Login Register Cart 0
Generic placeholder image

Current Medicinal Chemistry

Editor-in-Chief

ISSN (Print): 0929-8673
ISSN (Online): 1875-533X

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe Translate in Chinese
Review Article

Polypharmacy- Purpose, Benefits and Limitations

Author(s): Douglas Grover*, Michelle Tom, Gerald Maguire and Stephen Stahl

Volume 29, Issue 35, 2022

Published on: 10 February, 2022

Page: [5606 - 5614] Pages: 9

DOI: 10.2174/0929867329666220107153813

Price: $65

Open Access Journals Promotions 2
conference banner
Abstract

With what has become increasingly common among nearly all medical specialties, the number of patients who have various comorbid diseases both psychiatrically and mentally challenges the field of psychiatry. As a result, it is not uncommon for physicians to be imposed with treatment decisions regarding polypharmacy, the use of multiple medications to treat different diseases, or even the same illness several times. In recent years, the concept of polypharmacy has been known to have a negative undertone, implying that its use is inappropriate or causes more harm than the potential benefit. Although the use of any medication should involve risk versus benefit discussion, when used with good clinical judgment and pharmacologically sound knowledge, this practice can be potentially life-altering for patients.

Keywords: Polypharmacy, angiotensin-converting enzyme, antidepressant, neural circuitry, neurotransmitters, GABA.

