Trends in Psychotropic Medication Use, Polypharmacy, and Potential Major Drug-Drug Interactions Among US Youth

This study aims to assess trends in psychotropic medication use and polypharmacy, to investigate clinical indications for use, and to evaluate the prevalence of potential contraindicated or major drug-drug interactions (DDIs) among US residents 6 to 24 years of age.

We conducted a descriptive, repeated cross-sectional study using nationally representative data from the US National Health and Nutrition Examination Survey (NHANES) collected between 2001 and March 2020. Participants were stratified into children (6-11 years), adolescents (12-19 years), and young adults (20-24 years). Psychotropic medication use, including stimulants, antidepressants, antipsychotics, and benzodiazepine-related drugs, was assessed based on reported use within the past 30 days, and psychotropic polypharmacy as the concurrent use of 2 or more psychotropic medications. Trends were evaluated using survey-weighted linear regression across 4-year intervals, with 95% confidence intervals. Reported indications were analyzed separately for each age group. Potential DDIs among psychotropic medications were identified using Micromedex.

Psychotropic medication use among youth increased from 5.3% in 2001-2004 to 8.3% in 2017-March 2020 (adjusted time trend: 0.7 percentage points over 4 years; 95% CI: 0.3-1.1), with statistical increases observed among children and young adults, driven mainly by stimulants. Psychotropic polypharmacy prevalence rose from 1.8% to 3.3% during the same period (adjusted time trend: 0.3 percentage points; 95% CI: 0.01-0.5). Reported indications for psychotropic medication use varied by age, with neurodevelopmental conditions more common in children, and depression, anxiety, or bipolar disorders more common in young adults. Among psychotropic medication users, 26.0% were exposed to potential contraindicated or major DDIs, mainly from antipsychotics and antidepressants.

Psychotropic medication use increased in specific subgroups of US youth from 2001 to March 2020, most notably among children and young adults. A quarter of psychotropic medication users were exposed to potential contraindicated or major DDIs. These findings underscore the need for further real-world research focusing on medication safety, effectiveness, and DDI risks of psychotropic medications in youth populations to inform safer and more effective treatment strategies.

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way.