Polypharmacy of 2 Atypical Antipsychotics

Letter to the Editor

Sir: I am writing to respond to the BRAINSTORMS article by Dr. Stephen Stahl in the July 1999 issue of the Journal. I agree that polypharmacy should be avoided. I was a resident in the early 1970s, when even having a person on treatment with an antidepressant and diazepam was considered a serious therapeutic misadventure. In his article, Dr. Stahl stated that no justification exists for using 2 expensive atypical antipsychotics and that this mixture usually results from being trapped in a cross-titration between 2 atypical agents without an adequate trial of monotherapy. I describe a case of a patient who did receive adequate trials of clozapine and olanzapine but nevertheless did best on a mixture of the 2 drugs.