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Consensus Statement November 9, 2026

The American Society of Clinical Psychopharmacology Task Force Consensus Statement on Combination Psychopharmacology

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J Clin Psychiatry 2026;87(4):26cs16574

Abstract

Objective: Combination psychopharmacology is common but understudied. Expert guidance is needed to help practitioners follow rationale-based principles when devising and maintaining polydrug regimens.

Participants: The American Society of Clinical Psychopharmacology (ASCP) convened an expert Task Force composed of 60 academic clinical psychiatrists and psychiatric pharmacists from 16 countries. Members developed and completed a 2-round Delphi survey on the use of combination psychopharmacology.

Evidence: Survey content focused on experts’ opinions regarding pharmacokinetic and pharmacodynamic interactions, efficacy vs tolerability risk-benefit analyses, and clinical decision-making. Gaps were identified between evidence-based literature, personal experience, and pharmacologic rationales.

Consensus Process: Consensus (defined as ≥75% agreement [or disagreement] with “strong” or “moderate” ratings) was achieved on 62/66 items (94%). Findings encompassed several principles: (1) General: (a) reserve combination psychopharmacology for complex, comorbidly ill, treatment-resistant presentations; (b) favor complementary/nonredundant drug mechanisms; (c) recognize drug-drug interactions; (d) focus on the mechanistic coherence of polydrug regimens rather than sheer number of components; (e) proactively address cumulative adverse effects; (f) prioritize patient preference via shared decision-making. (2) Specific: (a) avoid nonclozapine antipsychotic combinations; (b) favor switching over augmenting after minimal improvement. (3) Strategic: (a) before augmenting, assure/update diagnoses, dose optimization, adherence, and alignment to therapeutic targets; (b) individualized decisions should govern sequential versus simultaneous pharmacotherapies for comorbidities; (c) consider when adjunctive psychotherapies are preferable to polypharmacotherapies.

Conclusions: In the context of limited research, the consensus recommendations from this Task Force can help practitioners identify clinically driven principles that shape coherent multidrug regimens and identify issues in need of further empirical investigation.

J Clin Psychiatry 2026;87(4):26cs16574

Author affiliations are listed at the end of this article.

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