Antipsychotic polypharmacy: squandering precious resources?

BRAINSTORMS is a monthly section of The Journal of Clinical Psychiatry aimed at providing updates of novel concepts emerging from the neurosciences that have relevance to the practicing psychiatrist. From the Neuroscience Education Institute in Carlsbad, Calif., and the Department of Psychiatry at the University of California San Diego. Reprint requests to: Stephen M. Stahl, M.D., Ph.D., Editor, Brainstorms, Neuroscience Education Institute, 5857 Owens Street, Ste. 102, Carlsbad, CA 92009. Blending an Antipsychotic Nectar Atypical antipsychotics represent a major advance in psychopharmacology, based on compelling evidence that monotherapy with atypical antipsychotics has superior benefits over monotherapy with conventional antipsychotics. Despite becoming the most expensive drugs in psychiatry and for many health care systems, atypical antipsychotics have now largely replaced conventional antipsychotics due to the perceived greater efficacy of the atypicals. An especially expensive clinical utilization of these already expensive drugs is to combine them with another antipsychotic (polypharmacy) in an attempt to further enhance their efficacy. Although only case reports and clinical anecdotes but no well-designed studies suggest that polypharmacy may be beneficial in some patients, this practice can occur in up to half of inpatients and a quarter of outpatients, contributing substantially to the overall costs of these drugs.