# Psychotropic medication prescribing for patients with insomnia comorbid with depressive or anxiety disorders in primary healthcare facilities in Beijing

## TL;DR

In Beijing's primary healthcare, most patients with insomnia and depression or anxiety are prescribed psychotropic medications, but few receive guideline-recommended treatments.

## Contribution

The study reveals a significant gap between clinical guidelines and actual prescribing practices for comorbid insomnia and mental health disorders in Chinese primary care.

## Key findings

- Over 90% of patients received psychotropic medications, with benzodiazepines being the most common.
- Only 29.9% of patients with insomnia and depression and 11.5% with insomnia and anxiety received guideline-recommended drugs.
- Older adults were less likely to receive guideline-aligned pharmacotherapy.

## Abstract

Depressive and anxiety disorders often co-occur with insomnia, creating complex treatment challenges. Although clinical guidelines recommend psychotherapy as first-line treatment for these comorbid conditions, limited access to psychological services in primary healthcare facilities in China often leads to heavy reliance on pharmacological therapy.

To the appropriateness of psychotropic medications for patients with insomnia comorbid with depressive or anxiety disorders at primary healthcare facilities in China.

This cross-sectional study included patients with documented diagnoses of insomnia comorbid depressive or anxiety disorders in 2022 at all 67 primary healthcare facilities in Dongcheng District, Beijing, China. The primary outcome was the prescribing rate of guideline-recommended psychotropic medications.

Among 842 patients with insomnia and depressive disorders and 1014 patients with insomnia and anxiety disorders, over 90% received psychotropic medications. Benzodiazepines were the most frequently prescribed classes (55.9 and 69.6%), followed by non-benzodiazepine hypnotics (42.5 and 42.4%), whereas medications recommended by the guideline, including antidepressants with sedative effects, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, were used infrequently. Only 29.9% of patients with insomnia and depressive disorders and 11.5% of those with insomnia and anxiety disorders received guideline-recommended pharmacotherapy, with lower concordance among older adults.

Guideline-recommended pharmacotherapy for insomnia comorbid with depressive or anxiety disorders was rarely implemented at primary care in China. This highlights the need to facilitate evidence-based practices and improve management of comorbid mental health conditions, particularly for older adults.