OBJECTIVES: Recognizing the prescribing pattern and associated costs of psychotropic medications and the factors associated with such prescribing is crucial and may play an important role in improving the health care services provided to patients on such medications. The objective of this study was to assess current trends and factors influencing the prescribing of psychotropic medications. The study also estimated the direct cost associated with these medications. METHODS: This is a retrospective study of (N=71,136) prescription events of psychotropic medications identified from outpatient pharmacy records of a major healthcare system in Riyadh, Saudi Arabia for years 2002, 2003, and 2004. Patient characteristics, psychotropic medications use and the associated costs over the three years period were determined. Logistic regression was used to evaluate the influence of physician specialty and other relevant factors on prescribing of different psychotropic medications. RESULTS: Over the three years period the use of high cost agents have sharply increased to account for around 8% of the total outpatient spending on pharmaceuticals in 2004. Prescriptions by General Practitioners (GPs) accounted for 35% of the total psychotropic medications prescribed. However, patients on these medications were more likely to receive a high cost drug from a psychiatrist than from any other specialty. CONCLUSIONS: The results of the study indicate that psychotropic medications are mainly prescribed by GPs and that the likelihood of being prescribed a psychotropic medication, which may be of high cost, is greater when patients see a psychiatrist. In Saudi Arabia, health care systems should closely monitor prescribing patterns for psychotropic medications to avoid unnecessary cost and consequently, the potential for inappropriate use of such agents.