The Making of Codex Alternus: What We Can Learn About Research on Non-Traditional Psychiatric Treatments

I will start with (1): Contrary to popular belief there is an abundance of choices of therapies for persons suffering from serious mental illness. In Codex Alternus there are nearly 560 therapies for all medical conditions listed in the table of contents. Approximately 270 therapies are listed for “schizophrenia” alone, and there are approximately 80 listed for “bipolar disorder.” There are nearly 90 therapies for medication-induced side effects, and for the extrapyramidal symptoms section there are 106 therapies listed. There also are 15 assorted complementary therapies listed for those who use electroconvulsive therapy.

Often drug-dependent psychiatric consumers and orthodox mental health professionals think there are few – if any – choices other than psychotherapy and drugs for the treatment of mental illness. There are many reasons for this:

1. Traditional mental health professionals and consumers think that there are few alternatives therapies choices because they have little exposure to the research that does appear in journals.
2. Traditional mental health professionals don’t often network with physicians who practice CAM medicine—often because there are so few who practice CAM.
3. Traditional mental health professionals have no financial incentives to look for solutions other than drugs and therapy.
4. Physicians’ education comes from pharmaceutical drug representatives or other physicians who are speakers with ties to the pharmaceutical industry, and consumers’ education comes from doctors, nurses, social workers, internet websites and outpatient programs which often teach a drug/therapy paradigm.
5. The professionals have biases against alternative and complementary medicine.
6. Consumers don’t know how to define and use CAM therapies that help with mental health conditions.

Codex Alternus offers a variety of Western techniques, including vitamins, amino acids, peptides, hormones, micronutrients, electronic stimulation techniques, mindfulness, meditation, mind-body therapies, and more. In addition, it includes a very large number of options, primarily herbal in nature, from non-Western medical systems including Ayurvedic (India), traditional Chinese medicine, Kampo medicine (Japan), and even African traditional medicine. The book is intended for clinicians and researchers, however consumers may benefit if they conduct research on the topics in the book before utilizing them. They will find that according to research, there are many alternative and complementary solutions for the treatment of psychosis and affective disorders with drugs, and there are therapies for those who choose not to use drugs. There is hope—spread the word!

Followers of natural medicine need to help promote safe and effective therapies to all mental health consumers. I recommend that they blog on Mad in America, providing testimonials of success with natural “antipsychotics” and add-on agents that help to reduce psychopathology.

The second thing I learned was that many of the therapies in the Codex Alternus improve the effectiveness and/or safety of psychotropic drugs.

When I say that alternative therapy may improve the safety of psychotropic drugs, I mainly am referring to the fact that antioxidants help to relieve oxidative stress caused by psychiatric drugs, and that supplements help to replenish nutrient depletion caused by psychiatric drugs. Further; many diets, mind-body therapies and exercises are healthy and promote better well-being, helping to keep the consumer from deteriorating as a result of the psychiatric drug.

Nearly every psychiatric drug has some kind of drug-nutrient-herb interaction—it varies with drug class, sometimes even with each individual type of psychotropic drug. While interactions with herbs are more common than with nutrients, more often than not psychiatric drugs (including AED mood stabilizers) deplete nutrients causing either subclinical or classical physical and mental symptoms. But in many cases herbs and nutrients work synergistically with psychotropics, enhancing the effectiveness.

In the cases of nutrient depletion caused by psychotropic drugs it is necessary to inform every practicing professional that these drugs are not safe without nutrient support. Long-term use of these drugs without nutrients may be one of the reasons we often see a poor response from the drugs; a decline in health in the patient, and reoccurring psychotic, depressive or anxiety symptoms. In the book there is a drug-nutrient-interaction chart for psychotropic drugs and it covers the importance of nutrient depletion, interactions and synergistic relationships.

Further, Antipsychotics and mood stabilizers such as lithium carbonate and valproic acid (Depakote) cause oxidative stress on the body. This increases the rate of breaks in the DNA, increases allostatic load and the rate of aging as well. Antioxidants often will help reduce the oxidative stress associated with the use of antipsychotics, however they are not a substitute for abstinence or drug withdrawal. They are necessary for people on short- and long-term antipsychotic therapy, and help preserve some of their physical and cognitive deterioration from the drugs. In Codex Alternus there is a listing of numerous studies that have shown antioxidants to help with oxidative stress—some are green tea, resveratrol and quercetin, among others.

Codex Alternus is full of research statistics. The references range from major meta-analyses to smaller suggestive studies and even some individual case studies. Of special help is a condensed quote of 2-4 sentences pulled directly from the results and conclusions of each study to give you a sense of the size, nature and key findings. These studies may provide research statistics on p values, PANSS scores, effect sizes, etc., that can be used to determine the efficacy of the therapies of interest.

Another thing I learned is (3): Out of all the psychiatric research on natural medicine there are only a handful of drug-naïve studies (98% is complementary add-on case reports and clinical trials).

Since psychiatry’s current paradigm is that medications are a necessary therapeutic tool for the treatment of schizophrenia and bipolar disorder, we will find that 98% or so of the clinical trials and case reports have only add-on therapies, to supplement an antipsychotic or mood stabilizer. Some of these clinical trials in Codex Alternus have been funded by pharmaceutical companies, and others have been funded by research grants from institutions that rely on pharmaceutical drug funding. Some of the objectives of the research are to find the biological mechanisms in which these natural substances affect the body and brain at a cellular level for the development of future drugs and synthetic derivatives. So, the possibility is that their objective is not to promote a natural substance for therapeutic clinical purposes.

Monotherapies used in drug-naïve persons are rare, and more studies should focus on a drug-naive paradigm to provide information on the true therapeutic value of the many alternative therapies. Without these studies it is hard to determine the value of many of the studies in the Codex Alternus if used in drug-naive persons. It may be a general assumption that there will be a therapeutic response; however the magnitude of the efficacy that the drugs contribute to total outcome is not known. Complementary therapy with many alternative therapies can be assumed to be more effective than monotherapy, but we need more trials that compare to treatment without psychotropics—not as an add-on. There are a few studies on monotherapies (many are case reports), which may be a starting ground for patients wanting to become drug-free.

Conclusion:

In summary, there are numerous evidence-based options for treatment of the severely mentally ill; including their drug-associated side-effects such as tardive dyskinesia. Getting the word out that there are alternatives is a priority. All consumers, and survivors and mental health professionals must educate each other and spread the word that there are safe and effective add-on therapies and replacements for psychiatric drugs.

Before many patients will accept that there is a need for alternative medicine they must understand the harms of psychiatric drugs. The use of complementary medicine is a first step for helping drug-dependent patients; the second is the use of alternative medicine and drug withdrawal. For more info on alternative and complementary therapies for serious mental illness please purchase the book: “Codex Alternus: A Research Collection of Alternaitve and Complementary Treatments for Schizophrenia , Bipolar Disorder and Associated Drug-Induced Side Effects.”

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