National Trends in Child and Adolescent Psychotropic Polypharmacy in Office-Based Practice, 1996-2007

Abstract

Objective To examine patterns and recent trends in multi-class psychotropic treatment among youth visits to office-based physicians in the United States. Method Annual data from the 1996–2007 National Ambulatory Medical Care Surveys were analyzed to examine patterns and trends in multi-class psychotropic treatment within a nationally representative sample of 3466 child and adolescent visits to office-based physicians in which a psychotropic medication was prescribed. Results There was an increase in the percentage of child visits in which psychotropic medications were prescribed that included at least two psychotropic classes. Across the twelve year period, multi-class psychotropic treatment rose from 14.3% of child psychotropic visits (1996–1999) to 20.2% (2004–2007) (AOR: 1.89; 95% CI: 1.22–2.94, p<.01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multi-class psychotropic treatment increased from 22.2% (1996–1999) to 32.2% (2004–2007) (AOR: 2.23, 95% CI: 1.42–3.52, p<.001). Over time, there were significant increases in multi-class psychotropic visits in which ADHD medications, antidepressants, or antipsychotics were prescribed, and a decrease in those visits in which mood stabilizers were prescribed. There were also specific increases in co-prescription of ADHD medications and antipsychotic medications (AOR: 6.22, 95% CI: 2.82–13.70, p<.001) and co-prescription of antidepressant and antipsychotic medications (AOR: 5.77, 95% CI: 2.88–11.60, p<.001). Conclusions Although little is known about the safety and efficacy of regimens that involve concomitant use of two or more psychotropic agents for children and adolescents, multi-class psychotropic pharmacy is becoming increasingly common in outpatient practice.