Contraindicated psychotropic medication use widespread among youth

One in 4 youth were exposed to potential contraindicated or major drug‐drug interactions (DDIs) during the two‐decade period ending in 2020, researchers have found. They urge that studies be conducted focusing on medication safety, effectiveness, and DDI risks of psychotropic medications in youth. For the study, “Trends in Psychotropic Medication Use, Polypharmacy, and Potential Major Drug‐Drug Interactions Among US Youth,” researchers assessed trends in psychotropic medication use and polypharmacy and evaluated the prevalence of potential contraindicated or major DDIs among Americans ages 6 to 24. The researchers used nationally representative data from the US National Health and Nutrition Examination Survey (NHANES) collected between 2001 and March 2020. Participants were stratified into three age groups: children (6‐11 years), adolescents (12‐19 years), and young adults (20‐24 years). They assessed psychotropic medication use, including stimulants, antidepressants, antipsychotics, and benzodiazepine‐related drugs, based on reported use within the past 30 days, and psychotropic polypharmacy as the concurrent use of 2 or more psychotropic medications. Psychotropic medication youth among youth increased from 5.3% in 2001‐2004 to 8.3% in 2017–March 2020, with increases driven mainly by stimulants. Psychotropic polypharmacy prevalence rose from 1.8% to 3.3% during the same period. Reported indications for psychotropic medication use varied by age, with neurodevelopmental conditions more common in children, and depression, anxiety, or bipolar disorders more common in young adults. Twenty‐six percent of psychotropic medication users were exposed to potential contraindicated or major DDIs, mainly from antipsychotics and antidepressants. With increases driven primarily by rising stimulant use, individuals ages 6 to 24 have been exposed to more DDIs over the past two decades. There was a moderate overall increase in the involvement of antipsychotics, as well. The increases may reflect the rise in the prevalence and improved recognition of ADHD, the researchers wrote. “Greater awareness among health care providers, parents, and educators, as well as improvements in screening and early intervention programs, may have contributed to higher diagnosis rates and consequently greater medication use,” they wrote. “Previous evidence suggests that early identification and timely therapeutic interventions during childhood and adolescence can improve long‐term outcomes, potentially influencing clinical decisions regarding early treatment initiation.” Previous studies of ADHD have shown some evidence for certain 2‐drug combinations, such as stimulant plus risperidone for comorbid aggression, the researchers wrote. But studies of three or more concurrent medications are scarce, and the ones that do exist often report higher rates of side effects, the researchers wrote. “A central concern with this practice is the limited evidence supporting the safety and effectiveness of most psychotropic drug combinations in pediatric populations. Although such prescribing may be clinically warranted in complex cases, it also introduces significant risks. Polypharmacy can obscure the source of emerging behavioral symptoms, making it difficult to distinguish between adverse drug effects and underlying psychiatric conditions, potentially resulting in a prescribing cascade.” The study was published December 19, 2025 in the Journal of the American Academy of Child and Adolescent Psychiatry.