Exploring psychotropic medication use in Dutch primary care: trends, prevalence, and associations with polypsychopharmacy

BACKGROUND: Polypsychopharmacy has been associated with increased risks of adverse drug reactions, metabolic syndrome, and higher healthcare utilization. Although its prevalence is well-documented in secondary and tertiary care, data from primary care settings remain scarce. AIM: This study investigated trends in polypsychopharmacy, associated factors, and prescribing patterns in Dutch primary care from 2012-2021. DESIGN & SETTING: We conducted a cross-sectional analysis of a primary care database containing medical records from approximately 500 000 adult patients across 100 practices. METHOD: Polypsychopharmacy was defined as concomitant use of two different psychotropic medication classes for≥90 days (chronic). Point prevalence was measured on July 1st of each year from 2012 to 2021. We performed a multivariate analyses (using 2021 data) to identify factors associated with polypsychopharmacy, including demographic characteristics, mental and physical comorbidities, analgesic use, and healthcare utilization. RESULTS: The prevalence of polypsychopharmacy increased from 7.6 (95% CI: 7.3-8.0) to 12.6 (95% CI: 12.3-13.1) per 1,000 patients between 2012-2021 (annual increase: 0.49 per 1,000; 95% CI: 0.40-0.57). The most common combinations were antidepressant-antipsychotic (473 per 100,000), antidepressant-anxiolytic (387 per 100,000), and antidepressant-hypnotics/sedatives (251 per 100,000). Factors associated with polypsychopharmacy included older age, female sex, multiple psychiatric diagnoses, use of analgesics, and high healthcare utilization. CONCLUSION: Polypsychopharmacy in Dutch primary care increased considerably over the past decade, increasing demands on general practice. Although certain regimens may be clinically justified, the upward trend underscores the need for further research into prescribing appropriateness, strategies to optimize psychotropic use, and the role of non-pharmacological treatments in primary care.