DB01-02 - Polypharmacy Should be Avoided

Abstract

Polypharmacy is widespread in many areas of psychiatry, but it is associated with a number of risks and uncertainties:

1. 1. The side-effect burden increases

2. 2. There is a risk of drug-drug interactions and increased or decreased plasma-levels

3. 3. When a patient is prescribed several drugs at one time and responds, it is often difficult to say which drug was effective. Due to this uncertainty, patients are often unnecessarily continued on a number of agents.

4. 4. The mechanism of action of many psychotropics is unclear. What the exact mechanism of combining several drugs on the brain is, is even more unclear.

5. 5. While it is already difficult for patients to compliantly take one drug, compliance becomes even more difficult if patients have to take several drugs. This is a particular challenge of people with cognitive deficits such as many patients with schizophrenia.

6. 6. Finally, there is simply no evidence for many augmentation strategies.

Therefore, monotherapy should be the rule, and polypharmacy should be restricted to treatment resistant cases, knowing the limited available evidence.