Recovery from schizophrenia
 
The conventional medication approach

Antipsychotics are the most commonly prescribed treatment for schizophrenia. In many cases, their sedative power reduces psychosis symptoms, including decreasing delusions and hallucinations. They also can save lives and be helpful in times of psychiatric crisis. 

However, individual reactions to antipsychotics vary widely. Some find them important to help achieve and maintain stability, while others find them ineffective or intolerable. A wide variety of side effects are common and can be debilitating.

But, most troubling is the prolonged use of these drugs. Examining research on recovery from schizophrenia, the past Director of the National Institute of Mental Health (NIMH) reached a stark conclusion

"Remaining on [antipsychotic] medication long-term might impede a full return to wellness". [1]

This startling comment is grounded in research that shows that people with schizophrenia who avoid antipsychotics are much more likely to achieve long-term recovery than those who use them. [2]

This conclusion is consistent with a study of people living in recovery from psychosis. Their experience was that antipsychotic drug use beyond the initial acute phase compromised their ability to function normally and contribute to their own recovery. [3]  They felt that long-term use of these drugs impeded their recovery due to their adverse physical and cognitive effects, and a decreased sense of self-agency.

Award-winning medicine and science writer Robert Whitaker summarized the research on long-term antipsychotic use. He, too, challenges their long-term use. Although the debate continues [4, 5], it remains clear that antipsychotics have significant and serious limitations. Placing the results of a number of gold-standard studies into a single graphic highlights the magnitude of these limitations (links to the actual studies found below):


Your health, your choice
Although the significant majority of doctors find that short-term antipsychotic use can be valuable in some situations, a growing number are restricting the use of antipsychotics to a minimum. 

The combined weight of negative evidence is leading many doctors to conclude that antipsychotics are a significantly flawed and potentially dangerous long-term option, especially for the developing brain and personhood of a child. These practitioners are driving a fundamental paradigm shift in psychiatry toward integrative mental health. They conclude that our mind, body and emotions require a much more holistic and integrated approach than a pill can provide. 

In addition, many people diagnosed with schizophrenia take multiple psychiatric drugs (called polypharmacy), a practice that lacks sufficient gold-standard trials to be considered strongly evidence-based. Polypharmacy is also associated with worsening outcomes [6] and can lead to a troubling prescribing cascade where new drugs are increasingly added to address side effects created by previous ones. This can create a growing burden of medication-induced toxicity in the body and a situation where the impact of every individual drug becomes unclear.

Understanding these realities, many people are reevaluating the risk/reward profile of antipsychotics and polypharmacy, and are working to take a more holistic evidence-based approach to their recovery.

Your practitioners are your trusted guides. Consider reviewing the above information on antipsychotics and polypharmacy with them. You may want to discuss the specific studies referenced below. 

The good news is that there are a number of non-drug approaches that have been shown to substantially reduce psychotic symptoms without the troubling short- and long-term side effects of antipsychotics. These approaches includes both biomedical treatments and psychosocial interventions that can sometimes lead to full remission. These non-drug approaches also leverage common sense approaches to wellness.

Always work with trusted and licensed practitioners.  Any changes in psychiatric drug use should always be done under practitioner care. Please see disclaimer.


An integrated wellness approach

There are thousands of peer-reviewed gold-standard medical studies that support the use of non-drug approaches for mental health recovery. In fact, there are 27 broad non-drug approaches that have proven effective. Many are useful for schizophrenia (download free monograph).

It is often best to consider schizophrenia from a holistic perspective that includes many therapeutic options separated into four categories of care.


The "higher" in this diagram we operate (toward Preventive), the better, since these are the approaches that help us sustain mental wellness. However, once we develop psychotic symptoms, it may be helpful to use techniques in multiple categories simultaneously to maximize recovery. 

Preventive care
Preventive approaches include a number of common sense practices we can adopt that often have a significant impact on mental health. Ones that have been proven helpful for schizophrenia include a safe home, proper diet, food-allergy care, exercise, calm awareness, social connections, mind-body disciplines (like yoga), and others.

Restorative care
Restorative approaches address root-causes and direct influencers of mental health symptoms. They come in two varieties: biomedical and psychosocial. Since our body and mind interact so deeply, it is often helpful to address both at the same time.

Biomedical practitioners help identify your unique bio-individuality through blood/urine and other testing, using detailed biomedical test panels. This is important since over 25% of the time, mental health symptoms are caused by or significantly influenced by physical issues. These tests can uncover nutrient imbalances, hormonal issues, amino acid irregularities, food allergies, pathogens, inflammation, toxicities, or other root-cause physical conditions. Walsh-protocol nutrient therapy has been found to be particularly effective: 75%-80% of people with schizophrenia who undergo 6 months of nutrient therapy report significant symptom improvement and the ability to reduce medication, while about 5% can eliminate medication altogether. [7] To help you locate practitioners, review our Integrative biomedical mental health practitioner finder

Psychosocial practitioners can help identify and address an individual's past trauma, stress, social challenges, emotional difficulties and unhelpful thinking patterns that can cause or influence psychotic symptoms. This is important since assistance is often helpful to work through issues that may be difficult to overcome alone. Cognitive Behavioral Therapy for Psychosis and individual psychotherapy have been shown to be helpful. Open Dialog has shown strong success in first-episode psychosis. [8]  A variety of trauma-informed therapies are also available, since childhood trauma is much more common in those with psychosis. In addition, peer support - working with people who have recovered from mental health issues and who can provide first-hand guidance - can be very important. Directories of therapists, psychologists, peer specialists and other psychosocial practitioners are usually available in your community.

Symptom-relief care
Symptom relief approaches seek to address any residual symptoms that are not removed by preventive and restorative care. Although antipsychotics are by far the most common form of symptom relief prescribed for psychosis, some herbs, sensory therapies and very low charge electrical devices have been shown effective to reduce symptoms.

Over-care avoidance
Over-care avoidance limits the use of psychiatric drugs and other medical interventions to only what is necessary. It is important to avoid excessive medical care since it is not only expensive, but can be harmful. 

Most often, this is limiting drug dosages, drug combinations and the duration of psychiatric drug use to minimize the many potential side effects and withdrawal difficulties. One form of over-care that is associated with very negative outcomes is antipsychotic polypharmacy - using more than one antipsychotic at the same time. As a result, the American Psychiatric Association and American Board of Internal Medicine are actively working to curb these practices. [9

However, some people find psychiatric drugs helpful. When using drugs, they should be taken in minimum effective dosages - no greater than the amount needed to gain significant symptom relief and for no longer than is required. 

Work with trusted integrative practitioners
Many practitioners are joining the paradigm shift to Integrative Mental Health - a discipline that embraces the best of conventional and non-drug treatments.

We are all different and require individualized paths to recovery. Integrative practitioners offer a variety of therapy options, and can advise you on the ones most appropriate for your bio-individuality, personal history, stressors, and preferences. Through experimentation, you can find the ones that work best for you. If your practitioners do not offer non-drug options, it is often best to engage practitioners that do. 

Dr. Kenneth Duckworth, Medical Director of the National Alliance on Mental Illness, is clear: "psychiatric medications... are rarely enough to promote recovery alone [10] ... many (people) report that a combination of treatments is most effective."[11]  In support of this outlook, NAMI advocates select non-drug options that can aid recovery [12] while Mental Health America articulates many more. [13]

Although non-drug approaches are not a universal panacea and they take more work than popping a pill, many people have found that non-drug options can significantly reduce the symptoms of schizophrenia with little or no side effectshelping them realize mental health recovery.

Resources