REGISTRO DOI: 10.5281/zenodo.7916379
Margleide da Silva Dourado1, João Pedro Ferreira Silva1, Ubeane dos Santos Miranda1, Ana Oclenidia Dantas Mesquita2, Robson de Jesus2, Leonardo Diego Lins3, Mayara de Souza Miranda2, José Alfredo de Oliveira Alkmin2, Tâmara Trindade de Carvalho Santos2, Anderson dos Santos Barbosa2
ABSTRACT
Depression in adolescence and the indiscriminate use of antidepressants has become frequent, can be configured as a public health problem in Brazil and in the world and presented greater problems with the Covid-19 pandemic. Therefore, this study had the general objective of reflecting on factors that influenced the use of antidepressants in adolescents during and after the COVID-19 pandemic, in addition to identifying the function and effects of the use of antidepressants, evaluating the factors related to the consumption of antidepressants by adolescents during and after the COVID-19 pandemic and to relate the problems that can occur with the self-medication of antidepressants. The research instrument used was the literature review, as it allows the investigator to cover a wider range of events than those that can be studied directly through the use as a basis of all other studies already carried out. Inclusion criteria were studies published in the last 3 years that were freely available online in full and that answered the guiding question with the following descriptors: antidepressants in adolescence, depression in childhood and adolescence, pandemic, COVID-19. Thus, it was possible to analyze the relationship between the use of antidepressants in childhood and adolescence, as well as pharmacological treatments, analyzed separately or in conjunction with other interventions. It was possible to verify that the main factor that influenced the use of antidepressants in adolescents during and after the COVID-19 pandemic was the social isolation that did not allow this group to have an active social life, favoring the development of various psychopathologies such as anxiety and depression. So, for this situation to be mitigated, the use of antidepressants was concomitantly started, either by prescription from a professional or just by self-medication.
Keywords: Depression; Child; Adolescent; Antidepressants; Pandemic, COVID-19.
RESUMO
A depressão na adolescência e o uso indiscriminado de antidepressivo tem se tornado frequente, pode ser configurado como um problema de saúde pública no Brasil e no mundo e apresentou maiores agravos com a pandemia do COVID-19. Sendo assim, este estudo teve como objetivo geral refletir sobre fatores influenciaram o uso de antidepressivos em adolescentes durante e após a pandemia COVID-19, além de identificar a função e os efeitos do uso de antidepressivos, avaliar os fatores relacionados ao consumo de antidepressivo por adolescentes durante e após a pandemia COVID-19 e relacionar os problemas que podem ocorrer com a automedicação de antidepressivos. O instrumento de pesquisa utilizado foi a revisão de literatura por permitir ao investigador cobrir uma gama mais ampla de eventos do que aqueles que podem ser estudados diretamente por meio da utilização como base de todos os outros estudos já realizados. Os critérios de inclusão foram estudos publicados nos últimos 3 anos que estavam disponíveis online gratuitamente na íntegra e que respondessem à questão norteadora com os seguintes descritores: antidepressivos na adolescência, depressão na infância e adolescência, pandemia, COVID-19. Dessa forma foi possível fazer uma análise da relação do uso de antidepressivos na infância e adolescência, assim como os tratamentos farmacológicos, analisados isoladamente ou em conjunto com outras intervenções. Foi possível verificar que o principal fator que influenciou o uso de antidepressivos em adolescentes durante e após a pandemia COVID-19 foi o isolamento social que não permitia a esse grupo uma vida social ativa, favorecendo o desenvolvimento de diversas psicopatologias como a ansiedade e a depressão. E para que esse quadro fosse amenizado surgiu concomitantemente a utilização de antidepressivos sejam por prescrição de um profissional ou apenas pela automedicação.
Palavras-chave: Depressão; Criança; Adolescente; Antidepressivos; Pandemia; COVID-19.
1 INTRODUCTION
Depression is understood, according to the World Health Organization (2000), as a serious public health problem, affecting more than 264 million people worldwide. Among those affected by the pathology are also adolescents, who have been developing this condition in an increasing and significant way all over the world. Although depressive moments occur naturally at this stage of life, due to the changes in biopsychosocial aspects that occur in it due to puberty, between 10 and 20% of adolescents may face mental health problems (WHO, 2000).
