1 in 4 young people using psychotropic drugs are taking dangerous combinations

Use of medications for mental health and behavioral conditions among children and young adults increased steadily for two decades, and about one in four young people taking these medicines were prescribed a combination that carries a risk of serious drug interactions, according to researchers from the Perelman School of Medicine at the University of Pennsylvania. They published their findings in the Journal of the American Academy of Child & Adolescent Psychiatry.

The combinations of these medications—most commonly involving antidepressants and antipsychotics—can lead to dangerous conditions that include abnormal heart rhythms, excessive sedation, or dangerously elevated 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, a professor of Epidemiology, Systems Pharmacology, and Translational Therapeutics. “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.”

Greatest increases seen in youngest and oldest studied

Psychotropic medications include antidepressants, stimulants used for ADHD, antipsychotics, and medications for anxiety or mood disorders. Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) that was collected between 2001 and March 2020 to evaluate psychotropic medication use in children age 6 through young adults age 24.

Overall, use increased from 5.3 percent in the 2001-2004 time period to 8.3 percent in 2017-2020. The greatest increases were among children 6-11 years old and young adults 20-24 years old. Use among adolescents (12-19 years old) was relatively stable.

Use of stimulant medications, which typically treat attention deficit hyperactivity disorder (ADHD), nearly doubled —from 2.7 to 5.4 percent—over the study period. All medication categories examined saw an increase.

A rise in combinations with serious interaction risks

During the study period, the rate of people who were taking at least one psychotropic medication in combination with another medication almost doubled, climbing from 1.8 to 3.3 percent. Researchers discovered that 26 percent of the population surveyed were taking multiple medications associated with major drug to drug interactions, meaning these combinations are classified as having the potential to cause serious harm and typically require close monitoring, dose adjustment, or avoidance in the first place.

While there are systems in place designed to catch these cases, including regular medication checks at clinician visits and electronic prescribing systems that flag potential issues, the findings show that the “complexity of real-world care like when patients switch providers or get care from different clinics” remains difficult to manage and cause dangerous combinations to be missed, said lead author Lin-Chieh Meng, MS, a doctoral student in Epidemiology.

Half of those taking an antipsychotic medication, which treats conditions such as bipolar disorder or schizophrenia, were identified as being at risk of a potentially dangerous major interaction as a result of taking another medicine. And just under half of those taking antidepressants were also identified as having at least one major interaction.

At the same time, prescribing some combinations may be intentional, reflecting the need to adjust medication in the goal to provide patients relief. “Some of what we observed may be the most recent episode of a long line of unsuccessful treatment attempts,” said co-author David Mandell, ScD, a professor of Psychiatry and director of the Penn Center for Mental Health. “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.”

A potential solution and challenges ahead

The researchers noted that health insurers may be uniquely positioned to help identify high‑risk combinations.

“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, PhD, an assistant professor in Psychiatry and an assistant professor of Health Care Management in the Wharton School.