The number of Medicaid-enrolled youth who were treated with three or more psychotropic drug classes at the same time increased from 4.2% to 4.6% between 2015 and 2020, according to a study of claims in one Mid-Atlantic state issued in Psychiatric Services.
“Concurrent use of multiple psychotropic medications, also referred to as polypharmacy, is a safety concern in pediatric psychiatry,” wrote Yueh-Yi Chiang, B.S., University of Maryland School of Pharmacy in Baltimore, and colleagues. “Most states’ Medicaid programs have implemented oversight of psychotropic regimens that involve the prescription of three or more therapeutic classes of medications for youths ages ≤18 years, which has resulted in some evidence of lower medication use.”
Chiang and colleagues put this to the test by examining Medicaid claims data for youths who were taking one or more of six psychotropic medication classes, including antipsychotics, mood stabilizers, antidepressants, anxiolytics, sedatives, and attention-deficit hyperactivity disorder (ADHD) medications, and who had at least 90 continuous days of Medicaid enrollment between 2015 and 2020 in an unnamed Mid-Atlantic state. Researchers looked at the average days per year of psychotropic polypharmacy—defined as concurrent claims for three or more therapeutic classes of psychotropics—as well as the prevalence of various class combinations. Researchers also assessed changes in the number of psychotropic polypharmacy days by year.
Researchers found 541,380 Medicaid-enrolled youths with at least one mental health encounter during the five-year study period. Of the 126,972 who were prescribed at least one psychotropic medication, one-third were Black and one-third were White. The total number of youths prescribed psychotropic polypharmacy increased from 2,259 of 53,569 (4.2%) in 2015 to 2,334 of 50,806 (4.6%) in 2020. In addition, during that same period, the average annual duration of psychotropic polypharmacy increased by more than one week.
Among youth treated with polypharmacy, the vast majority (97%) were prescribed combinations of three psychotropic drug classes; the most common combination was an ADHD medication plus an antipsychotic and an antidepressant. Youths in the sample were prescribed polypharmacy for an average of seven to eight months out of the year.
One limitation of the study was that it relied on Medicaid data from a single state, which may limit its generalizability to other states. “The lack of clinical information in claims data limits our ability to assess treatment decisions, illness severity, and clinical outcomes related to psychotropic polypharmacy,” the authors noted. “…Future studies, possibly incorporating a longitudinal cohort design, are needed to investigate the long-term safety and health outcomes associated with such polypharmacy regimens.”
For related information, see the Focus: The Journal of Lifelong Learning in Psychiatry article “Assessing and Responding to the Trauma of Child Maltreatment.”
(Image: Getty Images/iStock/simonkr)
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