In recent years, numerous scientific investigations have been carried out on depression in adolescence and the risks provided by self-medication with the use of antidepressants (BARBOZA et al., 2021; OLIVEIRA et al., 2019). In addition, it was possible to observe in a study developed that there are numerous complications and damage caused by self-medication at this stage of life (AMARAL, 2020). Currently, with the increase in cases of psychological illnesses, there is a growing irrational use of antidepressants, without a medical prescription, by healthy individuals, such as adolescents. However, still according to Amaral (2020), although antidepressants may be recommended for the treatment of sleep disorders, anxiety disorders or neuropathic pain, as they are psychoactive drugs, their inappropriate use may result in serious risks to the individual’s health and your quality of life.
Psychotropic drugs are chemical agents that interfere with behavior, consciousness, mood and cognition (SOARES; ANDRADE, 2022). Among the subclasses of psychoactive substances, antidepressants act on the Central Nervous System (CNS), collaborating mainly with the improvement of mood in people with depression. They correspond to chemical agents that directly interfere with the alteration of some mental processes, transforming consciousness, the ability to perceive and some individual behaviors (SOARES; ANDRADE, 2022; AMARAL, 2020). In addition, their use can result in both adverse reactions and some form of dependence (SOUZA, 2017).
Antidepressants raise doses of serotonin, dopamine, or adrenaline at synapses, inhibit reuptake, or reduce degradation to potentiate the effects of depression, compensating for disorders by restoring neurotransmitter concentrations. They are very specific medicines, which need to be prescribed according to the understanding of how they act in the body and what are their side effects, preventing the deepening of the depressive state (OLIVEIRA et al, 2021; SOUZA, 2017). According to Oliveira et al. (2021), the use of antidepressants should be a therapeutic resource aimed at improving the prognosis and contributing to other therapeutic actions, so that the individual can rehabilitate and insert himself socially. With this, a reductionist logic is overcome, in which the use of these is trivialized and the complexity of the subject is ignored.
Depression in adolescence and the indiscriminate use of antidepressants have become frequent today, becoming a public health problem in Brazil and in the world (SOUZA, 2017), which has worsened with the COVID-19 pandemic. Due to the aforementioned high level of antidepressant consumption by adolescents, a phenomenon also accentuated by the COVID-19 pandemic, it is understood that an in-depth study on the rational use of antidepressants is urgent and relevant.
Therefore, this study had the general objective of reflecting on factors that influenced the use of antidepressants in adolescents during and after the COVID-19 pandemic and the list of harms that may arise from the indiscriminate use and self-medication of these drugs. Observing the importance of these and the impact they can have on the lives of adolescents and on society, the production of new knowledge about them can contribute to care and follow-up actions in the mental health services of this public.
2 METHODOLOGIES
For the development of the study, a literature review was carried out for a reflective analysis based on the systematic search for studies already published on the subject. According to Gil (2008), notes that the great advantage of the literature review is that it allows the investigator to cover a wider range of events than those that can be studied directly. For researchers, it is one of the most serious problems to be measured. The articles used were those published in the last 3 years, due to the availability and timeliness of research in this period. Data were collected through a survey of the bibliography published in the main PUBMED databases; the Virtual Health Library (VHL); SCIELO (Online Scientific Electronic Library); Academic Google; from MEDLINE and LILACS (Latin American and Caribbean Health Sciences Literature). The following descriptors were used in the research: antidepressants in adolescence, depression in childhood and adolescence, pandemic, COVID-19.
Inclusion criteria were articles available online and free of charge in full, that answered the guiding question, published in Portuguese, English and Spanish with at least two descriptors in the title and in the proposed time frame. Exclusion criteria were editorials, works that did not answer the question, published before the 3-year interval, with less than two descriptors in the title and the repeated ones, keeping only one. If there was disagreement between the authors regarding the inclusion and exclusion criteria, a specific discussion about the work in question was held until a final consensus was reached.