« Previous Next »
[1]
Stahl, S.M. Stahl’s essential psychopharmacology: Neuroscientific basis and practical application, 4th ed.; Cambridge University Press: UK, 2013.
[2]
Nestler, E.J. Epigenetic mechanisms of depression. JAMA Psychiatry, 2014, 71(4), 454-456.
[http://dx.doi.org/10.1001/jamapsychiatry.2013.4291] [PMID: 24499927]
[3]
Gallego, J.A.; Bonetti, J.; Zhang, J.; Kane, J.M.; Correll, C.U. Prevalence and correlates of antipsychotic polypharmacy: A systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophr. Res., 2012, 138(1), 18-28.
[http://dx.doi.org/10.1016/j.schres.2012.03.018] [PMID: 22534420]
[4]
Bebbington, P.; Ramana, R. The epidemiology of bipolar affective disorder. Soc. Psychiatry Psychiatr. Epidemiol., 1995, 30(6), 279-292.
[http://dx.doi.org/10.1007/BF00805795] [PMID: 8560330]
[5]
Stahl, S.M. Drug combinations for bipolar spectrum disorders: Evidence-based prescribing or prescribing-based evidence? J. Clin. Psychiatry, 2004, 65(10), 1298-1299.
[http://dx.doi.org/10.4088/JCP.v65n1001] [PMID: 15491230]
[6]
Johansen, R.; Iversen, V.C.; Melle, I.; Hestad, K.A. Therapeutic alliance in early schizophrenia spectrum disorders: A cross-sectional study. Ann. Gen. Psychiatry, 2013, 12(1), 14.
[http://dx.doi.org/10.1186/1744-859X-12-14] [PMID: 23656747]
[7]
Frank, A.F.; Gunderson, J.G. The role of the therapeutic alliance in the treatment of schizophrenia. Relationship to course and outcome. Arch. Gen. Psychiatry, 1990, 47(3), 228-236.
[http://dx.doi.org/10.1001/archpsyc.1990.01810150028006] [PMID: 1968329]
[8]
McCabe, R.; Bullenkamp, J.; Hansson, L.; Lauber, C.; Martinez-Leal, R.; Rössler, W.; Salize, H.J.; Svensson, B.; Torres-Gonzalez, F.; van den Brink, R.; Wiersma, D.; Priebe, S. The therapeutic relationship and adherence to antipsychotic medication in schizophrenia. PLoS One, 2012, 7(4), e36080.
[http://dx.doi.org/10.1371/journal.pone.0036080] [PMID: 22558336]
[9]
Priebe, S.; Richardson, M.; Cooney, M.; Adedeji, O.; McCabe, R. Does the therapeutic relationship predict outcomes of psychiatric treatment in patients with psychosis? A systematic review. Psychother. Psychosom., 2011, 80(2), 70-77.
[http://dx.doi.org/10.1159/000320976] [PMID: 21196804]
[10]
Stahl, S.M. Emerging guidelines for the use of antipsychotic polypharmacy. Rev. Psiquiatr. Salud Ment., 2013, 6(3), 97-100.
[http://dx.doi.org/10.1016/j.rpsm.2013.01.001] [PMID: 23485567]
[11]
Moore, B.A.; Morrissette, D.A.; Meyer, J.M.; Stahl, S.M. Drug information update. Unconventional treatment strategies for schizophrenia: Polypharmacy and heroic dosing. BJPsych Bull., 2017, 41(3), 164-168.
[http://dx.doi.org/10.1192/pb.bp.115.053223] [PMID: 28584654]
[12]
Morrissette, D.A.; Stahl, S.M. Treating the violent patient with psychosis or impulsivity utilizing antipsychotic polypharmacy and high-dose monotherapy. CNS Spectr., 2014, 19(5), 439-448.
[http://dx.doi.org/10.1017/S1092852914000388] [PMID: 25119976]
[13]
Uchida, H.; Takeuchi, H.; Graff-Guerrero, A.; Suzuki, T.; Watanabe, K.; Mamo, D.C. Predicting dopamine D2 receptor occupancy from plasma levels of antipsychotic drugs: A systematic review and pooled analysis. J. Clin. Psychopharmacol., 2011, 31(3), 318-325.
[http://dx.doi.org/10.1097/JCP.0b013e318218d339] [PMID: 21508857]
[14]
Schwartz, T.L.; Stahl, S.M. Treatment strategies for dosing the second generation antipsychotics. CNS Neurosci. Ther., 2011, 17(2), 110-117.
[http://dx.doi.org/10.1111/j.1755-5949.2011.00234.x] [PMID: 21401911]
[15]
Stahl, Morrissette D. Should high dose or very long-term antipsychotic monotherapy be considered before antipsychotic polypharmacy? In: Polypharmacy in Psychiatry Practice; Ritsner, M.S., Ed.; Springer: Netherlands, 2013; pp. 107-125.
