacy purchases of psychiatric drugs increased by 32% between Calendar Weeks 2–11 and Calendar Week 12 in 2020, while there was a 9% increase between Calendar Weeks 13–50 and Calendar Week 51 that same year. Overall, the relative increase in the weekly pharmacy purchases of psychiatric drugs from wholesalers was less pronounced before the second COVID-19 lockdown in Germany than before the first. Further studies are warranted to identify factors (e.g., decreases in panic buying) that may have contributed to this decreasing trend.

Keywords: Pharmacy purchases, Psychiatric drugs, Lockdown, Coronavirus disease 2019, COVID-19, Germany

Introduction

The coronavirus disease (COVID-19) emerged in China at the end of 2019 and was declared a global pandemic in March 2020 (Atzrodt et al., 2020). As of May 15, 2021, the number of confirmed cases has exceeded 161 million, while there have been around 3.4 million related deaths (World Health Organization, 2021). In this context, many measures have been implemented to mitigate the spread of the disease (e.g., increased availability of personal protective equipment, cancellation of small gatherings, and national lockdowns), and these measures have been found to be relatively effective (Haug et al., 2020). Concurrently, COVID-19 has received massive media coverage, with the media playing a significant role in sharing critical messages pertaining to the pandemic with the general public (Basch et al., 2020).

Nonetheless, these public health measures and this media coverage have also had a wide range of deleterious effects on mental health, such as an increase in anxiety (Gao et al., 2020; Prati and Mancini, 2021) and depressive symptoms (Bendau et al., 2020; Fiorillo et al., 2020). In parallel, there has been a rise in the demand for psychiatric drugs since the beginning of the COVID-19 era (Ammassari et al., 2021; Howard et al., 2020; Kostev and Lauterbach, 2020; Rabeea et al., 2021; Stall et al., 2021; Vaduganathan et al., 2020). In Germany, pharmacy purchases of psychotropic and neurological drugs from wholesalers increased in the days prior to the first lockdown in March 2020 (Kostev and Lauterbach, 2020). A few months later, on December 16, 2020, Germany entered a second lockdown to prevent an increase in the number of new cases that might otherwise have occurred during the holiday season (Reuters, 2021). To date, little is known about how this second lockdown impacted the consumption of psychiatric drugs in this country (Moradian et al., 2021).

Therefore, the aim of this study was to analyze weekly pharmacy purchases of psychiatric drugs from wholesalers in Germany in 2019 and 2020. It was hypothesized that the general population had adapted at least somewhat to the COVID-19 crisis (PeConga et al., 2020) and that the second lockdown had had a reduced impact on the purchase of psychiatric drugs compared with the first lockdown.

Materials and methods

Database

This study used data from the IMS RPM® (Regional Pharmaceutical Market) Weekly Database, which contains data on the weekly purchases by public pharmacies from wholesalers in Germany. Each calendar week runs from Saturday to Friday. In Germany, public pharmacies are supplied with drugs by wholesalers after manufacturers and importers sell these drugs on the market (Kostev and Lauterbach, 2020). Values reported in this database are packing units that correspond to the number of packs purchased weekly. Finally, this database only contains aggregated data, and no pharmacy identification number is available.

Drugs of interest

The drugs of interest included antidepressants (Anatomical Classification of Pharmaceutical Products of the European Pharmaceutical Market Research Association (EphMRA): N06A), antipsychotics (N05A), hypnotics and sedatives (N05B), tranquilizers (N05C), antidementia drugs (N07D), and anticonvulsants (N03). As anticonvulsants are not only prescribed for epilepsy but also a wide range of psychiatric disorders (Nadkarni and Devinsky, 2005), these drugs were also included in the present analyses.

Study outcome

The outcome of this study was the number of pharmacy purchases of psychiatric drugs per week from wholesalers in Calendar Week 12 descriptively compared with that in Calendar Weeks 2–11 (average), and the same figure for Calendar Week 51 descriptively compared with that for Calendar Weeks 13–50 (average) in 2019 and 2020. Calendar Week 1 was not included in the analyses because it was not a whole calendar week (i.e., some days of the week fell in the previous calendar year). Calendar Weeks 12 and 51 in 2020 corresponded to the last days prior to the first and second COVID-19 lockdowns in Germany, respectively (Kostev and Lauterbach, 2020; Reuters, 2021). To analyze the impact of the COVID-19 pandemic on pharmacy purchases of psychiatric drugs, descriptive changes between Weeks 2–11 and Week 12, and between Weeks 13–50 and Week 51, were estimated in 2019 and 2020. An adjusted difference between 2019 and 2020 was further calculated for both Week 12 and Week 51.

