Polypharmacy in children and adolescents treated for major depressive disorder: a claims database study

To describe the rate and trajectory of change in psychiatric polypharmacy during the past decade in children and adolescents treated for major depressive disorder.

Data from the South Carolina Medicaid program covering outpatient and inpatient medical services and medication prescriptions from January 1996 through December 2005 were procured for the analysis herein. We examined pharmacotherapy patterns for 1,544 children and adolescents diagnosed with major depressive disorder using DSM-IV criteria.

A rapid upward trajectory in the rate of psychiatric polypharmacy (i.e., > or = 2 psychotropic medications) was noted (chi(2) = 810.46; p < .0001), with the greatest velocity of change between 1997 and 2003. The likelihood of being prescribed conventional unimodal antidepressants decreased significantly between 2001 and 2005 (chi(2) = 831.06; p < .0001). Non-African Americans and males were 1.27 times more likely to be prescribed a polypharmacy regimen, as were those with additional psychiatric disorders, especially attention-deficit/hyperactivity disorder (OR = 2.58), bipolar disorder (OR = 1.87), and psychotic disorders (OR = 1.74). Individuals with a substance use disorder were less likely (OR = 0.86) to be prescribed a polypharmacy regimen. The likelihood of being prescribed psychiatric polypharmacy increased as a function of the number of additional psychiatric disorders (chi(2) = 798.22; p < .0001).

Psychiatric polypharmacy is both prevalent and increasing in pediatric populations, in tandem with the greater diagnostic complexity (multiple disorders) of those treated. Simultaneously, practitioner reliance on conventional unimodal antidepressants has been decreasing, a trend that began prior to the U.S. Food and Drug Administration warnings regarding their potential for increasing the risk of suicidality.