i wonder is combining 2 or more antipsychotic is more effective than only 1 antipsychotic? and why? is long acting injectable antipsychotic is better than oral antipsychotic intake? and why?
i need scientific answer and if possible researches on pubmed regarding this issue.
Everyone reacts differently and there is no one way that works for everyone. I prefer low dose monotherapy in the context of a holistic approach.
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Generally you want to avoid being on more than 1 AP because of interactions that leads to more profound sideeffects.
So unless you have very debilitating symptoms I personally would not go down that road.
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LAI is superior to orals. I’m not sure if this is due to adherence, initially I thought that but not I doubt it. I also thought you would increased risk of TD but because of the plausible raid dissociation of second second gen antipsychotics you don’t see this either. LAIs don’t go by first pass metabolism so they are easier on the liver. You get a slight but negligible advantage with LAIs. Mainly the reason for using them is treatment adherence. The main issue with LAIs is that if you get bad side effects your stuck on that dosage for a 2 weeks, a month or more. They are not available for all medications. Theoretically stead state plasma levels might be better. However having more sedation at night to help sleep might be better but then that also by the same token it might be worse since the wash out means that you might have less antipsychotics in your system when you need them during the later parts of the day or that you need to increase overall medication load to get the same effect as an LAI. If you look at this dosage conversion chart then you can see that you can slightly reduce the oral vs LAI injectable dosage. So I would say because of the reduced and less liver stress LAIs are probably the way to go if you plan on staying on the medication long term.
Taking two antipsychotic might provide better results in TRS i.e. look up clozapine augmentation studies but they are generally not recommended because of QT waves and interactions namely increased chances of side effects also polypharmacy is generally discouraged since if you get a negative reaction from one medication it might be harder to know which one.
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