Abstract
Aims: This study aims to investigate the prevalence of concurrent psychotropic polypharmacy systematically, its associated adverse effects, and their relationship with individual factors such as diagnosis and gender in a child and adolescent outpatient population. While most existing literature on polypharmacy focuses on adults, there is a lack of recent, field-based data concerning children and adolescents.
Methods: Among 4,928 outpatient admissions in January 2024, 595 children receiving two or more concurrent psychotropic medications were included. Polypharmacy was operationalized as the concurrent use of two or more psychotropic medication classes for a minimum duration of 30 consecutive days, consistent with thresholds described in previous guidelines (e.g., AACAP, NICE). Over a six-month follow-up, diagnostic profiles, medication regimens, comorbidities, adverse effects, and adherence were evaluated using clinical records and national e-Nabız data.
Results: The sample was 57.1% male, with a median age of 13. Polypharmacy was most common among 16–18-year-olds. ADHD (52.8%), generalized anxiety disorder (19.5%), and depression/dysthymia (9.2%) were the most frequent diagnoses. Comorbidity was present in 76.6% of cases. Anxiety and mood disorders were more common in females, whereas specific learning disorder and enuresis were more prevalent in males. Stimulant-antipsychotic combinations were more typical in males; antidepressant-antipsychotic combinations were more common in females. Reported adverse effects included sleep disturbances, appetite changes, and irritability, with no significant differences between medication groups.
Conclusion: Polypharmacy was more frequent in adolescents and those with ADHD, anxiety, or depression. Gender differences in medication patterns likely reflect underlying psychopathology. Given the high rates of adverse effects, structured monitoring protocols, including sleep and appetite checklists, should be routinely implemented. The findings support the integration of scheduled medication reviews and age- and gender-sensitive pharmacotherapy planning in child and adolescent psychiatry.
References
- 1. Bakaki PM, Horace A, Dawson N, et al. Defining pediatric polypharmacy: A scoping review. PLoS One. 2018;13(11):e0208047. doi:10.1371/journal.pone.0208047
- 2. McLaren JL, Zito JM, Fegert JM, Barnett ER. Editorial: Psychotropic overprescribing to youth: scope of the problem, causes, and possible solutions. Front Psychiatry. 2024;15:1418600. doi:10.3389/fpsyt.2024.1418600
- 3. Zhaojian W, Meizhu J, Jun H, et al. Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study. Child Adolesc Psychiatry Ment Health. 2024;18(1):77. doi:10.1186/s13034-024-00766-4
- 4. Zito JM, Zhu Y, Safer DJ. Psychotropic Polypharmacy in the US Pediatric Population: A Methodologic Critique and Commentary. Front Psychiatry. 2021;12:644741. doi:10.3389/fpsyt.2021.644741
- 5. Højlund M, Köhler-Forsberg O, Gregersen AT, et al. Prevalence, correlates, tolerability-related outcomes, and efficacy-related outcomes of antipsychotic polypharmacy: a systematic review and meta-analysis. Lancet Psychiatry. 2024;11(12):975-989. doi:10.1016/S2215-0366(24)00314-6
- 6. Shahidullah JD, Roberts H, Parkhurst J, Ballard R, Mautone JA, Carlson JS. State of the Evidence for Use of Psychotropic Medications in School-Age Youth. Children (Basel). 2023;10(9):1454. doi:10.3390/children10091454
- 7. Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder. Lancet. 2020;395(10222):450-462. doi:10.1016/S0140-6736(19)33004-1
- 8. Larsson H. How can we improve the management of individuals with attention deficit hyperactivity disorders and co-occurring cardiometabolic disease?. Expert Rev Cardiovasc Ther. 2023;21(11):725-728. doi:10.1080/14779072.2023.2279608
- 9. Iffland M, Livingstone N, Jorgensen M, Hazell P, Gillies D. Pharmacological intervention for irritability, aggression, and self-injury in autism spectrum disorder (ASD). Cochrane Database Syst Rev. 2023;10(10):CD011769. doi:10.1002/14651858.CD011769.pub2
- 10. Bayraktar İ, Yalçın N, Nalbant K, Kültür EÇ, Demirkan K. Medication adherence and attitudes in adolescent psychiatry: Key influences. Clin Child Psychol Psychiatry. 2025;30(2):516-528. doi:10.1177/13591045251316607
- 11. Büber A, Gavcar EG, Başay Ö, Ünlü G, Kabukçu Başay B, Şenol H. Prevalence and Factors Affecting the Use of Antipsychotics and Antipsychotic Polypharmacy in a Child and Adolescent Psychiatry Inpatient Service. J Child Adolesc Psychopharmacol. 2023;33(2):69-75. doi:10.1089/cap.2022.0065
- 12. O'Brien MJ, Pauls AM, Cates AM, Larson PD, Zorn AN. Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior. J Pediatr. 2024;271:114056. doi:10.1016/j.jpeds.2024.114056
- 13. Kearns MA, Hawley KM. Predictors of polypharmacy and off-label prescribing of psychotropic medications: a national survey of child and adolescent psychiatrists. J Psychiatr Pract. 2014;20(6):438-447. doi:10.1097/01.pra.0000456592.20622.45
- 14. Siddiqui U, Conover MM, Voss EA, Kern DM, Litvak M, Antunes J. Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. J Atten Disord. 2024;28(10):1347-1356. doi:10.1177/10870547241251738
- 15. Niemczyk J, Equit M, Braun-Bither K, Klein AM, von Gontard A. Prevalence of incontinence, attention deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Eur Child Adolesc Psychiatry. 2015;24(7):837-843. doi:10.1007/s00787-014-0628-6
- 16. Masi G, Carucci S, Muratori P, Balia C, Sesso G, Milone A. Contemporary diagnosis and treatment of conduct disorder in youth. Expert Rev Neurother. 2023;23(12):1277-1296. doi:10.1080/14737175.2023.2271169
- 17. Danielson ML, Claussen AH, Bitsko RH, et al. ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment. J Clin Child Adolesc Psychol. 2024;53(3):343-360. doi:10.1080/15374416.2024.2335625
- 18. Breaux R, Dunn NC, Swanson CS, Larkin E, Waxmonsky J, Baweja R. A Mini-Review of Pharmacological and Psychosocial Interventions for Reducing Irritability Among Youth With ADHD. Front Psychiatry. 2022;13:794044. doi:10.3389/fpsyt.2022.794044
- 19. Collins JC, Wheeler AJ, McMillan SS, et al. Side Effects of Psychotropic Medications Experienced by a Community Sample of People Living With Severe and Persistent Mental Illness. Health Expect. 2024;27(6):e70122. doi:10.1111/hex.70122
Details
| Primary Language | English |
|---|---|
| Subjects | Psychiatry |
| Journal Section | Research Article |
| Authors | |
| Submission Date | August 29, 2025 |
| Acceptance Date | October 2, 2025 |
| Publication Date | March 12, 2026 |
| DOI | https://doi.org/10.66235/kumj.1906761 |
| IZ | https://izlik.org/JA66KC76UR |
| Published in Issue | Year 2026 Volume: 6 Issue: 1 |
Kastamonu Medical Journal is licensed under a Creative Commons CC BY-NC-ND 4.0 International License.
This is an open-access journal distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0).
Click here to get help about article submission processes and "Copyright Transfer Form".