Jacob Ballon1, T Scott Stroup. 1. Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, USA.
Abstract
PURPOSE OF REVIEW: Combining psychotropic medications is common for people diagnosed with schizophrenia facing a variety of clinical circumstances. This review provides an update on evidence regarding the effectiveness of polypharmacy approaches. RECENT FINDINGS: Epidemiology studies have demonstrated that polypharmacy is extremely common, but evidence regarding all polypharmacy approaches for schizophrenia from randomized controlled trials remains scarce. Combinations of antipsychotic medicines are unsupported by evidence. Antidepressants are commonly used to treat depressive symptoms; this logical role for antidepressants has little support from randomized controlled trials (RCTs) but may be associated with lower suicide and all-cause mortality. Insufficient evidence supports the use of benzodiazepines for schizophrenia; possible risks of benzodiazepines, including increased mortality rates revealed in observational studies, warrant caution and further study. SUMMARY: The lack of evidence regarding common treatment strategies exacerbates the tremendous challenge of providing optimal pharmacotherapy for individuals with schizophrenia. Comparative effectiveness research, using observational methods when appropriate and RCTs when possible, is needed to inform clinical practice, use resources wisely and improve outcomes.
PURPOSE OF REVIEW: Combining psychotropic medications is common for people diagnosed with schizophrenia facing a variety of clinical circumstances. This review provides an update on evidence regarding the effectiveness of polypharmacy approaches. RECENT FINDINGS: Epidemiology studies have demonstrated that polypharmacy is extremely common, but evidence regarding all polypharmacy approaches for schizophrenia from randomized controlled trials remains scarce. Combinations of antipsychotic medicines are unsupported by evidence. Antidepressants are commonly used to treat depressive symptoms; this logical role for antidepressants has little support from randomized controlled trials (RCTs) but may be associated with lower suicide and all-cause mortality. Insufficient evidence supports the use of benzodiazepines for schizophrenia; possible risks of benzodiazepines, including increased mortality rates revealed in observational studies, warrant caution and further study. SUMMARY: The lack of evidence regarding common treatment strategies exacerbates the tremendous challenge of providing optimal pharmacotherapy for individuals with schizophrenia. Comparative effectiveness research, using observational methods when appropriate and RCTs when possible, is needed to inform clinical practice, use resources wisely and improve outcomes.
Authors: D C Henderson; X Fan; P M Copeland; C P Borba; T B Daley; D D Nguyen; H Zhang; D Hayden; O Freudenreich; C Cather; A E Evins; D C Goff Journal: Acta Psychiatr Scand Date: 2007-02 Impact factor: 6.392
Authors: Robert W Buchanan; Julie Kreyenbuhl; Deanna L Kelly; Jason M Noel; Douglas L Boggs; Bernard A Fischer; Seth Himelhoch; Beverly Fang; Eunice Peterson; Patrick R Aquino; William Keller Journal: Schizophr Bull Date: 2009-12-02 Impact factor: 9.306
Authors: Christoph U Correll; Christine Rummel-Kluge; Caroline Corves; John M Kane; Stefan Leucht Journal: Schizophr Bull Date: 2008-04-15 Impact factor: 9.306
Authors: Gary Remington; Ofer Agid; George Foussias; Gagan Fervaha; Hiroyoshi Takeuchi; Jimmy Lee; Margaret Hahn Journal: Can J Psychiatry Date: 2015-03 Impact factor: 4.356