Polypharmacy among Adolescents and Young Adults Newly Initiating Anti-Anxiety and Anti-Depressive Medications

Background: Polypharmacy of mental health related medications among adolescents and young adults is understudied. When inappropriate, polypharmacy can have adverse health outcomes by creating new symptoms or worsening those already being treated.

Objectives: To measure the rate of anti-anxiety (AA) and anti-depressive (AD) polypharmacy among adolescents and young adults in the United States.

Methods: We retrospectively studied health insurance claims from a large national plan from 2017 to 2023. The study population was comprised of commercial insurance enrollees aged 12-17 (adolescents) and 18-24 (young adults) years with at least one drug dispensing for AA and AD classes of medications including benzodiazepines, selective serotonin reuptake inhibitors, tricyclic antidepressants, tetracyclics, serotonin modifiers, and norepinephrine reuptake inhibitors identified using general product identifiers between 5700-5899 and national drug codes. Polypharmacy was defined as ≥ 5 different drugs of interest dispensed to an individual in a given calendar year. Descriptive statistics of the number of users, yearly prescription counts, and polypharmacy rates were obtained.

Results: We identified 77,689 adolescents and 201,111 young adults initiating the drugs of interest during the study period. Among adolescents, the average number of unique drugs increased from 1.9 in 2017 to 2.5 in 2020 then steadily decreased to 1.9 in 2023. The pattern was similar among young adults, with a peak observed at 2.4 in 2020. The proportion of polypharmacy among adolescents in the study population increased from 6% in 2017 to 13% in 2020 then steadily decreased back to 5% in 2023. The pattern was similar among young adults, with a peak at 11% with 5 or more different drugs observed in the year 2020.

Conclusions: Polypharmacy of anti-anxiety and anti-depressive drugs peaked during the first 2 years of the COVID-19 pandemic among adolescents and young adults commercially insured and returned to pre-pandemic levels by 2023. Future studies may describe the population of AA and AD treatment users who ceased treatment after the pandemic and investigate long term treatment behaviors.