Statistical analysis

This was a descriptive study of aggregated data, and no statistical test was therefore performed. Descriptive changes between Weeks 2–11 and Week 12, and between Weeks 13–50 and Week 51 in 2019 and 2020 were estimated in percentages. An adjusted difference in these changes between 2019 and 2020 was further calculated.

Results

The number of packing units of psychiatric drugs purchased weekly between Calendar Weeks 2 and 52 in 2019 and 2020 is displayed in Fig. 1 . Table 1 shows the descriptive changes in the number of packing units of psychiatric drugs purchased per week between Calendar Weeks 2–11 and Calendar Week 12, and between Calendar Weeks 13–50 and Calendar Week 51 in 2019 and 2020. Descriptively, compared with 2019, there was a 32% increase in the number of packing units of psychiatric drugs purchased between Calendar Weeks 2–11 and Calendar Week 12 in 2020, while the number of purchases increased by 9% between Calendar Weeks 13–50 and Calendar Week 51 that same year.

Fig. 1.

Fig. 1

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Number of packing units of psychiatric drugs purchased per week in 2019 and 2020

As Calendar Week 1 does not correspond to a full week, this week was not included in the analyses.

Table 1.

Descriptive changes in the number of packing units of psychiatric drugs purchased per week between Calendar Weeks 2–11 and Calendar Week 12, and between Calendar Weeks 13–50 and Calendar Week 51 in 2019 and 2020.

Drugs Weeks 2–11, 2020 (average) Week 12, 2020 Descriptive change between Weeks 2–11, 2020 and Week 12, 2020 (%) Descriptive change between Weeks 2–11, 2019 and Week 12, 2019 (%) Adjusted difference between 2019 and 2020 (%) Weeks 13–50, 2020 (average) Week 51, 2020 Descriptive change between Weeks 13–50, 2020 and Week 51, 2020 (%) Descriptive change between Weeks 13–50, 2019 and Week 51, 2019 (%) Adjusted difference between 2019 and 2020 (%)
Psychiatric drugs (all classes) 1,720,783 2,193,883 27% −5% 32% 1,539,288 2,276,822 48% 39% 9%
Antidepressants 537,211 671,647 25% −4% 29% 466,661 692,581 48% 39% 9%
Antipsychotics 288,595 379,673 32% −5% 37% 273,663 406,741 49% 43% 6%
Hypnotics and sedatives 418,705 487,663 16% −11% 27% 362,340 553,456 53% 35% 18%
Tranquilizers 139,394 186,594 34% −2% 36% 127,731 179,294 40% 42% −2%
Antidementia drugs 30,907 36,059 17% −5% 22% 28,033 40,997 46% 35% 11%
Anticonvulsants 305,972 432,247 41% 0% 41% 280,860 403,753 44% 39% 5%
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As Calendar Week 1 does not correspond to a full week, this week was not included in the analyses.

Discussion

This study conducted in Germany showed that there was an increase in pharmacy purchases of psychiatric drugs from wholesalers in the days prior to both the first and second COVID-19 lockdowns. Given the aggregated nature of the data, no statistical test was performed. Interestingly, the relative increase in the number of purchases was less pronounced before the second COVID-19 lockdown than before the first. To the best of our knowledge, this is the first study to compare the impact of two different lockdowns in the same country on the consumption of psychiatric drugs.

One important finding of this study is that the official announcement of the two COVID-19 lockdowns was descriptively associated with an increase in weekly purchases of psychiatric drugs. This result is in line with recent literature also reporting an increase in the consumption of psychiatric medications since the beginning of the COVID-19 pandemic (Ammassari et al., 2021; Howard et al., 2020; Kostev and Lauterbach, 2020; Rabeea et al., 2021; Stall et al., 2021; Vaduganathan et al., 2020). For example, a cross-sectional study revealed that the out-of-pocket purchases of anxiolytics significantly increased by 3.8% during the early phase of the COVID-19 crisis in Italy (Ammassari et al., 2021). Another study found that the number of prescriptions for antidepressants increased by 4 million and the related costs by £139 million in England in 2020 compared with 2019 (Rabeea et al., 2021). Finally, in a sample of 58,332 pharmacies from the United States, it was observed that sertraline was more frequently dispensed in February and March 2020 than in the same months in 2019 (Vaduganathan et al., 2020).

