Combination therapy is a characteristic of pharmacotherapy for patients with schizophrenia in Japan, and this can result in megadose polypharmacy. Attitudes of physicians to pharmacotherapy have been changing since the advent of second generation antipsychotics. After 2008,the prescription rate for second generation antipsychotics in Japan exceeded 80%, overtaking that of first generation antipsychotics, but the rate of monotherapy prescription remains low. The increase in the prescription rate for second generation antipsychotics has resulted in a decrease in the combination rate and dose of antiparkinsonian drugs, but no marked change has been seen for anxiolytic/hypnotic drugs,or the combination rate and dose of mood stabilizers. Furthermore,the rate of combination prescription for second generation antipsychotics has increased over the last few years, and further studies of new forms of megadose polypharmacy are now necessary.