Combination Therapy: Is Clinical Practice Leading the Way?

Letter to the Editor

Sir: In "Antipsychotic Polypharmacy: Squandering Precious Resources?" Dr. Stahl’s primary recommendation that we should give adequate and extended trials of atypical antipsychotics as alternatives to combination therapy is good advice and no doubt largely accepted in clinical practice. However, the recommendation to try some agents at higher doses, particularly olanzapine and quetiapine, suffers the same difficulties the author noted for combination therapy. Namely, this option is not supported by good controlled data, atypicality may be compromised, and the cost increases dramatically.