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Polypharmacy for schizophrenia

Ballon, Jacob; Stroup, T. Scott

Current Opinion in Psychiatry: March 2013 - Volume 26 - Issue 2 - p 208–213
doi: 10.1097/YCO.0b013e32835d9efb
SCHIZOPHRENIA AND RELATED DISORDERS: Edited by W. Wolfgang Fleischhacker and Lynn E. DeLisi

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.

Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, USA

Correspondence to Scott Stroup, MD, MPH, 1051 Riverside Dr., Unit 100, New York, NY 10032, USA. Tel: +1 212 543 5676; fax: +1 212 543 5085; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.