Many years ago I dove into a deep and murky pond: the bottomless depths of medical databases that hold mental health research extracted from the bowels of journals from around the world.

I dove in, not as a career choice, but as a survival instinct, when a loved-one entered psychiatric crisis. Above the water line, I found a disjointed and overburdened mental health system offering an array of psychiatric drugs that brought partial symptom relief with a debilitating array of side effects. Below the water line, I grasped for evidence of something better. My loved-one needed options.

I inhaled everything I could find about non-drug options. As weeks turned into months, my initial desperation became rimmed with a band of hope. To my amazement, submerged in this research was a treasure trove: thousands and thousands of gold-standard trials that support the use of non-drug approaches for mental health recovery.

Research says: non-drug options work

After examining over 4000 studies, and hundreds of meta-analyses, I surfaced from my research and was hit with a startling “Aha” moment: non-drug approaches really work.

They generally offer significant symptom reduction, and in some cases, full remission. They have a side effect profile that is dramatically better than drugs: usually none, or quite mild.[1] Unlike drugs, many non-drug approaches target known causes and influencers of mental health issues, not just symptoms. And these approaches help people achieve sustainable wellness.

Non-drug approaches, however, are no panacea. Some approaches work better than others. Some have very strong evidence, others suggestive. Some people don’t get any benefit from certain techniques, while others find them life-altering. Such is the nature of our individuality.

But non-drug approaches are also no fad. They are validated by disciplined peer-reviewed studies. They’re also more than theory. A growing number of practitioners embrace and heal with Integrative Mental Health – a discipline that uses the best of conventional psychiatry and non-drug options.

From symptom relief to a wellness continuum

Surprisingly, there are so many non-drug approaches that we need an organizing structure to make sense of them all. The U.S. Institute of Medicine and European Union of General Practitioners/Family Physicians[2] offer such a framework – a wellness continuum with four categories of care:

• Preventive: Wellness practices that help avoid mental health issues.

• Restorative: Approaches that reinstate mental wellness by addressing root causes.

• Symptom Relief: Methods to minimize mental health symptoms.

• Over-Care Avoidance: Ways to avoid unnecessary and potentially harmful treatment.

Sorting the large basket of non-drug approaches and pouring them into the wellness continuum, the following picture emerges.

Viewing recovery approaches in this context broadens our perspective and helps us see the forest, instead of the trees. It helps us…

• Avoid drug myopia. Drugs are one piece of the puzzle, not a necessary centerpiece.

• Think wellness. Move from a narrow concept of symptom relief to a broad strategy of well-being.

• Choose from a broad menu of options. You and your practitioners can select approaches to build an individualized recovery plan to fit your unique bio-individuality, history, and preferences.

Interestingly, the continuum’s last pillar – over-care avoidance – is a cautionary one. Since psychiatry has the powerful hammer of drugs, most mental health conditions, and many normal life situations, begin to look like nails. This pillar reminds us that hammers can both build and harm.

A large menu: 27 non-drug approaches

Pulling back the covers of the wellness continuum reveals 27 broad non-drug options.[3] These can be best understood by considering them in the following groupings.

Wellness Basics help minimize and avoid mental health issues. Exercise, a nutritious diet, healthy digestion, calm awareness, restful sleep, a safe home, inner grounding, meaningful activity, and social interaction are just a few important basics. Thousands of studies show that these fundamentals have a profound effect on mental health.

Biomedical therapies address many physical issues that impact mental health. These therapies are important since over 25% of mental disorders are caused by or significantly influenced by physical issues.[4]  For lower socioeconomic status individuals, the figure approaches one-half.[5] Although a biomedical analysis is required in the psychiatric differential diagnosis process, it is rarely conducted thoroughly.[6] Robust biomedical testing should be considered mandatory. It may allow precise targeting at root causes: food allergies, gut microbial imbalances, pathogens, hormonal irregularities, environmental toxins, inflammation, oxidative stress, and more.

