Breaking Down Psychiatric Polypharmacy: From Evidence to Practice

Abstract Psychiatric polypharmacy, the use of multiple psychotropic medications, has significantly increased in recent decades. Prescriptions for three or more medications went from 5% in 1974 to 40% in 1995. The rates vary widely, from 13% to 90% globally. About one-third of outpatient psychiatric patients receive multiple medications, with higher rates observed among men aged 25–45, as well as among children and the elderly. Despite its prevalence, guidelines on psychiatric polypharmacy are underdeveloped. Concerns exist regarding adverse effects and drug interactions, particularly among older adults with schizophrenia. The article aims to explore the concerns surrounding this practice, employing a classification system to evaluate different approaches to polypharmacy. The classification system includes five categories: “Same-class polypharmacy,” involving multiple medications from the same class; “multi-class polypharmacy,” combining drugs from different classes; “adjunctive polypharmacy,” where one medication is prescribed to counteract side effects of another; “augmentation polypharmacy,” adding a low dose of medication to another; and “total polypharmacy,” representing the total number of medications a patient takes. Demographic studies reveal that polypharmacy is far more common in inpatient settings, in older adults, and in those with specific diagnoses such as schizophrenia and bipolar disorder.