[16]
Remington, G.; Mamo, D.; Labelle, A.; Reiss, J.; Shammi, C.; Mannaert, E.; Mann, S.; Kapur, S. A PET study evaluating dopamine D2 receptor occupancy for long-acting injectable risperidone. Am. J. Psychiatry, 2006, 163(3), 396-401.
[http://dx.doi.org/10.1176/appi.ajp.163.3.396] [PMID: 16513859]
[17]
Marder, S.R.; Meibach, R.C. Risperidone in the treatment of schizophrenia. Am. J. Psychiatry, 1994, 151(6), 825-835.
[http://dx.doi.org/10.1176/ajp.151.6.825] [PMID: 7514366]
[18]
Davis, J.M.; Chen, N. Dose response and dose equivalence of antipsychotics. J. Clin. Psychopharmacol., 2004, 24(2), 192-208.
[http://dx.doi.org/10.1097/01.jcp.0000117422.05703.ae] [PMID: 15206667]
[19]
Kegeles, L.S.; Abi-Dargham, A.; Frankle, W.G.; Gil, R.; Cooper, T.B.; Slifstein, M.; Hwang, D.R.; Huang, Y.; Haber, S.N.; Laruelle, M. Increased synaptic dopamine function in associative regions of the striatum in schizophrenia. Arch. Gen. Psychiatry, 2010, 67(3), 231-239.
[http://dx.doi.org/10.1001/archgenpsychiatry.2010.10] [PMID: 20194823]
[20]
Thompson, J.L.; Urban, N.; Slifstein, M.; Xu, X.; Kegeles, L.S.; Girgis, R.R.; Beckerman, Y.; Harkavy-Friedman, J.M.; Gil, R.; Abi-Dargham, A. Striatal dopamine release in schizophrenia comorbid with substance dependence. Mol. Psychiatry, 2013, 18(8), 909-915.
[http://dx.doi.org/10.1038/mp.2012.109] [PMID: 22869037]
[21]
Stahl, S.M.; Grady, M.M. A critical review of atypical antipsychotic utilization: Comparing monotherapy with polypharmacy and augmentation. Curr. Med. Chem., 2004, 11(3), 313-327.
[http://dx.doi.org/10.2174/0929867043456070] [PMID: 14965234]
[22]
Tiihonen, J.; Taipale, H.; Mehtälä, J.; Vattulainen, P.; Correll, C.U.; Tanskanen, A. Association of antipsychotic polypharmacy vs. monotherapy with psychiatric rehospitalization among adults with schizophrenia. JAMA Psychiatry, 2019, 76(5), 499-507.
[http://dx.doi.org/10.1001/jamapsychiatry.2018.4320] [PMID: 30785608]
[23]
Denicoff, K.D.; Smith-Jackson, E.E.; Disney, E.R.; Ali, S.O.; Leverich, G.S.; Post, R.M. Comparative prophylactic efficacy of lithium, carbamazepine, and the combination in bipolar disorder. J. Clin. Psychiatry, 1997, 58(11), 470-478.
[http://dx.doi.org/10.4088/JCP.v58n1102] [PMID: 9413412]
[24]
Chiapponi, C.; Piras, F.; Piras, F.; Caltagirone, C.; Spalletta, G. GABA system in schizophrenia and mood disorders: A mini review on third-generation imaging studies. Front. Psychiatry, 2016, 7, 61.
[http://dx.doi.org/10.3389/fpsyt.2016.00061] [PMID: 27148090]
[25]
Post, R.M.; Speer, A.M.; Leverich, G.S. Complex combination therapy: The evolution toward rational polypharmacy in lithium-resistant bipolar illness. Bipolar Psychopharmacotherapy: Caring for the Patient; Akiskal, H.S.; Tohen, M., Eds.; John Wiley & Sons Ltd: London, 2006, pp. 135-167.
[http://dx.doi.org/10.1002/0470017953.ch9]
[26]
Herrman, H.; Kieling, C.; McGorry, P.; Horton, R.; Sargent, J.; Patel, V. Reducing the global burden of depression: A Lancet-World Psychiatric Association Commission. Lancet, 2019, 393(10189), e42-e43.
[http://dx.doi.org/10.1016/S0140-6736(18)32408-5] [PMID: 30482607]
[27]
Zuilhof, Z.; Norris, S.; Blondeau, C.; Tessier, P.; Blier, P. Optimized regimens of combined medications for the treatment of major depressive disorder: A double-blind, randomized-controlled trial. Neuropsychiatr. Dis. Treat., 2018, 14, 3209-3218.
[http://dx.doi.org/10.2147/NDT.S175203] [PMID: 30538479]
[28]
Fava, M.; Davidson, K.G. Definition and epidemiology of treatment-resistant depression. Psychiatr. Clin. North Am., 1996, 19(2), 179-200.
[http://dx.doi.org/10.1016/S0193-953X(05)70283-5] [PMID: 8827185]
[29]
