Notes From Prague: Is Polypharmacy Necessary in Psychiatry?

NOTES FROM PRAGUE: A EUROPEAN PERSPECTIVE

March 4, 2012

Polypharmacy: is it necessary in psychiatry? Professors H-J Mller (pro) and S Leucht (con) made a good case for their sides at the 20th European Congress of Psychiatry.

Prof. Mller provided several points for co-medication in psychiatric disorders. He noted that:

1. Two or more active medications can increase efficacy
2. One drug may not be sufficient to target all complex symptoms
3. Both psychiatric and somatic comorbidities are good reasons to combine medications
4. There is good evidence for using co-medicines for the treatment of many disorders; in cases where there is not enough evidence based on research, clinical experience may be legitimately taken into consideration, and
5. Combining medications may be necessary as antidotes to adverse effects

Although he professed to be treating patients with polypharmacy on occassion, Prof Leucht explained that his concern is with doctors who have a "magic potion" of combined medications and who use this as treatment across the board, with no differentiation among patients.

He went on to argue against some of the points for co-medication. For example, adding medications as antidotes to adverse effects only increases the medication burden. In addition, treatment resistance may, in reality, be a case of treatment nonadherence; therefore, adding a medication will likely not add any benefits.