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August 27, 2004

Polypharmacy (multi-drug treatments) for Bipolar

Last week The Wall Street Journal examined "polypharmacy," a treatment for patients with depression and other brain disorders that involves customized "drug cocktails" of multiple medicines.

With "polypharmacy", patients who do not respond to one medication alone take several treatments that target different brain chemicals or the same parts of the brain with drugs that act slightly differently.

Physicians "arrive at the right mix by tinkering with a sequence of different drugs based on past experiences, word of mouth and drug company marketing," the Journal reports.

Polypharmacy, "driven in part by the shortcomings of many available medications," is "psychiatry's answer to HIV/AIDS drug cocktails and combinations of cancer drugs," the Journal reports. Polypharmacy is based on the theory that mental illnesses are based in biology.

Patients who take several different medications likely will have "multiple side effects -- and multiple prescription bills," according to the Journal. The treatment of schizophrenia patients with multiple medications has become controversial because of the increased cost, and officials for some state health care programs have "balked at paying for combinations of psychiatric drugs without evidence that the treatment actually works," the Journal reports. In addition, some psychiatrists "question whether more drugs are necessarily better," according to the Journal.

According to S. Nassir Ghaemi, a psychiatrist who wrote a book on polypharmacy, a large amount of evidence exists that supports the effectiveness of the treatment in patients with bipolar disorder. A government-funded study that involves patients with depression scheduled for release in 2005 also could provide evidence of the effectiveness of polypharmacy


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