Dangers of Polydrugging 

What is Polypharmacy and Polydrugging?

Polypharmacy¹  refers to the concurrent use of multiple medications by a patient. In the context of mental health and psychiatry, it is often specifically termed polydrugging - the practice of prescribing two or more psychotropic medications simultaneously. While sometimes viewed by mainstream medicine as a way to target overlapping symptoms (such as adding a sedative to an antidepressant for sleep), stacking multiple CNS activating drugs create a complex pharmacological puzzle that can severely jeopardize a patient's neurological stability.

Why does Polydrugging Happen?

Patients rarely start out taking multiple psychiatric medications at once. Instead, polydrugging usually happens through a compounding cascade of mismanaged symptoms within the medical system:

1. The Masking of Tolerance

When a patient is prescribed a drug like a benzodiazepine or an antidepressant for a prolonged period, the brain builds tolerance,² ³  causing original symptoms to return, worsen and increasing risk of interdose withdrawal symptoms, particularly in the case of benzodiazepines.⁴  Instead of recognising tolerance, clinicians may add a second or third drug to suppress the emerging symptoms. 

2. Treating Side Effects as New Conditions

If a medication causes severe insomnia, agitation or anxiety, a prescriber may add a new medication to counteract these specific side effects rather than addressing the root cause.

3. Diagnostic Overshadowing 

Complex physical symptoms arising from a sensitive or injured nervous system can be misinterpreted as psychiatric relapse,⁵ prompting prescribers to continually expand the pharmacological cocktail. This can cause devastating consequences for patients. 

The Dangers of Polydrugging 

Combining multiple psychotropic drugs places an extraordinary burden on the central nervous system:

Each psychotropic drug alters brain chemistry across different pathways (such as GABA, serotonin, dopamine, or calcium channels). Combining them creates a multi-layered pharmacological picture that can make future tapers considerably more complex and difficult to predict.⁶  The risk of severe side effects - from emotional numbing and cognitive dulling to autonomic instability and akathisia - increases dramatically with every additional drug introduced. 

When a patient on a multi-drug regimen attempts to heal or taper, they face a grueling obstacle. Trying to taper one drug while the others mask, distort or destabilise the central nervous system turns discontinuation into a protracted clinical minefield. 

References

1. Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17, 230. https://doi.org/10.1186/s12877-017-0621-2

2. National Institute for Health and Care Excellence. (2022). Medicines associated with dependence or withdrawal symptoms: Safe prescribing and withdrawal management for adults (NICE guideline NG215). https://www.nice.org.uk/guidance/ng215

3. World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652

4. Lader, M. (2011). Benzodiazepines revisited—will we ever learn? Addiction, 106(12), 2086–2109. https://doi.org/10.1111/j.1360-0443.2011.03563.x

5. National Institute for Health and Care Excellence. (2022). Medicines associated with dependence or withdrawal symptoms: Safe prescribing and withdrawal management for adults (NICE guideline NG215). https://www.nice.org.uk/guidance/ng215

6. Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538–546. https://doi.org/10.1016/S2215-0366(19)30032-X