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Combining Psychiatric Drugs is Growing in the U.S.


More and more people are being offered a combination of psychiatric drugs a study shows. While the safety of antipsychotic and antidepressants drugs has been a big debate in children, this is the first study to look at trends over time of prescribing multiple psychiatric drugs to adults. The authors found that patients are commonly prescribed untested combinations of drugs, where the efficacy and possible side effects of the combos are unknown.

The researchers from the department of psychiatry at Johns Hopkins University and New York State Psychiatric Institute studied prescription patterns beginning in 1996. They looked at a whole range of psychiatric medicines, from antidepressants such as Wellbutrin, to antipsychotic like Loxapac, as well as mood stabilizers and sedatives. From 1996 to 1997, 42 percent of patients were prescribed of two or more of these medications.

"We have to figure out if these combinations are adding any benefits to patients," Dr. Ramin Mojtabai of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, Maryland told Reuters Health.

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The study focused on the four major classes of psychotropic (brain or mind affecting) medications: antidepressants, antipsychotics, mood stabilizers, and sedatives.

Mojtabai and Olfson found that antidepressants were the most commonly prescribed medications. Prescribing antidepressants with another antidepressant, a sedative or a mood stabilizer were the three most common psychotropic combinations.

During the study period, as more patients were prescribed at least one psychotropic drug, the number of office visits where two or more drugs were prescribed jumped from roughly 43 percent to 60 percent -- a "substantial increase," the authors note in the Archives of General Psychiatry.

Insured women, 45 to 64 years old and on a repeat visit to the psychiatrist, were the most likely to get two or more prescriptions. "There is growing evidence regarding the increased adverse effects associated with such combinations," the authors write. For example, they cite studies that have found some combinations have resulted in weight gain and increased cholesterol levels.

Patients with major depression, bipolar disorder, anxiety disorders or schizophrenia were more likely to be prescribed combos of two or more psychiatric drugs. Similarly, patients with more than one diagnosis were more likely to be on multiple meds than those with only one diagnosis. The study did not find an increase in the number of people with severe mental illness. Rather, the researchers say the increase in combo drugs is more likely to do with changes in how psychiatry is practiced.