The use of psychotropic medications among children and young adults has increased steadily over the past two decades, according to a study by researchers from the Perelman School of Medicine at the University of Pennsylvania. The findings, published in the Journal of the American Academy of Child & Adolescent Psychiatry, indicate that about one in four young people prescribed these drugs are taking combinations that carry risks of serious drug interactions.
The research highlights that these combinations—most often involving antidepressants and antipsychotics—can result in dangerous conditions such as abnormal heart rhythms, excessive sedation, or dangerously high serotonin levels.
“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. “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.”
Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and March 2020. They examined psychotropic medication use among children aged 6 through young adults up to age 24. The study found that overall use rose from 5.3 percent during 2001-2004 to 8.3 percent in 2017-2020. The most significant increases were seen among children aged 6-11 years old and young adults aged 20-24 years old; usage rates among adolescents remained relatively stable.
Use of stimulant medications commonly prescribed for attention deficit hyperactivity disorder (ADHD) nearly doubled during this period—from 2.7 percent to 5.4 percent—and all categories of psychotropic medications saw an increase.
The rate at which individuals took at least one psychotropic medication alongside another drug also nearly doubled during the study period, rising from 1.8 percent to 3.3 percent. Researchers determined that approximately 26 percent of those surveyed were using multiple medications associated with major drug-to-drug interactions—combinations classified as potentially causing serious harm and typically requiring close monitoring or dose adjustment.
Lead author Lin-Chieh Meng noted challenges remain despite existing safeguards such as regular medication checks and electronic prescribing systems designed to flag potential issues: “complexity of real-world care like when patients switch providers or get care from different clinics” can allow dangerous combinations to go unnoticed.
Half of those taking antipsychotic medications were identified as being at risk for a potentially dangerous interaction due to concurrent use with another medicine; just under half using antidepressants faced similar risks.
Some combination prescriptions may be intentional efforts by clinicians trying various approaches after unsuccessful treatment attempts for mental health conditions. Co-author David Mandell commented: “Some of what we observed may be the most recent episode of a long line of unsuccessful treatment attempts… In some cases, the risks associated with this may be worth the benefit, though it still should undergo a very high level of scrutiny.”
Researchers suggested that health insurers could play a role in identifying high-risk combinations because they have access to comprehensive prescription records across different healthcare settings. As co-author Molly Candon stated: “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.”
