Attention-Deficit/Hyperactivity Disorder and Psychotropic Polypharmacy Prescribing Trends

Attention-deficit/hyperactivity disorder (ADHD) medication use and psychotherapeutic polypharmacy is increasing. This study was designed to assess annual rates of ADHD medication prescribing and psychotherapeutic polypharmacy among patients 2 to 24 years old in the United States, identify commonly prescribed ADHD medications and concomitant psychotropic agents, and assess if specific characteristics are associated with polypharmacy.

In this cross-sectional study, we used publicly available ambulatory health care data sets to evaluate ADHD and psychotropic polypharmacy use in patients 2 to 24 years old from 2006 to 2015. National rates were estimated by using sampling weights, and common ADHD and psychotropic drugs prescribed were identified. Multivariate logistic regression models were developed to assess the strength of association between polypharmacy and patient or provider characteristics.

Between 2006 and 2015, ADHD medication prescribing increased from 4.8% to 8.4%. ADHD polypharmacy increased from 16.8% to 20.5%, whereas psychotropic polypharmacy increased from 26.0% to 40.7%. The most common ADHD combinations were stimulants and α-2 agonists (67.1%), whereas the most common concomitant psychotropic agents were selective serotonin reuptake inhibitors (14.4%) and second-generation antipsychotics (11.8%). Factors associated with polypharmacy were age, female sex (psychotropic), nonprivate insurance, northeast and south regions (ADHD), receipt of mental health counseling or psychotherapy, and calendar year.

ADHD and psychotropic polypharmacy use is increasing and associated with specific patient characteristics. These patterns should spark further inquiry about the appropriateness, efficacy, and safety of psychotherapeutic polypharmacy in children and young adults, particularly within subgroups in which the use is high.