The Psychiatrist (2010) 34: 41-43. doi: 10.1192/pb.bp.109.027086
© 2010 The Royal College of Psychiatrists
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Editorial

Antipsychotic polypharmacy - confusion reigns{dagger}

David Taylor1

David Taylor is Chief Pharmacist at the South London and Maudsley NHS Foundation Trust, and Professor of Psychopharmacology at King's College London, UK.

Declaration of interest D.T. has received consultancy fees, lecturing honoraria and/or research funding from AstraZeneca, Janssen-Cilag, Servier, Sanofi-Aventis, Lundbeck, Bristol-Myers Squibb, Novartis, Eli Lilly and Wyeth.

{dagger} See original paper, pp. 44-46, and review article, pp. 58-62, this issue.

1 Pharmacy Department, South London and Maudsley NHS Foundation Trust, and Pharmaceutical Sciences Division, King's College London

Correspondence: Correspondence to David Taylor (David.Taylor{at}slam.nhs.uk)

Abstract

Polypharmacy is usually employed where single drugs are considered insufficiently effective. Some polypharmacy is rational and evidence based, some neither. Antipsychotic polypharmacy remains stubbornly widespread despite condemnation of the practice by numerous bodies. The practice could not be said to be evidence based. Its persistence probably stems from a well-meaning desire to improve response and from confusion about the mechanism of action of antipsychotics. In particular, the concept that more antipsychotic(s) must always be, or might be, ‘better’ is virtually groundless. Nonetheless, some specific antipsychotic polypharmacy regimens have shown particular benefits on adverse effect profiles. Targeted, evidence-based polypharmacy may be the way forward.


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