As a young boy growing up, Saturday mornings typically began at 7am with me sitting on the floor in our family den watching Roy Rogers and the Cisco Kid. I may not have always understood the plotlines, but it was clear to me who the good and bad guys were and what respective hats they wore.

Such a good guy/bad guy distinction is not nearly as clear when it come to polypharmacy because it is not a simple black-or-white issue; instead it is nuanced and complex.

To most, the word polypharmacy means “many drugs.” And although this is true, the reasoning that so often emanates from this is that many drugs is “too many.” This simply isn’t true in some instances. Here’s why:

The core issue is not how polypharmacy is defined or the number of medications employed. What’s important is whether the utilization of multiple drug treatments carries an accompanying therapeutic benefit that manifests as discernable symptom improvement in the affected patient. Sometimes it doesn’t because at the first sign of treatment non-response, some prescribers find it necessary to pile on more drugs in the absence of clear rationale or good data. Fueled by “more is more” thinking, such prescribers tinker with a patient’s drug regimen to excess.

Polypharmacy can be beneficial though when it provides more options to help patients achieve better outcomes. Bipolar disorder comes to mind. Severe bipolar I disorder may require several medications to effectively manage the manic and depressive symptoms in both the acute and maintenance phases of treatment. Also, multiple medications may be necessary to treat mental disorders accompanied by physical health problems and other co-morbidities such as diabetes and hypertension.

The most important issue in medication management – regardless of the context – is to conceptualize a reason for each drug choice. This requires careful thought and planning, a healthy respect for the benefits/risks of adding or discontinuing from a patient’s regimen and a thorough knowledge of the kinetics, dynamics and characteristics of all medications being considered for use.