Today, treatment with more than one medication is the norm, not the exception, for almost any disorder (e.g., hypertension, diabetes), including psychiatric disorders. Unless you have a framework that guides your prescribing practice, patients are at risk for unnecessary and harmful polypharmacy (and you are at risk of being quickly relegated to merely dispensing medications as the patient’s “psychopharmacologist”).

We have no agreed-upon definition of what constitutes “polypharmacy.” In its narrowest sense, polypharmacy refers to the combination of two or more antipsychotics (same-class polypharmacy). In a slightly broader sense, polypharmacy refers to using two or more medications for the same condition. In its broadest sense, it is simple pill counting. Polypharmacy often has a negative connotation and implies the use of (too) many or unnecessary medications. What is rarely talked about is that at the molecular level, the concept might not be very meaningful at all (Freudenreich and Goff, 2003). Monotherapy with clozapine at the pill-counting level is polypharmacy at the molecular level—clozapine targets a multitude of receptors in the brain. With such a fuzzy concept, it is easy to see how one person’s rational combination treatment becomes another person’s irrational polypharmacy.