TOPLINE:

Polypsychopharmacy — the concomitant use of two or more different classes of psychotropic medication — increased between 2012 and 2021 in Dutch primary care; the most common combinations involved antidepressants with antipsychotics, anxiolytics, or sedatives-hypnotics. Factors such as multiple psychiatric diagnoses, opioid use, and high GP consultation frequency were associated with polypsychopharmacy.

METHODOLOGY:

• Researchers conducted a cross-sectional analysis of a regional database in Netherlands containing medical records from 272,460 to 311,031 adult patients across 100 general medical practices from 2012 to 2021.
• Polypsychopharmacy was defined as the concomitant use of psychotropic medication from two or more different classes for at least 90 days. The classes included antidepressants, antipsychotics, anxiolytics, antiepileptics, hypnotics and sedatives, antidementia drugs, and psychostimulants.
• The point prevalence of polypsychopharmacy was measured annually from 2012 to 2021, with trends analysed on the basis of the number of concomitant medication classes (two and three or more) and patient age groups (18-44, 45-64, and ≥ 65 years).
• Factors associated with polypsychopharmacy, such as demographic characteristics, comorbidities, analgesic use, and healthcare utilisation indicators, were assessed.
• In 2021, 3921 of the 311,031 patients fulfilled the criteria for polypsychopharmacy.

TAKEAWAY:

• The prevalence of polypsychopharmacy increased from 7.6 (95% CI, 7.3-8.0) to 12.6 (95% CI, 12.3-13.1) per 1000 patients from 2012 to 2021, with an average annual increase of 0.49 per 1000 patients (95% CI, 0.40-0.57).
• Polypsychopharmacy was associated with female sex (adjusted odds ratio [aOR], 1.25; 95% CI, 1.16-1.34), the age of 45-64 years (aOR, 1.88; 95% CI, 1.72-2.05) and 65 years or above (aOR, 2.05; 95% CI, 1.85-2.28), and opioid use (aOR, 2.69; 95% CI, 2.42-2.99). Having multiple psychiatric diagnoses showed strong associations with polypsychopharmacy.
• Healthcare utilisation markers such as psychiatric referral (aOR, 3.27; 95% CI, 3.00-3.55) and higher GP appointment frequency (7-12 appointments: aOR, 1.67; 95% CI, 1.48-1.89 and 13 appointments or more: aOR, 2.46; 95% CI, 2.19-2.77) were associated with polypsychopharmacy.
• The most common psychotropic medication combinations were antidepressants-antipsychotics (473 per 100,000 patients), antidepressants-anxiolytics (387 per 100,000 patients), and antidepressants-hypnotics-sedatives (251 per 100,000 patients).

IN PRACTICE:

"The observed rise in polypsychopharmacy highlights the need for structured medication reviews in primary care, particularly for older patients, those with multiple psychiatric diagnoses, and patients using opioids," the authors of the study wrote, further adding that "[i]mproving access to non-pharmacological interventions and strengthening collaboration between primary care and mental health services could further support rational prescribing."

SOURCE:

This study was led by Julia Cybulska, Department of Pharmacy, Radboudumc, Nijmegen, Netherlands. It was published online on May 08, 2026, in BJGP Open.

LIMITATIONS:

The study focused on various classes of psychotropic medications; intraclass polypsychopharmacy was not included in the analysis. Participation in the academic primary care network was optional, and the data covered only a single region in Netherlands. Slight differences in individual coding behaviour may have occurred, and psychiatric diagnoses may not have been fully registered.

DISCLOSURES:

This study did not receive any specific funding. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.