3 RESULTS AND DISCUSSIONS
Depression is defined as a severe, recurrent or persistent mental disorder over time, with an episodic course, which causes functional damage in psychological, behavioral, emotional, family, social and occupational aspects that, when not properly treated, can result in disability (AMARAL, 2020). It is a disease with psychological characteristics, characterized by sadness, disinterest in participating in social activities in which they seek happiness, presenting the presence of feelings of guilt and insecurity (AMARAL, 2020).
According to Pereira et al. (2020), apud Moura et al. (2021), however, this disease affects the respiratory system of the heart, causing symptoms such as fever, body aches, loss of smell and taste, and can even lead to death, due to the severe deterioration of multiple systems. One can also understand ideational changes, such as regret, pessimism, desire to sleep permanently, imagination of plans and suicidal acts. These feelings and depressive reactions are often related to significant loss of job, housing, socioeconomic status, close and dear person, or something purely symbolic (GONÇALVES, 2020).
Therefore, high levels of stress are tangible evidence, which is seen as the newest malaise of our times. Because it is a serious emotional problem, which can affect children and adolescents, care is important so that the patient does not live in a place of social disadvantage, since he cannot adapt to the norms proposed by the family and social situation (AMARAL, 2020). To better understand stress and depression in youth, it is clear that the participation of the family is a very important factor, since it is capable of making the environment more pleasant from the moment that the young person feels quite confident in showing their interests (OLIVEIRA et al., 2020).
Adolescents experience many new situations, including social pressures, as they approach adulthood, making a transition period very difficult for many (SILVA, 2021; AMARAL, 2020). Depression, in this sense, has been known as the disease of the century, especially in this generation. According to Lannes (2022), depression is a mental disorder that affects the general public, but mainly affects children and young people, as they have a higher risk of suicide in this age group.
The Sars-CoV-2, or COVID-19, epidemic shook the entire world, as in addition to death, it left a huge impact on many people carrying this virus (MOURA et al., 2021). The problem started in the Chinese province of Wuhan and since the beginning of 2020 there have been reports of its spread; reaching the whole world, which made it an epidemic. The situation is even worse at a social and economic level, since, in addition to infectious conditions, there is a lack of access to health, social inequality and racial discrimination (MOURA et al., 2021). Since, in this epidemic situation, emotions such as fear, anxiety, sadness and worry are considered normal and understandable for people to express, in some cases this reaction can be heightened and aggravated. This aggravation can lead to an increase in mental disorders among elderly men and women, health professionals, children, and vulnerable groups (OPAS, 2020; LIMA et al., 2020).
Carvalho (2020), states that the COVID 19 epidemic was one of the situations that most caused these psychological actions caused by confinement, among them: lack of visits from close people, whether friends or family, fear of the consequences caused by this virus and vulnerability of people, that if they have some chronic diseases, they are prone to COVID-19.
The high level of pollution, the failure of the health system and the lack of access to hospitals and the difficulties faced in some areas, even in relation to the lack of oxygen, accompanied by the dissemination of false content about the disease and the effectiveness of medicines and vaccines, led people to look for certain medications, to keep them and even take them, without proper medical guidance, making these medications available to young people (GALHDI et al., 2020). It was possible to observe that during the epidemic, fear increases the levels of stress and anxiety in healthy people and significantly increases the symptoms of those with mental disorders that are more common in young people (RAMÍREZ-ORTIZ et al., 2020).
Patients diagnosed or suspected of being infected with COVID-19 may have intense emotional and behavioral reactions, in addition to guilt, fear, anger, rage, loneliness, anxiety, insomnia, among others. It is important that, in this process, everyone is aware of the signs of depression in order to help the teenager and support him in seeking help. It is important that family and friends understand the situation of the teenager and do not treat him with pity or make him feel too protected by treating him as a different person, as this can cause the teenager more sadness and anxiety (RAFAEL, 2020).
According to Carvalho (2020), it is recommended that simple actions be taken that can show young people how important they are to people and that they carry out activities that promote their sense of well-being. In addition, it is important for the family to show that the young person is integrated into the family and that they are important in decision-making, for example. The use of antidepressants among young people has increased in different parts of the world, which despite their benefits in treatments, these drugs can increase the risk of suicidal thoughts and behaviors in adolescents with major depression, when used indiscriminately (SILVA, 2021) .
