6 - Complex Regimens and Rationale-Based Combination Drug Therapies

Summary

Many patients with complicated psychiatric disorders – which we will define here as conditions involving multiple comorbidities, atypical or protracted symptoms, persistent functional impairment, and poor treatment response – often find themselves taking multidrug therapy regimens. Sometimes, combination therapies reflect wise, thoughtful, and even elegant amalgams crafted with careful deliberation. Such handiwork might capitalize on pharmacodynamic synergies and complementary, nonredundant mechanisms of action, or specific medications may make unique contributions to an overall regimen (such as drugs thought to exert anti-impulsivity, antisuicide, pro-cognitive, or anxiolytic effects). In a well-devised multidrug treatment plan, each component ideally has a well-defined job description and fills a particular role, much the way each player on a sports team covers a unique position, or every instrument in an orchestra makes its own distinct contribution to form a cohesive whole. In that sense, every drug within a psychopharmacology regimen should serve an identifiable and unambiguous function.