Mental Health World Conference 2026

Abstract

Introduction Polypharmacy in psychiatry, defined as the concomitant use of multiple psychotropic drugs, has become increasingly common, with reported prevalence rates ranging from 13 percent to 90percent. Despite its growing use, evidence supporting many pharmacological combinations remains limited. Symptom targeted prescribing has been identified as a key factor contributing to progressively more complex therapeutic regimens, raising questions about patients perceptions of their treatment.

Objectives To critically review the evidence on polypharmacy in psychiatry, focusing on its prevalence, associated clinical risks, and the role of symptom targeted prescribing in its development.

Methodology Narrative review based on observational studies, reviews, and recent clinical consensus documents, analysing three dimensions: prevalence, clinical consequences, and underlying mechanisms of polypharmacy.

Results Polypharmacy is a frequent and growing practice. Longitudinal studies suggest approximately one third of patients may be over medicated, with multiple drugs and higher doses associated with greater adverse effect burden. Evidence supporting many psychopharmacological combinations is limited, with unclear additional clinical benefit in various contexts. Symptom targeted prescribing emerges as a main contributing mechanism, as a fragmented approach leads to progressive medication accumulation. This pattern is particularly evident in conditions lacking robust pharmacological indications, such as borderline personality disorder. Polypharmacy is further associated with increased drug interactions, adverse effects, reduced adherence, and worse clinical outcomes.

Overdiagnosis in psychiatry represents an additional contributing factor to over medication.