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Polypharmacy in Children and Adolescents Treated for Major Depressive Disorder: A Claims Database Study

Roger S. McIntyre, M.D., F.R.C.P.C., and Jeanette M. Jerrell, Ph.D.


Objective: To describe the rate and trajectory of change in psychiatric polypharmacy during the past decade in children and adolescents treated for major depressive disorder.

Method: Data from the South Carolina Medicaid program covering outpatient and inpatient medical services and medication prescriptions from January 1996 through December 2005 were procured for the analysis herein. We examined pharmacotherapy patterns for 1544 children and adolescents diagnosed with major depressive
disorder using DSM-IV criteria.

Results: A rapid upward trajectory in the rate of psychiatric polypharmacy (i.e., 2 psychotropic medications) was noted (chi2 =810.46; p<.0001), with the greatest velocity of change between 1997 and 2003. The likelihood of being prescribed conventional unimodal antidepressants decreased significantly between 2001 and 2005 (chi2 =831.06; p<.0001). Non-African Americans and males were 1.27 times more likely to be prescribed a polypharmacy regimen, as were those with additional psychiatric disorders, especially attention-deficit/hyperactivity disorder (OR=2.58), bipolar disorder (OR=1.87), and psychotic disorders (OR=1.74). Individuals with a substance use disorder were less likely (OR=0.86) to be prescribed a polypharmacy regimen. The likelihood of being prescribed psychiatric polypharmacy increased as a function of the number of additional psychiatric disorders (chi2 =798.22; p<.0001).

Conclusion: Psychiatric polypharmacy is both prevalent and increasing in pediatric populations, in tandem with the greater diagnostic complexity (multiple disorders) of those treated. Simultaneously, practitioner reliance on conventional unimodal antidepressants has been decreasing, a trend that began prior to the U.S. Food and Drug Administration warnings regarding their potential for increasing the risk of suicidality.

 

(J Clin Psychiatry 2009;70(2):240-246. Online Ahead of Print January 27, 2009. doi:10.4088/JCP.08m04212)


Received March 13, 2008; accepted June 10, 2008. From the Department of Psychiatry, University of Toronto, Canada (Dr. McIntyre), and the Department of Neuropsychiatry, University of South Carolina School of Medicine, Columbia (Dr. Jerrell).

Data analysis was supported by a State Mental Health Data Infrastructure Grant (SM54192) from the Substance Abuse and Mental Health Services Administration.

The views expressed do not necessarily represent those of the funding agency or official findings of the South Carolina Department of Health and Human Services (Medicaid).

Dr. McIntyre has received honorarium for speaking and has been a consultant to Schering-Plough; has received research/grant support from Eli Lilly, Stanley Medical Research Institute, and National Alliance for Research on Schizophrenia and Depression; has served on advisory boards for AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen-Ortho, Solvay/Wyeth, Eli Lilly, Organon, Lundbeck, Biovail, Pfizer, and Shire; has served on speakers bureaus for Janssen-Ortho, AstraZeneca, Eli Lilly, Lundbeck, and Biovail; and has served as a faculty on CME activities for AstraZeneca, Bristol-Myers Squibb, France Foundation, I3 CME, Solvay/Wyeth, and Physicians Postgraduate Press. Dr. Jerrell reports no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Roger S. McIntyre, M.D., F.R.C.P.C., Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst St., MP 9-325, Toronto, Ontario, Canada M5T 2S8 (e-mail: roger.mcintyre@uhn.on.ca).