["Journal of Intellectual Disability Research, EarlyView. ", "\nABSTRACT\n\nBackground\nPsychotropic use and psychotropic polypharmacy are common in people with intellectual disabilities, but representative population‐based studies on this topic are scarce. We evaluated the prevalence of psychotropic use and psychotropic polypharmacy in a Finnish nationwide cohort of people with intellectual disabilities aged 0–97 years.\n\n\nMethods\nThe annual prevalence of psychotropic use in 2019 was studied among 37 196 individuals with intellectual disabilities and an age‐ and sex‐matched comparison cohort with no diagnosis of intellectual disabilities. Psychotropics included antipsychotics, antidepressants, anxiolytics, hypnotics and sedatives and antiepileptics indicated for bipolar disorder (carbamazepine, valproic acid, lamotrigine, pregabalin and clonazepam). Prevalence of interclass psychotropic polypharmacy (use from ≥ 2 different psychotropic groups) was evaluated in a 4‐month time window at the end of 2019.\n\n\nResults\nPrevalence of psychotropic use was higher in the intellectual disability cohort (42.3%) than comparison cohort (15.0%). Antipsychotics were the most common psychotropic group in the intellectual disability cohort (28%), with lower prevalence in the comparison cohort (3.3%). The prevalence of antidepressant use was 19.4% in the intellectual disability cohort and 9.7% in the comparison cohort. A likely indication was identified for 52.9% of psychotropic users with intellectual disability (major psychiatric comorbidity 38.1%, challenging behaviour 22.1%). Psychotropic polypharmacy was more common in the intellectual disability cohort (18.2%), than in the comparison cohort (3.6%).\n\n\nConclusions\nOur findings highlight concerns about psychotropic polypharmacy and potential overmedication. Using a comprehensive, nationwide cohort, this study emphasises the need for more evidence‐based, person‐centred approaches, including careful diagnostics, non‐pharmacological interventions and regular treatment reviews.\n\n"]