Of the children and adolescents newly treated with antipsychotic medication, nearly half (44.9) also took a psychotropic drug according to a recent study published in the Nordic Journal of Psychiatry.

Second-generation antipsychotics (SGAs) such as risperidone, quetiapine, and aripiprazole are used to treat attention-deficit/hyperactivity disorder, autism spectrum disorder, disruptive behavioral disorder, depression, and bipolar disorder, as well as insomnia and aggression for short periods. They’re also prescribed off-label for other conditions, which has led to increased use of these medications in youth overall. Risk for adverse effects increases with ongoing use and with concomitant use of psychotropic drugs.

To examine the polypharmacy situation in children and adolescents, the researchers conducted a nationwide study of children and teens in Finland aged 1 to 17 years who had received an antipsychotic drug between January 1, 2008, and December 31, 2017. Using national health insurance data, they identified antipsychotic users who had new prescriptions for risperidone, quetiapine, olanzapine, and aripiprazole. They excluded short-term users and patients who turned 18 in 2017. The study ultimately included 14,849 patients. Of these, the investigators looked for patients who had also received a psychotropic drug prescription at least twice within 2 years before starting the antipsychotic.


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Out of more than 14,000 youth who had received a new antipsychotic prescription, 44.9% also had a psychotropic prescription. In children aged 7 to 12 years, boys had dual prescriptions more often than girls (59.5% vs 32.6%, P = .005). In adolescents (age groups 13 to 15 and 16 to 17 years) girls had significantly more polypharmacy than boys (54.9% vs 42.0%, P <.001 and 54.8% vs 44.0%, P <.001, respectively).

The most frequently used concomitant psychotropic drug classes were antidepressants (66.2%) and psychostimulants/atomoxetine (30.8%). Among children aged 12 and under, psychostimulants/atomoxetine were the most used concomitant drugs with antipsychotics, while antidepressants were more common in children and teens aged 12 and up.

Although the researchers had access to a large dataset, the data did not include diagnoses. The researchers assumed the drugs were purchased for a mental health or psychiatric condition.

The researchers also noted that concomitant antipsychotic/psychotropic drug appears to be on the rise. They conclude, “these findings serve as a reminder to clinicians to carefully evaluate the efficacy of psychotropic polypharmacy in children and adolescents.”

Reference

Varimo E, Saastamoinen LK, Rättö H, Aronen ET. Polypharmacy in children and adolescents initiating antipsychotic drug in 2008-2016: a nationwide register study Nord J Psychiatry. Published online March 9, 2022. doi:10.1080/08039488.2022.2042597