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Antipsychotic polypharmacy: is there evidence for its use?
Vijayalakshmy Patrick1, Elizabeth Levin, Steven Schleifer
1University of Medicine and Dentistry New Jersey, New Jersey Medical School, Newark, USA.
Journal of Psychiatric Practice
|July 26, 2005
Summary
Antipsychotic polypharmacy, using multiple antipsychotic medications, is common but lacks strong evidence. More research is needed to determine if combining antipsychotics offers benefits over single-drug therapy.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Antipsychotic polypharmacy is prevalent in clinical settings.
- Controlled studies evaluating the efficacy of antipsychotic combinations are scarce.
Purpose of the Study:
- To review existing literature on the benefits and drawbacks of combination antipsychotic therapy compared to monotherapy.
- To assess the evidence base for current clinical practices in antipsychotic polypharmacy.
Main Methods:
- A comprehensive literature search of PubMed from 1976 to 2002.
- Inclusion of clinical trials, case series, and reports assessing combination vs. monotherapy.
- Identification of 52 relevant reports, including 4 double-blind studies, 13 open-label trials, and 35 case reports.
Main Results:
- Only a few studies met rigorous design criteria for direct comparison.
- A majority of clinical trials (75% double-blind, 69% open-label) indicated effectiveness of combination therapy.
- Case reports showed positive outcomes in 37% of instances.
Conclusions:
- Current antipsychotic polypharmacy practices are not strongly evidence-based.
- There is insufficient evidence to discourage the use of antipsychotic combinations.
- Further systematic research is essential to validate the use of antipsychotic polypharmacy.
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