Mental Illness:
Is 1 Drug Better Than 2?

Mixing mental illness drug 'cocktails' is still more art than science.

by Daniel DeNoon

(Oct. 11, 2004) - They call them drug cocktails. They're becoming the vogue for mental illnesses such as bipolar disorder and schizophrenia. But mixing drugs is still more art than science.

If you have a serious mental illness, it's becoming more likely that you'll be treated with multiple drugs. Doctors call this polypharmacy. Polypharmacy is common for conditions such as heart disease, cancer, and HIV infection. The basic idea is to attack the mental illness on multiple fronts, using different drugs with different actions.

That's the upside. It can offer mental illness patients tremendous benefits when doctors have a careful, rational plan for trying multiple drugs. But there's a downside, too, says Andrew C. Furman, MD, director of clinical services for psychiatry at Atlanta's Grady Memorial Hospital and associate professor of psychiatry at Emory University.

"Unfortunately, in the majority of cases doctors are just throwing everything they possibly can at a mental illness in hopes that something will get better," says Furman.

That happens too often, agrees Alan J. Gelenberg, MD, head of psychiatry at the University of Arizona and editor-in-chief of the Journal of Clinical Psychiatry.

"What often happens in busy practices, both private and public, is that medications are thrown on without adequate information," according to Gelenberg. "Patients can end up with regimens that include multiple drugs without a rationale for using them all. It is not uncommon to look at a medical chart and say, 'I can't figure out why a patient is on this combination regimen.'"

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That can be bad news for mental illness patients, says Beth Murphy, MD, PhD, a psychiatric drug researcher at McLean Hospital in Belmont, Mass., and instructor in clinical psychiatry at Harvard University.

"The bad news is it costs more. And the more medicines you take, the more likely it is you will have an adverse response," says Murphy. "Moreover, it increases the chance your medicines will [harmfully] interact with one another."

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