Mental Illness: Is 1 Drug Better Than 2?

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

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The Example of Bipolar Disorder

Bipolar disorder is perhaps the best example of a mental illness in which different drugs may be effective. These patients cycle between deep depression and mania or euphoria.

"People with bipolar disorder need different things at different times," Murphy says. "At some point they might need an antidepressant, at others they may need additional help to maintain their sleep cycles. So I think polypharmacy today is more of a fluid and responsive regimen than it would have been in the past."

That's a far cry from simply piling one mental illness drug on top of another.

"Most psychiatrists in the bipolar world start with one medication, then see how you do, then add a second or a third drug as needed," Frye says. "Should we start treatment with two or three drugs? I think it is an important theoretical question. I generally start with one drug now for bipolar patients, but that may change. If a clinical trial shows that new, first-break bipolar patients do better beginning with two drugs rather than one, I would change my practice. For now, a doctor will start with a single medication and go from there."

Mental Illness: What Patients Should Know

Rule No. 1: Don't stop taking your medication. If your doctor has prescribed multiple mental illness drugs for you and you aren't sure why, ask. Suddenly stopping any of your medications could seriously affect your treatment.

"Do not stop your medicine," Furman warns. "But it is always reasonable to discuss with your mental health provider what you are on and reappraise what medications you should take. By no means should you stop any medicine without talking to your doctor. You may be on three or four medications for very good reasons."

Rule No. 2: Find a doctor qualified to treat mental illness that you can talk to. Then, talk.

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"The patient needs to ask, 'Why are we adding this drug? Should we subtract another drug? Is this the best dose? Is this really needed?" Gelenberg advises.

"Accurate reporting of your symptoms really will allow your psychiatrist to tailor your medical regimens to your needs," Murphy says. "There is a burden on the consumer to be aware of things like sleep cycles, to notice when a couple of nights in a row go by when you didn't seem to need any sleep, and to take this kind of information to your doctor."

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Sources: Mark A. Frye, MD, associate professor of psychiatry, David Geffen School of Medicine, UCLA; director, Bipolar Disorder Research Program, UCLA. Andrew C. Furman, MD, associate professor of psychiatry, Emory University; director of clinical services for psychiatry, Grady Memorial Hospital, Atlanta. Alan J. Gelenberg, MD, professor and head of psychiatry, University of Arizona; editor-in-chief, Journal of Clinical Psychiatry. Beth Murphy, MD, PhD, assistant director, clinical evaluation center, and co-investigator, psychopharmacology clinical research unit, McLean Hospital, Belmont, Mass.; clinical instructor of psychiatry, Harvard University. Gelenberg, A.J. Annals of Clinical Psychiatry, September-December 2003; vol 15: pp 203-216. Zarate, C.A. Jr., Bipolar Disorder, June 2003; vol 37: pp 12-17. Frye, M.A. Journal of Clinical Psychiatry, January 2000; vol 61: pp 9-15.

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