[The Issue Regarding Polypharmacy of Antidepressants and Anxiolytics How Can We Manage Them?].

Abstract

Newer antidepressants and anxiolytics can be used easily as these drugs have fewer side effects which could markedly influence the quality of life compared with other types of psycho- tropic drugs. When symptoms do not remit with antidepressants, the following factors should be focused on : reconsideration of the diagnosis, assessment of side effects, comorbidity, psychoso- cial factors, therapeutic alliance and adherence, and reconsideration of dose settings from the viewpoint of pharmacodynamics. As shown in the major treatment guidelines, it is recom- mended to start with monotherapy and, if it does not work, a switch is recommended, but after this step, we have to depend on augmentation or combination with the burden of side effects. Once polypharmacy is initiated, putting closely categorized antidepressants into one and being careful to minimize withdrawal symptoms and risk factors are the ways to make the prescrip- tion simple. Regarding anxiolytics, clinicians should be aware of factors which could lead to depen- dence, such as short half-life and high-potency drugs used pro re nata, and these factors could result in poly- and high-dose pharmacy as well. Moreover, it will be difficult to reduce doses, as these drugs are associated with withdrawal symptoms. These factors could lead to long use and dependence. To prevent dependence and polypharmacy, administer the lowest effective dose and avoid using them aimlessly. Using booklets to help educate patients to reduce doses gradually, safe discontinuation will be achievable.