RATIONAL AND IRRATIONAL PSYCHOPHARMACOLOGY COMBINATIONS

Combination drug therapy regimens in psychiatry ideally reflect wellcrafted thoughtful, complementary, synergistic mechanisms or purposefully targeted interventions designed to address complex psychopathology or comorbid conditions. At other times, combinations may arise more haphazardly, resulting from inaccurate diagnoses, suboptimal dosing of primary agents, and iterative prescribing habits that retain previouslyprescribed medications that could be ineffective, obsolete or otherwise inappropriate and therefore warrant deprescribing. Irrational polypharmacy regimens may fail to account for redundant or contradictory drug mechanisms of action, can exacerbate rather than ameliorate key target symptoms (e.g., antidepressants during mania), may ignore the relative merits of monotherapy dosing optimization strategies, impose complexities that foster nonadherence, fail to recognize or minimize additive adverse drug effects, or pose hazards that outweigh benefits. Because many forms of serious mental illness may not respond adequately to monotherapies, even when dosing and duration are deemed adequate or optimized, properly devised combination pharmacotherapy regimens can offer more effective strategies for difficult-to-treat psychiatric conditions. This interactive audience presentation will review new findings from the ASCP presidential task force on polypharmacy Delphi survey items related to desirable versus undesirable pharmacokinetic effects (e.g., drug-drug interactions), pharmacodynamic redundancies versus complementary or synergistic effects, and other mechanistic considerations that avoid irrational combinations and reflect logical strategies to maximize favorable clinical outcomes.

References

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