Reply to Letter to the Editor "Polypharmacy of 2 Atypical Antipsychotics"

Letter to the Editor

Sir: In response to my article on antipsychotic polypharmacy, Dr. Rhoads reports serendipitous observations of a schizoaffective patient who apparently did much better on treatment with a combination of clozapine and olanzapine than she did with either agent alone. A number of anecdotal observations like his are beginning to make their way into the medical literature, usually as case reports or uncontrolled case series. For example, both risperidone and loxapine have also been reported to have favorable effects in augmenting clozapine’s efficacy in a small number of schizophrenic or schizoaffective patients. A recent report by Taylor et al. is the largest series to date (13 patients with only partial responses to clozapine monotherapy) and, although an open study, did use standardized rating scales to rate symptoms on nonclozapine monotherapy, clozapine monotherapy, and risperidone augmentation of clozapine. Their results suggest that 4 patients were much improved, 6 patients minimally improved, and 3 patients were unchanged when risperidone was added to clozapine.