ASCP 2026 Task Force Reaches International Consensus on Psychiatric Polypharmacy

An international task force convened by the American Society of Clinical Psychopharmacology (ASCP) has reached broad expert consensus on key principles surrounding psychiatric polypharmacy, S. Nasir Ghaemi, MD, MPH, told Psychiatric Times at the 2026 ASCP Annual Meeting in Miami, Florida.¹

The presidentially appointed task force was chaired by Joseph Goldberg, MD, and included 60 international psychopharmacology experts representing clinical trialists, psychopharmacology educators and investigators, academic pharmacists, psychiatrists, and authors of previous practice guidelines. Consensus was arrived via a Delphi process, leveraging experts’ attitudes and beliefs about such issues as criteria for polypharmacy treatments, mechanisms of action and drug-drug interactions, sequential versus simultaneous augmentation strategies, as well as safety and tolerability.

“We did get over 90% consensus from international experts on 50 or so questions,” Ghaemi reported. The work represents one of the first organized efforts to systematically capture expert consensus around psychiatric polypharmacy practices. “It’s never been done before, actually,” he said.

The task force manuscript has been completed and is expected to be submitted to The Lancet Psychiatry, Ghaemi added.

Experts Emphasize Monotherapy Before Polypharmacy

“There was a general consensus that it’s always better, of course, to use fewer medications rather than more,” Ghaemi said. To do that, the task force recommended that clinicians begin with monotherapy before considering combination approaches.

“When people start using multiple medications, it’s often because either the diagnosis isn’t good enough or the medications aren’t good enough,” Ghaemi told Psychiatric Times.

“When you see that someone’s on multiple medications, it’s really important to reassess diagnosis,” he added. “The diagnosis is key to making sure you’re using the right medications.”

To avoid excessive prescribing, Ghaemi described a personal clinical rule aimed at limiting accumulation of psychiatric medications over time.

“Every time you add a medication, you should stop a medication,” he told Psychiatric Times. “If you do that, you won’t end up in the polypharmacy problem of being on four, five, six, seven medications.”

According to Ghaemi, he rarely treats patients with more than 2 or 3 psychiatric medications simultaneously.

Complicated Cases and Polypharmacy Risks

One problem that can come of polypharmacy, Ghaemi cautioned, are balancing adverse effects and diminishing clinical benefit as additional medications are added.²

“When you get past a certain point, the side effects add up, the benefits are less, and the benefits are not as much as the harms,” Ghaemi said.

Ghaemi also discussed how polypharmacy frequently develops in routine psychiatric practice through symptom-targeted prescribing.

“What usually is the case is that clinicians are giving a drug for a symptom,” he said.

He described how medications may be sequentially added for sleep, anxiety, energy, cognition, and mood symptoms, ultimately resulting in large medication regimens. “That’ll add up easily to five, six, seven drugs,” Ghaemi said.

Ghaemi noted that the discussion surrounding psychiatric polypharmacy differs from appropriate treatment of multiple medical comorbidities in older adults, where use of several medications may be clinically necessary.

Dr Ghaemi is a lecturer on psychiatry at Harvard Medical School, Cambridge Health Alliance, and is employed by Bristol Myers Squibb. The views expressed are solely those of the author and do not necessarily reflect the official policy or position of his employers. His latest book, Soul on Fire, explores the life and psyche of Martin Luther King Jr and the psychology of nonviolence.

References

1. Goldberg J, Ghaemi N, Kuruvila, et al. Findings From the ASCP Presidential Task Force on Psychotropic Drug Polypharmacotherapy. Presented at the 2026 ASCP Annual Meeting; May 26-29, 2026; Miami, FL.

2. Ghaemi SN. Polypharmacy in Psychiatry. CRC Press; 2002.