The May 7 article "Polypharmacy: Too Much of a Good Thing?"
describes a study that compares hospitalized patients on antipsychotic
polytherapy with hospitalized patients on antipsychotic monotherapy. Since
this study found no difference in outcome between these two groups, both
Psychiatric News and the authors of the study speculated that
antipsychotic polytherapy is unwarranted.
The patients in the polytherapy group were matched carefully. However, as
both articles acknowledged, patients in the polytherapy may have been more
treatment resistant than patients in the monotherapy group. Patients in the
polytherapy group had an earlier onset of illness. Also, they might not have
responded as well to an initial antipsychotic in their outpatient and/or
inpatient treatment. Why else would psychiatrists have given them more than
one antipsychotic at the same time?
If patients in the polytherapy group were more treatment resistant than
patients in the monotherapy group, then a different explanation is required
for this study. Specifically, a better explanation would be that the
treatment-resistant patients in the polytherapy group needed an additional
antipsychotic to reach the same therapeutic level as the patients in the
monotherapy group. Rather than conclude that polytherapy is unwarranted, we
might then speculate that many treatment-resistant patients need to be given
more than one antipsychotic to reach the same therapeutic level as less
Despite the need for controlled studies, which both articles acknowledged,
the obvious emphasis in both articles is on the potential futility of
polytherapy rather than on the potential need for polytherapy for
treatment-resistant patients. I believe that this bias is unwarranted.