Polypharmacy among psychiatric patients

The purpose of the present study is to determine the frequency of polypharmacy among psychiatric patients in Helsinki, and to ascertain whether this practice is supported by clinical trials. The drugs prescribed in 1 day to a sample of patients (n = 694) in mental hospitals and outpatient clinics in Helsinki were studied. 69% of patients received more than on psychotropic drug in 1 day (61% received "proper" psychotropic drugs). On the average there were 2.1 different psychotropic drugs per patient, and the maximum was 6. A review of controlled clinical trials on the simultaneous use of more than one proper psychotropic drug in psychiatric diseases (excluding fixed combinations) revealed 14 trials. In only three trials was the combination better than its single components or placebo. Thus, there seems to be no evidence from clinical trials defending the frequent polypharmacy. A radical reduction in the number of psychotropic drugs prescribed for psychiatric patients is apparently desirable.