July 05, 2005

Multiple Meds and Treatment-resistant Schizophrenia

For some patients the use of a single antipsychotic just does not seem to work, that's when combining antipsychotics comes into consideration.

This does not mean having a patient use two or more antipsychotics for a brief period of time (for example when phasing off one, while starting a new medication). Rather, what we are talking about here is using 2 or more antipsychotics over a certain amount of time for "long term control." How safe combination antipsychotic therapy is has come into question. About 10% to 20% of patients with schizophrenia have undergone such therapy in the US. 90% or more schizophrenia patients are administered such therapy in some Asian countries, including Japan. Usually combining antipsychotics is only used for treatment resistant schizophrenia, at least in the US.

There are certain medical risks one takes when using such therapy. "Treating patients with antipsychotic combinations may be associated with medical risks (Table 1). Patients are less likely to adhere to complex medication regimens than to simple ones. Thus, adding a second antipsychotic may decrease adherence to the first antipsychotic and to other medications, such as for hypertension, diabetes, etc" (Miller, 2005).

The medical benefits are: reduced symptoms and reduced metabolic side effects. Obviously the risks and benefits do not affect every individual who undertakes combination antipsychotics. Adding another medication will add risk simply because every drug comes with certain side effects, therefore adding to the risk. Usually doctors should first question whether the benefits outweigh the risks and whether using combination antipsychotics is the best way to attain such benefits.

The source of this article is Current Psychiatry Online.

You can view the full article at: http://tinyurl.com/7aozy It was written by Alexander L. Miller, MD.


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