Skip Navigation LinksHome > March 2010 - Volume 23 - Issue 2 > Polypharmacy in schizophrenia.
Current Opinion in Psychiatry:
doi: 10.1097/YCO.0b013e3283366427
Schizophrenia: Edited by W. Wolfgang Fleischhacker

Polypharmacy in schizophrenia.

Zink, Mathias; Englisch, Susanne; Meyer-Lindenberg, Andreas

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Abstract

Purpose of review: Although most guidelines recommend monotherapy in schizophrenia, the combined application of multiple psychotropic agents is very common, especially in treatment-refractory cases. We review the empirical basis supporting these attempts and their relevance for clinical practice.

Recent findings: Polypharmacy intends to address different aspects of treatment resistance, most importantly insufficient response of psychotic positive and negative symptoms, but also cognitive disturbances, affective comorbidity, obsessive–compulsive syndromes and side-effects of antipsychotic drugs. This review summarizes the current state of evidence of combined antipsychotic treatment strategies and the augmentation of antipsychotics with mood stabilizers, antidepressants and experimental substances.

Summary: In general, rigorous data on combination therapy in schizophrenia are rare and further randomized controlled trials, naturalistic trials and head-to-head-trials are necessary. Some evidence supports a combination of antipsychotics and antidepressants for negative symptoms and comorbid major depressive episodes. The add-on of lithium and mood stabilizers lacks compelling evidence, but might be beneficial for specific subgroups. For treatment-resistant cognitive symptoms, antipsychotic medication should be combined with cognitive remediation, as no pharmacological add-on strategy has gained convincing evidence so far. Treatment-emergent positive and/or negative symptoms under clozapine monotherapy might benefit from adding a second atypical substance.

© 2010 Lippincott Williams & Wilkins, Inc.

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