COVID-19 lockdowns have been found to have deleterious effects on the mental health of the general population (Fiorillo et al., 2020; Prati and Mancini, 2021). This could explain the increase in the number of pharmacy purchases of psychiatric drugs per week in the days prior to the first and second COVID-19 lockdowns in Germany. These deleterious effects may be mediated by several factors such as loneliness, financial burden, and fear of COVID-19. Since the beginning of the COVID-19 pandemic, there has been a substantial reduction in the number of social contacts, which has favored the occurrence of loneliness (Groarke et al., 2020) and psychiatric conditions (Robb et al., 2020). This increased incidence of psychiatric disorders is of particular concern, given that the utilization of medical services has also declined (Michalowsky et al., 2021). In terms of financial burden, the COVID-19 crisis has resulted in a major economic crisis, and a substantial proportion of people have lost their jobs (Bui et al., 2020). This economic burden may have led to adverse mental health outcomes (Ruengorn et al., 2021). A third potential mediating factor is the irrational fear of COVID-19 (i.e., coronaphobia). This fear may interfere with daily living activities and predispose people to poorer overall mental well-being (Arora et al., 2020). It has also been shown that some of the COVID-19 information conveyed by the media may have been inaccurate (Tasnim et al., 2020), and this media coverage may have played a key role in the development of coronaphobia.

Interestingly, this study further revealed that the number of weekly pharmacy purchases of psychiatric drugs from wholesalers was less impacted by the second COVID-19 lockdown than the first. Our hypothesis is that there was a decrease in panic buying, a consumer behavior characterized by buying an unnecessarily large amount of essential goods in the context of natural disasters and health or economic crises (Yuen et al., 2020). As China is one of the largest producers and manufacturers of drugs in the world (Miller and Cohrssen, 2020), people may have feared that imports of these drugs into their countries could have been delayed or even prevented after the beginning of the first lockdown, leading to a sharp increase in pharmacy purchases in the days following the official announcement of this lockdown. In Germany, measures were undertaken following the first lockdown to identify, address, and prevent drug shortages (Vogler and Fischer, 2020). In this context, the fear of drug shortages among the German public at the beginning of the second COVID-19 lockdown might have been lower than at the beginning of the first. Nevertheless, another study conducted in Germany suggested that there had been an increase in depressive symptoms between the first and the second COVID-19 lockdowns (Moradian et al., 2021), underlining the need for further research to clarify the discrepancies in the findings of these two studies.

Although the present findings have advanced the field, this study is subject to several limitations that need to be acknowledged at this point. First, this study included pharmaceutical data only, while clinical data would have allowed for more detailed analyses. Second, given that these data were of aggregate nature, no statistical test was performed to compare the number of pharmacy purchases between 2019 and 2020. Third, pharmacy purchases were used as a proxy to indicate the purchasing behavior of patients with regard to psychiatric drugs, although pharmacy purchases may also be predicted by other factors such as the sociodemographic characteristics of pharmacies and their size or the geographical areas in which they are located. Fourth, most psychiatric medications are prescribed drugs, and it was not possible to study the influence of patient and primary care physician behavior on pharmacy purchases. Fifth, as a substantial proportion of patients may have bought medicines on the Internet (Fittler et al., 2018), the present study may have underestimated the effects of the COVID-19 lockdowns on the purchase of psychiatric drugs in Germany.

In conclusion, there was an increase in the number of pharmacy purchases of psychiatric drugs per week from wholesalers in the days prior to the first and second lockdowns in Germany. However, this increase in the purchase of psychiatric medications was less pronounced before the second COVID-19 lockdown than before the first. Further research is needed to better understand the factors (e.g., decreases in panic buying) that played a significant role in the lessening impact of the lockdowns on the consumption of psychiatric drugs among the German population.

Funding

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

Louis Jacob contributed to the design of the study, managed the literature searches, wrote the first draft of the manuscript, and corrected the manuscript. Jens Bohlken contributed to the design of the study and corrected the manuscript. Karel Kostev contributed to the design of the study, performed the statistical analyses, and corrected the manuscript. All authors contributed to and have approved the final manuscript.

Declaration of competing interest

The authors declare that they have no competing financial interests.

Acknowledgments

We would like to thank Claudia Herrmann for the management of the data used in this study.

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