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. 2010 Oct;49(10):1001-10.
doi: 10.1016/j.jaac.2010.07.007. Epub 2010 Sep 1.

National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007

Jonathan S Comer  1 , Mark Olfson, Ramin Mojtabai
Affiliations

National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007

Jonathan S Comer et al. J Am Acad Child Adolesc Psychiatry. 2010 Oct.

Abstract

Objective: To examine patterns and recent trends in multiclass 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 multiclass psychotropic treatment within a nationally representative sample of 3,466 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 12 year period, multiclass psychotropic treatment rose from 14.3% of child psychotropic visits (1996-1999) to 20.2% (2004-2007) (adjusted odds ratio [AOR] = 1.89, 95% confidence interval [CI] = 1.22-2.94, p < .01). Among medical visits in which a current mental disorder was diagnosed, the percentage with multiclass 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 multiclass 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, multiclass psychotropic pharmacy is becoming increasingly common in outpatient practice.

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Conflict of interest statement

Disclosure: Dr. Olfson, in the past five years, has received investigator initiated grants from AstraZeneca, Bristol-Myers Squibb, and Eli Lilly and Co. He has served on the speakers’ bureau for Janssen Pharmaceutica, and as a consultant to Pfizer, AstraZeneca, Eli Lilly and Co., and Bristol-Myers Squibb. Dr. Mojtabai has received research funding and consulting fees from Bristol-Myers Squibb. Dr. Comer reports no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1
Figure 1
Trends in multi-class psychotropic visitsa involving antidepressants, attention-deficit/hyperactivity disorder (ADHD) medications, antipsychotics, mood stabilizers, or sedative-hypnotics among youth office-based psychiatric visits in which a psychotropic drug is mentioned, United States 1996–2007. a. Multi-class psychotropic visits refer to visits in which patient was prescribed two or more psychotropic agents from across medication classes
See this image and copyright information in PMC

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