Prevalence, Time Trends, and Utilization Patterns of Psychotropic Polypharmacy Among Pediatric Medicaid Beneficiaries, 1999-2010

Psychiatr Serv. 2018 Aug 1;69(8):919-926. doi: 10.1176/ Epub 2018 Jun 8.


Objectives: This study estimated the prevalence, time trends, and state-level variation of same- and multiclass psychotropic polypharmacy among youths in Medicaid fee-for-service plans.

Methods: Using pharmacy records from 29 Medicaid states from 1999 to 2010, the authors constructed ten two-year cohorts of beneficiaries between ages 0 and 17 years who received at least one psychotropic to treat a mental disorder. Polypharmacy was defined as any period in which dispensed days' supply of psychotropics overlapped for more than 45 days. Same- and multiclass psychotropic polypharmacy prevalence was stratified by age and state.

Results: A total of 692,485 children were included across each two-year cohort. The prevalence of any-class and multiclass psychotropic polypharmacy grew steadily, from 21.2% and 18.8% in 1999-2000 to 27.3% and 24.4% in 2009-2010, respectively. The prevalence increased with older age, with highest estimates for late adolescents. For same-class psychotropic polypharmacy, a constant upward trend was noted over time, except for antidepressants. Polypharmacy increased over the decade for central nervous system stimulants, from .1% to .6%, and for alpha-agonists, from .1% to .4%. Heterogeneous prevalences of psychotropic polypharmacy were noted across states, ranging from 6.9% to 48.8% for any-class psychotropic polypharmacy, from .4% to 6.4% for same-class antidepressant polypharmacy, and from .1% to 4.6% for antipsychotics.

Conclusions: The study found an overall increasing trend of psychotropic polypharmacy coupled with significant variation across the examined states. A more granular assessment that considers patient characteristics and local contextual factors is warranted.

Keywords: Drugs & psychotherapy, Drug treatment/psychopharmacology, Epidemiology, Psychopharmacology/general, polypharmacy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Medicaid*
  • Mental Disorders / drug therapy
  • Mental Disorders / epidemiology*
  • Polypharmacy*
  • Psychotropic Drugs / therapeutic use*
  • Time Factors
  • United States


  • Psychotropic Drugs