Bains and Nielssen (Reference Bains and Nielssen2003) discourage the combined prescription of a (conventional) depot antipsychotic preparation with oral atypical medications, on the grounds that there is ‘no published research to support such a combination on theoretical or practical grounds’. The authors considered that ‘use of atypical antipsychotics may be seen as a way of minimising distressing side-effects and also reducing the risk of developing tardive dyskinesia (by allowing the use of lower net doses of depot antipsychotic)’. Ultimately, however, they appear not to accept this approach, stating that ‘none of the treating psychiatrists [in their study] offered this rationale for treatment’.
Combination therapy with an atypical antipsychotic agent can, in some poorly-compliant patients, represent the most viable way of ensuring the delivery of an effective dose of antipsychotic medication, while at the same time limiting (especially extrapyramidal) side-effects.
Moreover, some patients, while rejecting varying doses of depot antipsychotic medication, are more accepting of a fixed dose of the injected preparation, with temporary addiction of an oral agent, the dose of which can be easily adjusted according to mental state and requirements.
The scientific literature and professional guidelines recommend antipsychotic monotherapy. However, while it is accepted that this should be a standard principle in antipsychotic prescribing, there seems to be a — perhaps substantial — minority of patients for whom the combination of oral atypical and depot conventional antipsychotic appears to be more appropriate. The authors' apparent espousal of a blanket rejection of combination therapy is therefore unfortunate.
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