Antidepressant Treatment Initiation Among Children with Long COVID

Background: Limited data exist on antidepressant use among children who develop post-acute sequelae of coronavirus disease 2019 (COVID-19) or long COVID.

Objective: To compare the risk of antidepressant initiation among children with long COVID compared with children with COVID infection.

Methods: We conducted a retrospective cohort study of children aged 3-17 years old who were newly diagnosed with COVID (ICD-10-CM code U07.1 and U07.2) or long COVID (ICD-10-CM code U09.9) between October 1, 2021, and April 4, 2022. The sample was derived from Komodo’s Healthcare MapTM database, which has more than 325 million patients across the U.S. The date of the earliest medical claim associated with a COVID/long COVID diagnosis was the index date. The baseline period was 6 months before index date. The outcome assessment period is twelve months after index date. For COVID exposed group, children having a medical claim associated with a history of COVID infection and long COVID during the baseline period were excluded. We randomly selected 2 COVID exposed children for every 1 long COVID exposed. We included children with the continuous pharmacy and medicine coverage enrollment of 6 months prior to and 12 months after the index. All children with antidepressant use during the baseline period were excluded. The primary outcome was antidepressant initiation. Propensity score matching was used to balance baseline covariates, including demographics, psychiatric disorders, medical comorbidities, healthcare utilization, and psychotropic medication use. Logistic regression models were used to estimate the risk of antidepressant initiation among children with long COVID compared with children with COVID infection.

Results: Our sample included 18,268 children aged 3-17 years-old with COVID infection and 9,134 children with long COVID from October 2021 through April 2022. Compared with children with COVID infection, a higher proportion of children with long COVID had psychiatric disorders, particularly depression, anxiety, medical comorbidities, healthcare utilization, and mood stabilizer and sedative use. Overall, 2.3% (422/18,268) of the children with COVID and 5.1% (464/9,134) of children with long COVID initiated antidepressant. After propensity score matching, 3.2% (275/8,503) of the children with COVID and 4.7% (401/8,503) of children with long COVID initiated antidepressant. Compared with children with COVID, children with long COVID had a significantly higher odds of initiating antidepressant (OR= 1.48, 95%CI=1.27, 1,73).

Conclusion: Children with long COVID are at higher risk of initiating antidepressant treatment than in children with COVID.