Nationwide Epic Cosmos Data Reveals Antidepressant Prescription Rate Trends Across Demographic Groups

Sex disparities in depression and its treatment are well-documented, but less is known about how these patterns vary across the lifespan and intersect with race, neighborhood vulnerability, and prior health challenges.

We analyzed data from 2.5 million patients sampled from the Epic Cosmos Electronic Health Record (EHR) database. Active antidepressant prescriptions were used as a proxy for depression diagnoses. Data were stratified by age, sex, race/ethnicity, residence, Social Vulnerability Index (SVI 2018), prior antidepressant use, and high-risk behaviors (HIV and chlamydia testing). Rates of prescriptions by sex and odds ratios (OR) for females versus males across age at time of visit were calculated.

The probability of receiving an antidepressant prescription rose sharply during adolescence, but more steeply for females, with female vs. male differences peaking at ages 17-18 (OR = 2). In the overall population, the sex gap narrowed in young adulthood (OR = 1.6 at ages 25-30), remained stable through mid-life, and widened again after age 55 (OR = 1.75 by age 70). However, the later-life increase was not observed uniformly across some groups, such as the unmarried, divorced, and living in vulnerable areas. The white population had noticeably higher prescription rates across the life span, while the Asian group had the highest adolescent peak (female vs. male OR = 2.75). Prior HIV and chlamydia testing strata demonstrated higher antidepressant prescribing and a larger, earlier adolescent female-to-male OR, although this factor likely explains only a small portion of the overall adolescent sex difference at the population level.

The well-known depression sex gap in adolescents observed in the general population, and the lesser-known retirement gap, are shaped by a combination of demographic, economic, and behavioral factors, explored in this study.