The Perils Of Polypharmacy

Polypharmacy was once the exception in psychiatry, now it seems to have become the rule. Patients frequently are taking 3,4, even 5 psych meds at one time. And often it's primary care doctors, not psychiatrists, who are doing the prescribing -- usually without adequate training in psychiatry. Some polypharmacy is rational -- e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer. But most polypharmacy is irrational -- the result of carelessly adding meds without ever subtracting them; of treating each individual symptom separately; of chasing side effects; of too many docs providing uncoordinated care; and/or of patients demanding more meds than are good for them. Polypharmacy has never been, and will never be, systematically studied in controlled clinical trials. It is hard enough doing simple studies comparing drug A vs drug B vs placebo. It is impossibly impractical to do studies comparing multiple drug regimen, because these would require too many cells and too big a sample size to test all the possible permutations. The result: polypharmacy is rarely ever evidence based, almost always a shot in the dark. I have asked Dr Luis Bastida Ribas, the director of a psychiatric clinic in Spain, to provide a clinician's perspective on polypharmacy. Dr Bastida Ribas writes: "The patients referred to our clinic often arrive already taking many medications. Getting to know patients well enough for good diagnosis and treatment req...
Source: Science - The Huffington Post - Category: Science Source Type: news