Of particular promise is Walsh-protocol nutrient therapy. It looks deep into each umbrella diagnosis and identifies an array of different bio-types, each requiring a unique therapeutic response. Over 70% of people receiving individualized nutrient therapy gain substantial symptom improvement – sometimes complete remission – across many diagnoses, often accompanied by a significant reduction in psychiatric drug dosages.[7]

Psychosocial therapies address trauma, stress, emotional difficulties, unhelpful thinking, and more – all of which impact mental health. These therapies work as well as or better than drugs for depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder; and are helpful in avoiding bipolar relapse.[8] Dialectic Behavioral Therapy is the go-to treatment for Borderline Personality Disorder.[9] Open Dialogue offers great promise for first episode psychosis.[10] And none of these have psychotropic side effects. Even though these approaches are effective, they are seldom used.[11]

Symptom Relief goes well beyond drugs. Every diagnosis has associated herbs that can provide relief. A variety of calming sensory therapies aid many diagnoses. And a set of new electrical therapies deliver symptom relief with micro-currents 200 times less powerful than electroconvulsive therapy, from cell-phone sized devices, with no cognitive side effects.

Over-care avoidance works to avert the significant risk of three common psychiatric practices: off-label prescribing (using drugs in ways not validated by FDA trials), polypharmacy (using more than one drug for a particular disorder) and over-prescribing (giving drugs when not medically warranted). Remarkably, 94% of psychiatric off-label prescribing has little or no scientific evidence supporting it.[12]  Outcomes from antipsychotic polypharamacy,[13] and overprescribing for the elderly, [14] are particularly grim. Recognizing these risks, the American Psychiatric Association[15]  and multiple U.S. public health organizations[16] work to curb these practices.

Good news, bad news, and a bit of heresy

The good news is that there are practitioners today who are skilled in using non-drug approaches. They have many titles: integrative psychiatrist, functional medicine practitioner, naturopath, therapist, psychologist, neurogastroenterologist, endocrinologist, and more. In many ways, these practitioners form the leading edge of psychiatry. They offer a much broader menu of recovery options than conventional psychiatry. These practitioners respect the value of drugs, especially in crisis. However, they seek to enhance core wellness through non-drug approaches.

The bad news is that there aren’t nearly enough of these practitioners. Their care is often only partially covered by medical insurance, if at all. By necessity, they focus on only a subset of the total menu of options, requiring coordination of care across multiple practitioners. Additionally, many non-drug approaches aren’t valued in the Diagnostic and Statistical Manual (DSM) – the U.S. psychiatric bible – so using them may be at odds with conventional mental health practitioners.

Individuals with mental health challenges articulate a recurring theme, an urgent plea, and a critical demand: people need options. Drugs simply aren’t enough.  

After swimming in this research, I submit a bit of heresy: we have a cornucopia of options. Although research must continue, the major task before us is not creating more options. Rather, we must…

• Understand and broadly employ the non-drug options already in hand

• Significantly expand practitioner training on the most effective non-drug treatment protocols

• Use robust biomedical and psychological evaluations to inform non-drug therapy selection

• Refresh the DSM to reflect the significant evidence-base for non-drug treatments

• Eliminate the many barriers that curtail access to non-drug treatments

• Reorient our time, enthusiasm, and resources to make these solutions available to those in need

Nobody said this was going to be easy.

The path forward

The path ahead is long and crooked. To move forward, we must change our consciousness about non-drug treatments. They aren’t quackery. They are potentially life-altering tools. They aren’t perfect, but they work. 

To achieve this change of consciousness, let us be both a burr under the saddle and a beacon in the darkness. Both are required for progress. And as this consciousness is changed, we set the stage for the greater task: the herculean effort of reconstituting psychiatry.

Detail on the 27 non-drug options of Integrative Mental Health can be found in the book, Choices in Recovery.

