![]() ![]() That is only just happening now in psychiatry." "This is a painful contrast to other areas of medicine where doctors have large-scale clinical trial data to guide them. "We have little clinical trial data on which to base this, so it is still more an art than a science," Frye says. Frye, MD, director of the UCLA bipolar disorder research program and associate professor of psychiatry at UCLA's David Geffen School of Medicine. Multiple drug treatment is becoming state-of-the-art treatment for bipolar disorder, notes Mark A. We have increased our understanding of the biochemistry that underlies these illnesses, but we don't know all we would like to know." "We don't have enough understanding to know exactly which medicines a given individual will respond to. But even with these incredible advances, the understanding of the brain is not at the same place as the understanding of the heart," says Murphy. "This being the decade of the brain, there has been a burgeoning of understanding. "Psychiatry isn't the same as cardiology in our understanding of the exact mechanisms of illness." "Definitely the increase in psychiatric polypharmacy is not coming from a better understanding of disease," remarks Gelenberg. That makes prescribing mental illness drugs far different from prescribing drugs for heart disease, Gelenberg says. Drugs for mental illness work on the brain - by far the most complex and least understood part of the body. What is more, they have a precise idea of how this helps treat disease. When they prescribe drugs for physical diseases, doctors usually know exactly how each drug acts on the body. Mental Illness: Much to Learn About Drugs "Moreover, it increases the chance your medicines will interact with one another." ![]() And the more medicines you take, the more likely it is you will have an adverse response," says Murphy. 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. 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.'" "Patients can end up with regimens that include multiple drugs without a rationale for using them all. "What often happens in busy practices, both private and public, is that medications are thrown on without adequate information," according to Gelenberg. Gelenberg, MD, head of psychiatry at the University of Arizona and editor-in-chief of the Journal of Clinical Psychiatry. "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. Furman, MD, director of clinical services for psychiatry at Atlanta's Grady Memorial Hospital and associate professor of psychiatry at Emory University. But there's a downside, too, says Andrew C. It can offer mental illness patients tremendous benefits when doctors have a careful, rational plan for trying multiple drugs. The basic idea is to attack the mental illness on multiple fronts, using different drugs with different actions. Polypharmacy is common for conditions such as heart disease, cancer, and HIV infection. If you have a serious mental illness, it's becoming more likely that you'll be treated with multiple drugs. But mixing drugs is still more art than science. They're becoming the vogue for mental illnesses such as bipolar disorder and schizophrenia. Mixing mental illness drug 'cocktails' is still more art than science. Many patients receive multiple psychiatric medications for a mental health condition, but there's little scientific evidence to back the practice.
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