Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary
Julie M Zito1,2, Yue Zhu1,3, Daniel J Safer4
1Department of Pharmaceutical Health Services Research, School of Pharmacy, Baltimore, MD, United States.
Frontiers in Psychiatry
|July 1, 2021
Summary
Pediatric psychotropic polypharmacy, the use of multiple medications for youth, has increased significantly. This trend involves longer treatment durations and more adverse events, highlighting a need for standardized research methods.
Area of Science:
- Pediatric psychopharmacology
- Public health
- Medication safety
Background:
- Psychotropic concomitant medication use in U.S. youth with emotional and behavioral disorders has risen dramatically over 25 years.
- Analyzing these trends necessitates accurate data on patient age, overlapping medication use, and precise outcome measurement.
- Existing literature reporting on pediatric psychotropic polypharmacy has notable gaps.
Purpose of the Study:
- To review the trends and characteristics of pediatric psychotropic polypharmacy in the U.S. from 2000-2020.
- To identify factors contributing to the rise in concurrent psychotropic medication use among children and adolescents.
- To highlight the need for standardized methodologies and further research in this area.
Main Methods:
- Conducted an electronic literature search from 2000-2020 using keywords like "pediatric," "concomitant," "polypharmacy," and "concurrent psychotropic."
- Included English language, U.S.-based studies and relevant textbook references.
- Analyzed 35 inter-class studies, categorizing them by data source and clinical topic.
Main Results:
- Pediatric psychotropic polypharmacy affects a substantially larger number of youth compared to two decades ago, with up to 300,000 youth receiving 3 or more medication classes concurrently.
- Concomitant use is prolonged, often spanning 69-89% of annual medicated days.
- Regimens with three medication classes were associated with more adverse event reports than those with two classes.
Conclusions:
- The documented increase in U.S. pediatric psychotropic polypharmacy over the past 20 years necessitates standardized research methodologies.
- Future population-based studies should focus on the number of youth on 3+ medication classes and the duration of use.
- Extensive post-marketing research is crucial to evaluate the effectiveness, safety, and tolerability of complex medication regimens in young patients.
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