Epilog: Once I realized that non-drug approaches worked, my head reeled with cognitive dissonance. Why are so few practitioners using them? After all, good research, like nature, abhors a vacuum. Why wasn’t this research spreading like wild fire? Over time, the answer hit me. There are few nefarious bad guys, no lack of willing ears, and no paucity of smart people. Rather, there is an overabundance of the one thing that always seems to oppose good ideas: a mountain of institutional inertia.

Thankfully, we don’t need to fight all of that inertia right now. Instead, we must navigate that inertia with a little Sun Tzu indirection to enable our victory in the art of war that is personal recovery… But that, my friends, is a worthy subject of an upcoming post.

* * * * * * * *

[See extended public comments on this post at Mad in America.]

©Craig Wagner 2017. From www.OnwardMentalHealth.com, your site for integrative mental health resources, tools, and insight. 

[1] Brown R et al, How to Use Herbs, Nutrients and Yoga in Mental Health Care, WW Norton & Co, 2009, http://goo.gl/cWlG0g.

[2] Katz D et al, Preventive Medicine, Integrative Medicine & Health of the Public, Commissioned for the US Institute of Medicine, 2009, http://goo.gl/RWOPrb; European Union of General Practitioners/Family Physicians, UEMO position on Disease Mongering / Quaternary Prevention, 2011, https://goo.gl/usrpEC.  “Preventive”, “restorative”, “symptom relief” and “over-care avoidance” are more descriptive terms and used in place of “primary”, “secondary”, “tertiary” and “quanternary” used in these references.

[3] Wagner C, Choices in Recovery – 27 non-drug options for adult mental health – and evidence-based Guide, Onward Mental Health, 2017. https://goo.gl/9JMXOZ.

[4] Koranyi EK et al, Physical illnesses underlying psychiatric symptoms, Psycho Psychosom. 1992, PMID: 1488499, http://goo.gl/V9Wi23.

[5] Hall RC, Physical illness manifesting as psychiatric disease. II. Analysis of a state hospital inpatient population, Arch Gen Psychiatry. 1980, PMID: 7416911.

[6] First M, Essentials of Making an Accurate Psychiatric Diagnosis, Video from online Psychiatric Times, 2014, http://goo.gl/bvtPuF.

[7] Walsh W, Nutrient Power Heal Your Biochemistry and Heal your Brain, Skyhorse Publishing, 2014, http://goo.gl/DxoIvQ.

[8] Canadian Psychological Assoc, The Efficacy and Effectiveness of Psychological Treatments, 2013, http://goo.gl/ysJzMf.

[9] DeVylder JE, Dialectical Behavior Therapy for the Treatment of Borderline Personality Disorder: An Evaluation of the Evidence, 2010, International Journal of Psychosocial Rehabilitation, http://goo.gl/JxtpCb.

[10] SEIKKULA J et al, Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies, Psychotherapy Research, 2006, https://goo.gl/7g4N56.

[11] Farah WH et al, Non-pharmacological treatment of depression: a systematic review and evidence map, Evid Based Med. 2016, PMID: 27836921.

[12] Radley DC et al, Off-label prescribing among office-based physicians. Arch Intern Med. 2006, PMID: 16682577, https://goo.gl/swRvVr.

[13] Waddington JL, Mortality in schizophrenia. Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study, Br J Psychiatry 1998, PMID: 9926037, http://goo.gl/e0vaXZ.

[14] Mientka M, Antipsychotic Medications Overprescribed For Everything, From Hyper Children To Nursing Home Residents, Medical Daily, 2013, http://goo.gl/aCXHQn.

[15] American Psychiatric Association, Five Things Physicians and Patients Should Question, Choosing Wisely, 2015, http://goo.gl/t3blZ8.

[16] BCBS of Illinois, National Initiative Examines Antipsychotic Drug Use in the Elderly, Open Letter, August 2014, http://goo.gl/HmU3YL.