Use of psychotropic medications among children and young adults has increased steadily over the past two decades, according to a study from the Perelman School of Medicine at the University of Pennsylvania. The research, published in the Journal of the American Academy of Child & Adolescent Psychiatry, found that about one in four young people taking these medicines were prescribed combinations that carry risks for serious drug interactions.
Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and March 2020. They examined medication use in children aged 6 through young adults aged 24. The overall use of psychotropic medications rose from 5.3 percent in 2001-2004 to 8.3 percent in 2017-2020. The largest increases were seen among children aged 6-11 and young adults aged 20-24, while rates among adolescents remained relatively stable.
The study noted a significant rise in stimulant medication use—commonly prescribed for attention deficit hyperactivity disorder (ADHD)—which nearly doubled during the study period. All categories of psychotropic drugs saw increased usage.
The rate of people taking at least one psychotropic medication alongside another also nearly doubled, increasing from 1.8 to 3.3 percent over the same period. Researchers found that approximately 26 percent of those surveyed were on multiple medications associated with major drug-to-drug interactions, which can cause serious harm and typically require close monitoring or avoidance.
“While these medicines can be helpful, our research highlights the need for careful monitoring when multiple medications are used, more research on long-term safety, and better access to non-drug treatments like therapy,” said senior author Sean Hennessy, PharmD, PhD, professor at Penn Medicine’s Perelman School of Medicine. “Families should have open dialogue with their clinicians to help weigh the benefits and risks of these prescriptions and ensure regular follow-up to keep treatment safe and effective.”
Half of those taking antipsychotic medications—used for conditions such as bipolar disorder or schizophrenia—were identified as being at risk for potentially dangerous major interactions due to other medicines they were prescribed. Just under half using antidepressants faced similar risks.
Lead author Lin-Chieh Meng pointed out that systems intended to catch risky combinations—including electronic prescribing alerts—are not always sufficient due to complexities such as patients switching providers or receiving care at different clinics.
Co-author David Mandell noted that some combinations may be intentionally prescribed after unsuccessful attempts with other treatments: “Some of what we observed may be the most recent episode of a long line of unsuccessful treatment attempts,” he said. “All medicine has tradeoffs and, as a mentor of mine says, ‘The brain doesn’t know the DSM.’ In some cases, the risks associated with this may be worth the benefit, though it still should undergo a very high level of scrutiny.”
The researchers suggested health insurers could play an important role by identifying high-risk combinations across different care settings: “Insurers are in a unique position to address these concerns because they have access to all prescription fills and can track patients across transitions in care,” said co-author Molly Candon.
