Rising use of tranquillisers and sedatives among teenage girls

A rise in prescribed tranquillisers and sedatives among Maltese teenage girls could reflect growing anxiety, post-pandemic stress and a tendency to medicalise distress rather than expand school-based counselling and non-pharmacological support, experts said.

“This gendered pattern suggests a growing incidence of psychological distress among Maltese adolescent females. Several factors may account for this trend. International and local data indicate that adolescent girls are more likely to experience anxiety, depressive symptoms and sleep difficulties, phenomena that appear to have intensified in the aftermath of the COVID-19 pandemic and the increasing psychosocial pressures associated with social media exposure and academic demands,” explained clinical psychologist Nicholas Briffa.

He was speaking in reaction to the results of the Malta report within the European School Survey Project on Alcohol and Other Drugs (ESPAD) 2024 released earlier this week.

The ESPAD was conducted among 113,882 students aged 15 to 16 across 37 European countries last year. It is carried out every five years, with the previous one held in 2019. The 2024 study was the first after the coronavirus pandemic that struck in 2020 and lasted about two years. In Malta, 2,880 students from 43 schools participated.

The Malta report showed that, overall, girls had higher rates of lifetime use of alcohol, cigarettes, e-cigarettes and cannabis, and they also spent more time on social media. Boys had higher rates of gaming and gambling.

Data showed that the prevalence of prescribed tranquilliser and sedative use among adolescent girls increased by nearly five percentage points between 2019 and 2024, reaching 15%, while rates among boys stood at 10%, up two percentage points.

While the report did not name the type of tranquillisers prescribed, the part of the questionnaire addressing the subject included the context: “Tranquillisers and sedatives, like Valium and Ativan, are sometimes prescribed by doctors to help people to calm down, get to sleep or to relax. Pharmacies are not supposed to sell them without a prescription.”

If the increase of prescribed tranquillisers and sedatives to young people was indeed the case, it was “very worrying”– Anton Grech, chair of Mental Health Services

Misconception

Anton Grech, chair of the Mental Health Services, said that if the increase of prescribed tranquillisers and sedatives to young people was indeed the case, it was “very worrying”.

However, he cautioned that there was often a public misconception about what tranquillisers and sedatives actually are. In medical terms, such medications are used to treat sleep disorders or agitation but the public often wrongly associates them with antidepressants.

Grech explained that if the figures in the ESPAD report referred to tranquillisers and sedatives being prescribed psychiatrically to young people, this could be due to an increase in ADHD cases.

While sedatives or tranquillisers are generally not standard treatments for ADHD, they may occasionally be used to help manage anxiety or sleep problems in some individuals with the condition.

Another possible reason for their use could be the treatment of anxiety, which is growing among young people. Ideally, however, such cases should be managed through non-medical approaches whenever possible.

Clinical psychologist Briffa agreed with the latter, stressing the need for a multifaceted approach that includes training healthcare professionals to adopt gender-sensitive assessment practices and promote non-pharmacological interventions to mitigate the risk of overprescription.

He went on to elaborate that there could be a range of reasons leading to growing psychological distress in girls that included the post-pandemic aftermath and the increasing psychosocial pressures associated with social media exposure and academic demands.

“The rise in prescription rates may also point to a process of medicalisation, wherein emotional distress is increasingly managed through pharmacological means rather than through psychosocial interventions,” he said.

Briffa noted that gender differences in help-seeking behaviour may further explain this disparity, as girls are typically more willing to disclose emotional difficulties and to seek professional support than boys.

Girls are typically more willing to disclose emotional difficulties and to seek professional support than boys– Clinical psychologist Nicholas Briffa

Stress

Child and adolescent psychiatrist Nigel Camilleri, clinical lead for TAASC and vice president of the Association for Child and Adolescent Mental Health (ACAMH) Malta, noted that there is now greater recognition of mental health disorders among boys and girls and an increase in people reaching out for help.

TAASC is an independent multidisciplinary service providing quality evidenced-based assessment and interventions for children, adolescents and adults with mental health difficulties and neurodevelopmental disorders.

Research has shown there is a higher rate of emotional distress among girls, often leading to anxiety and depression. This is influenced by a range of factors, including social pressures also brought on by social media use, body image concerns and academic demands, all of which were further compounded by the pandemic.

Camilleri highlighted the need for professionals to better differentiate between normal stress, which can foster resilience and be managed through healthy coping strategies, and toxic stress, which manifests as trauma and requires therapy and, in some cases, medication.

One of the main challenges, he added, is the limited access young people have to psychological therapy or young people choosing medication as the first line of treatment.

He highlighted that strengthening mental health support for young girls and women requires a deeper understanding of their psychological development and the social worlds they inhabit.

“Emotional distress among adolescents cannot be seen in isolation; it is shaped by family dynamics, cultural expectations and wider systemic pressures such as school demands and social media influence,” he said. Camilleri stressed the need to reduce the growing trend of over-diagnosing adolescents, instead ensuring that professionals receive high-quality training to recognise and accurately assess mental health disorders during this critical stage of development.

“Adopting a systemic approach means recognising that a young person’s symptoms often reflect the environment they live in. By involving families in the therapeutic process, support can move beyond symptom management towards meaningful change and growth for the family as a whole,” he explained. This, he noted, is where true prevention and recovery begin.

Briffa agreed and spoke of the need for schools and community settings that strengthen early identification and prevention strategies through psychoeducation, resilience-building programmes and the promotion of mental health literacy.

“Greater investment in school-based counselling and accessible psychological services would help ensure that emotional difficulties are managed through therapeutic rather than purely pharmacological means… Moreover, national policies should continue to address the societal factors that contribute to youth distress, including academic pressure, social media exposure and the stigma surrounding mental health, thereby fostering a more supportive environment for adolescent well-being,” he said.