The effects of each antidepressant depend on its category, route of administration, amount, time, absorption and use, and interaction with other drugs. In the short term, serotonin levels are lowered, but with this temporary increase in the serotonin substance in the synaptic cleft. They act directly on the central nervous system and increase the level of serotonin produced by the body, which leads to a feeling of well-being, increased appetite and improved sleep, but it allows serious side effects such as pharyngitis, sinusitis, insomnia, symptoms such as fever. , headache, nausea, fatigue and diarrhea (BARBOZA, 2021).
The use of medicines corresponds to a relevant resource for health, especially in the prevention, treatment and cure of various clinical conditions. Despite this, the risk of unwanted effects can occur when not used rationally, as in cases of self-medication (WHO, 2000). Psychopharmacological treatment through the use of antidepressants has not only been used with individuals with depression, but by some who wish to escape their tensions and worries and acquire a sense of well-being, and the inappropriate use of these substances has caused psychological dependence. , biological and social (AMARAL, 2020).
Adolescents have increasingly resorted to self-medication and the use of illicit and licit psychoactive substances. Numerous reasons can lead to the non-prescribed or prescribed use of medication, such as the social context, morbidities, demographic, economic and social aspects, self-demand, lifestyle, and maturity outside the determined time. These factors can result in the emergence of depressive disorders, which lead to the use of antidepressants (TREBIEN, 2021).
According to Silva (2021), when adolescents use antidepressants, they initially experience euphoria similar to that caused by alcohol, followed by mental confusion, disorientation and hallucinations and/or hallucinations. These effects can last from three to sixty minutes. Therefore, it is important to follow up with a professional, knowing that young people are not fully aware of their actions, and may have difficulties in understanding the dangerous consequences of excessive drug use. The misuse of drugs without careful examination by a qualified specialist can cause adverse reactions, the appearance of nonspecific symptoms and deterioration of health status (BRASIL, 2020).
According to Rossi et al. (2021) apud Lima and Alvim (2019), self-medication is a practice that has been growing worldwide, even in developed countries and much of this is due to advertising, which influences the practice, in addition, obviously, to problems related to the health system and the ease of obtaining medication. According to the authors, in these cases, the patient buys the medicine for himself or for the guardian, because he believes that he will be able to solve the problem, without taking into account that self-medication is a dangerous habit, which can be harmful to health. For Rafael et al. (2020), this practice of self-medication can worsen health, rather than cure it; it is necessary to alert people about the risks associated with it and also alert the ease within reach of people in the age group in question.
4 CONCLUSIONS
The use of psychotropic drugs is a public health problem, especially since this type of drug is used by different people of different ages and in many cases without special care. After the COVID-19 pandemic, many people, particularly young and old, began to experience symptoms such as anxiety and depression, which led them to look for a quick cure and potentially dangerous medications.
Given the problems encountered, it is clear the need for health care that focuses on the mental health of young people, in addition to using strategies to prevent mental disorders. It is necessary to seek ways to stimulate and consolidate communication between children and adolescents and their families, enabling them to better cope with the problems caused by the pandemic. Emphasis should be placed on the role of public authorities, which should be directed towards disseminating the best information through health promotion and the correct use of medication.
The factors that influenced and influence the use of antidepressants in adolescents during and after the COVID-19 pandemic are the interferences in the mental health of young people, during the pandemic due to the increase related to the isolation of these adolescents without having a very active social life and in the post pandemic, the fear of everything that happened and the return to the routine that was stagnant for more than two years.
There are still few works focused on the use of drugs of concern in the COVID-19 pandemic, which requires the publication of new works that discuss this topic in more detail, as this is important for the development and clarification of strategies to better prepare the population in public health emergencies, to reduce health damage related to the indiscriminate use of drugs that can become dangerous when misused.
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¹Student of the Pharmacy course at Faculdade AGES de Jacobina.
²Professor at the AGES Faculty of Jacobina.
³Professor at the State University of Bahia – UNEB.