TABLE 3.

Pediatric psychotropic polypharmacy in privately insured populations.

Data source, Study period, References	Age, yrs.	Other	Psychotropic concomitants	Overlappingdays	Outcome
2011–2014 Truven Market Scan, Zhou et al. (37)	6–17	133,354–157,303 children;95,632–111,280 adolescents.ADHD alone or w/comorbidity, Continuously enrolled w/ ≥1 stimulants	Any 2,3,4, ≥5 concomitant medications	≥30	Stimulant + 1 or more medications increased for: Children: 22.9–25.0%; Adolescents: 25.2–28.2%. Off label: stimulant + *SSRI; stimulant + **AAP were common
2009, Truven Market Scan, Betts et al. (38)	6–17	N = 71,201 children 6–12;N = 49,959 adolescents 13–17. ADHD alone or w/ comorbidity and stimulant use	Stimulant + 14 other class pairs within & interclass	≥30	12.6% of non-comorbid ADHD had ≥2 classes while 41.7% of ADHD with comorbidities experienced combinations. *SSRIs and **AAPs were common.
2004–2006, IMS LifeLink, Bali et al. (39)	6–16	N = 37,981 long-acting stimulant users w/ 1 year followup for antipsychotic users	***LAS w/ or without concomitant antipsychotic	≥14	Only 3.9% of LAS users had a concomitant antipsychotic added. 71 day greater persistence in the off-label combination was deemed improved adherence compared with LAS alone.
1997–1999 surveys of ****APA member volunteers, Duffy et al. (40)	2–17	189 prescribing psychiatrists for 332 youth	2; 3; ≥4 within or interclass	Point prevalence	40% monotherapy; 30.5% 2 medications; 10.2% 3 medications; 2.9% ≥4 medications, 16.2% no medication prescribed.

^*SSRI, Selective Serotonin Reuptake Inhibitor;

^**AAP, Atypical Antipsychotic;

^***LAS, Long-acting stimulant;

^****APA, American Psychiatric Association.