I am writing to compliment Dr. Henry A. Nasrallah for having the guts to write “Polypharmacy subtypes” (From the Editor, Current Psychiatry, April 2011, p. 10-12). I try hard to have patients on no more than 4 medications, 1 from each class if indicated. In California, what Dr. Nasrallah described as ridiculous and hazardous is all too rampant. I have inherited patients taking as many as 7 psychotropics and the initial evaluation of these patients usually begins with families stating that they are angry about their loved ones being “doped up to the point of being zombies.” When I am finally able to get a good history of symptoms, I typically find that patients do not meet DSM-IV-TR criteria for some diagnoses. I then wean them off the medications, see what symptoms emerge, and then “reinvent the wheel” with their medication regimens. I was verbally reprimanded by the medical director at 1 job because he thought a patient was “doing well” on 7 medications despite the fact he was oversedated. I also have inherited patients on medications that interacted with other medications and were causing medical problems.
Problems with polypharmacy in California are, as I said, rampant.
Terry Roh, MD
Child and Adult Psychiatrist
Lutheran Social Services of Southern California
Big Bear Lake, CA