Israel, J.A. Remission in depression: Definition and initial treatment approaches. J. Psychopharmacol., 2006, 20(3)(Suppl.), 5-10.
[http://dx.doi.org/10.1177/1359786806064306] [PMID: 16644766]
[30]
Nierenberg, A.A.; Husain, M.M.; Trivedi, M.H.; Fava, M.; Warden, D.; Wisniewski, S.R.; Miyahara, S.; Rush, A.J. Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: A STAR*D report. Psychol. Med., 2010, 40(1), 41-50.
[http://dx.doi.org/10.1017/S0033291709006011] [PMID: 19460188]
[31]
Oluboka, O.J.; Katzman, M.A.; Habert, J.; McIntosh, D.; MacQueen, G.M.; Milev, R.V.; McIntyre, R.S.; Blier, P. Functional recovery in major depressive disorder: Providing early optimal treatment for the individual patient. Int. J. Neuropsychopharmacol., 2018, 21(2), 128-144.
[http://dx.doi.org/10.1093/ijnp/pyx081] [PMID: 29024974]
[32]
Zigman, D.; Blier, P. A framework to avoid irrational polypharmacy in psychiatry. J. Psychopharmacol., 2012, 26(12), 1507-1511.
[http://dx.doi.org/10.1177/0269881112453211] [PMID: 22767374]
[33]
Nelson, J.C.; Mazure, C.M.; Jatlow, P.I.; Bowers, M.B., Jr; Price, L.H. Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study. Biol. Psychiatry, 2004, 55(3), 296-300.
[http://dx.doi.org/10.1016/j.biopsych.2003.08.007] [PMID: 14744472]
[34]
Lam, R.W.; Hossie, H.; Solomons, K.; Yatham, L.N. Citalopram and bupropion-SR: combining versus switching in patients with treatment-resistant depression. J. Clin. Psychiatry, 2004, 65(3), 337-340.
[http://dx.doi.org/10.4088/JCP.v65n0308] [PMID: 15096072]
[35]
Hannan, N. Venlafaxine-mirtazapine combination in the treatment of persistent depressive illness. J. Psychopharmacol., 2008, 22(6), 698.
[PMID: 17329295]
[36]
Blier, P.; Ward, H.E.; Tremblay, P.; Laberge, L.; Hébert, C.; Bergeron, R. Combination of antidepressant medications from treatment initiation for major depressive disorder: A double-blind randomized study. Am. J. Psychiatry, 2010, 167(3), 281-288.
[http://dx.doi.org/10.1176/appi.ajp.2009.09020186] [PMID: 20008946]
[37]
Blier, P.; Gobbi, G.; Turcotte, J.E.; de Montigny, C.; Boucher, N.; Hébert, C.; Debonnel, G. Mirtazapine and paroxetine in major depression: A comparison of monotherapy versus their combination from treatment initiation. Eur. Neuropsychopharmacol., 2009, 19(7), 457-465.
[http://dx.doi.org/10.1016/j.euroneuro.2009.01.015] [PMID: 19345072]
[38]
Price, J.L.; Drevets, W.C. Neurocircuitry of mood disorders. Neuropsychopharmacology, 2010, 35(1), 192-216.
[http://dx.doi.org/10.1038/npp.2009.104] [PMID: 19693001]
[39]
Zarate, C.A., Jr; Singh, J.B.; Carlson, P.J.; Brutsche, N.E.; Ameli, R.; Luckenbaugh, D.A.; Charney, D.S.; Manji, H.K. A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Arch. Gen. Psychiatry, 2006, 63(8), 856-864.
[http://dx.doi.org/10.1001/archpsyc.63.8.856] [PMID: 16894061]
[40]
Popova, V.; Daly, E.J.; Trivedi, M.; Cooper, K.; Lane, R.; Lim, P.; Mazzucco, C.; Hough, D.; Thase, M.E.; Shelton, R.C.; Molero, P.; Vieta, E.; Bajbouj, M.; Manji, H.; Drevets, W.C.; Singh, J.B. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: A randomized double-blind active-controlled study. Am. J. Psychiatry, 2019, 176(6), 428-438.
[http://dx.doi.org/10.1176/appi.ajp.2019.19020172] [PMID: 31109201]
[41]
Lim, M.; Li, Z.; Xie, H.; Tan, B.L.; Lee, J. The effect of therapeutic alliance on attitudes toward psychiatric medications in schizophrenia. J. Clin. Psychopharmacol., 2021, 41(5), 551-560.
[http://dx.doi.org/10.1097/JCP.0000000000001449] [PMID: 34411007]

Rights & Permissions Print Cite
Article Metrics
67
4
Wayfinder Image
Open Access Journals Promotions
World Antimicrobial Awareness Week
© 2024 Bentham Science Publishers | Privacy Policy