The news
The number of children and adolescents being prescribed multiple psychiatric medications at the same time is increasing, according to a new study in the state of Maryland. The phenomenon is growing despite warnings that combinations of psychotropic drugs in young people have not been tested for safety or studied for their effect on the developing brain.
The study, published Friday in JAMA Open Network, looked at prescribing patterns among patients 17 and younger enrolled in Medicaid in Maryland from 2015 to 2020. In this group, there was a 9.5 percent increase in the prevalence of “polypharmacy,” which the study defined as taking three or more different classes of psychiatric medications, including antidepressants, mood-stabilizing anticonvulsants, sedatives, and ADHD and anxiety medications.
The big picture
The study looked at just one state, but state data have been used in the past to investigate this issue, in part because of the relative ease of collecting data from Medicaid, the state-run health insurance program.
At the same time, some surveys using nationally weighted samples have revealed the increasing prevalence of polypharmacy among young people. A recent publication pulled data from the National Ambulatory Medical Care Survey and found that in 2015, 40.7 percent of people ages 2 to 24 in the United States who took one ADHD medication also took a second psychiatric medication. This figure had increased from 26 percent in 2006.
The latest data from Maryland shows that, in at least one state, the practice continues to increase and “was much more likely among youth who were disabled or in foster care,” the new study noted.
Mental health experts said that psychoactive drugs can be very helpful and that doctors have discretion to prescribe what they see fit. A concern among some experts is that many drugs used in frequently prescribed cocktails are not approved for use in young people. And it’s unclear how the simultaneous use of multiple psychotropic drugs affects long-term brain development.
The numbers
The latest study looked at data from 126,972 people during the study period. It found that in 2015, 4.2 percent of Medicaid enrollees under the age of 17 in Maryland had overlapping prescriptions for three or more different classes of psychiatric drugs. This percentage increased to 4.6% in 2020.
The numbers were higher for those in foster care, where the prevalence of polypharmacy rose to 11.3 percent from 10.8 percent.
“The findings highlight the importance of monitoring the use of psychotropic combinations, particularly among vulnerable populations, such as Medicaid-enrolled youth who have a disability or are in foster care,” the study concluded.
