Clinical and adverse effect profiles of paediatric polypharmacy by gender and ADHD status

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.