ADHD Polypharmacy Rates Are Increasing

A recent study sought to examine rates of attention-deficit/hyperactivity disorder (ADHD) medication use and psychotherapeutic polypharmacy among US patients aged 2 to 24 years, identify commonly prescribed ADHD agents, and determine if any specific characteristics are linked to increased likelihood of polypharmacy.

The researchers conducted a cross-sectional study using data from ambulatory health care data sets from 2006 to 2015. Sampling weights were used to estimate national rates, and multivariate logistic regression models were used to assess the associations between patient and provider characteristics and likelihood of polypharmacy.

Overall, rates of medication prescribing increased from 4.8% to 8.4% from 2006 to 2015, with ADHD polypharmacy increasing from 16.8% to 20.5% and psychotropic polypharmacy increasing from 26.0% to 40.7%.

The most common ADHD medication combinations were stimulants and α-2 agonists, while selective serotonin reuptake inhibitors and second-generation antipsychotics were the most common concomitant psychotropic agents. Age, female sex, nonprivate insurance, northeast and south regions, receipt of counseling or psychotherapy, and calendar year were all characteristics associated with polypharmacy.

“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,” the researchers concluded.

—Michael Potts

Reference:

Girand HL, Litkowiec S, Sohn M. Attention-deficit/hyperactivity disorder and psychotropic polypharmacy prescribing trends. Published online July 1, 2020. Pediatrics. Doi: 10.1542/peds.2019-2832