8 Years of Mental Health Research Distilled to 4 Infographics

Craig Wagner
71
5210

Pictures are worth a thousand words. They can distill mountains of detail into essential understandings. So I’ve chosen pictures to distill the mountain of mental health research I’ve examined over the last eight years. Three infographics summarize research on psychiatric drugs, and one asserts why I think Integrative Mental Health is the best path available for mental health recovery.

First, antidepressants.

Antidepressant Limitations

The FDA1 and meta-analyses2 tell us that the advantage of antidepressants over placebo for treating depression is razor thin; so small, in fact, that most people can’t tell the difference. To gain this small advantage people must accept antidepressants’ side effects, risks, and limitations which can be significant. Even more startling, at milder symptom levels — representing about 85% of people taking these drugs for depression — antidepressants have no advantage over placebo.3

Second, antipsychotics.

Antipsychotic Limitations

For many people, antipsychotics reduce psychosis. But less than a quarter of those with chronic psychosis see even a 50% reduction in symptoms when using them.4 And this partial symptom relief often comes with life-altering side effects. Additionally, evidence suggests that antipsychotics may do more harm than good in the long term.5

Finally, benzodiazepines.

Benzodiazepine Limitations

Benzodiazepines can reduce anxiety, often quickly. But prescribing guidelines say their use should be restricted to very short durations. There is good reason: significant cognitive decline and potentially life-threatening withdrawal make them a questionable solution beyond episodic anxiety.

Psychiatric drugs, the big picture

These infographics paint a troubling reality of psychiatric drugs. It isn’t surprising that most carry the strictest FDA warning, a black box. But there is another reality: some people find meds indispensable.

This hit home with me last fall at the Massachusetts Psychiatric Rehabilitation Association summit. After I presented these infographics I received nods of recognition as people saw their own experience in the numbers. But at the break, a peer support specialist spoke with me. “I’ve been on Clozapine for years,” she said. “It’s the only thing that works for me. It’s what allows me to do my job.”

So these infographics don’t suggest a mass exodus from drugs. Rather, they suggest exercising informed caution if you choose to use them. The risk/reward profiles of these drugs are much more questionable than their ubiquitous prescribing might indicate.

The infographics contain another message: look beyond drugs to other approaches that give more avenues for recovery. Thankfully, many such options exist.

Integrative Mental Health and the web of causation

Integrative Mental Health is an emerging paradigm that provides a diverse set of evidence-based options that include, but go well beyond, medication.

Unlike conventional psychiatry which focuses on symptoms and prescribes drugs to reduce them, integrative practitioners seek to understand and treat the causes that lie beneath the symptoms. They probe for markers of biological, social, environmental, and habitual factors unique to the individual.

They see these factors interacting in a dynamic web of causation. Some people have one factor that strongly predominates. Others strain under the accumulated weight of many smaller issues. And sometimes a minor incremental stressor can be the straw that breaks the camel’s back and ushers in a crisis of mental distress.

Here is a conceptual view of the web of causation, highlighting factors shown in research to be associated with mental distress.

Causes and Influencers

Integrative practitioners perform biomedical testing, psychosocial evaluation, and probe personal history to understand this web. They address suspected causative factors, selecting from a menu of 27 evidence-based non-drug options. These include diet, exercise, digestive care, calming practices, nutrient supplements, herbs, psychological therapies, and much more. Nearly all these options have very low or no side effects and can be used with drugs. This is good news since drugs can be a part of the equation as well.

In thousands of cases, these customized interventions have significantly decreased symptoms, allowing drug dosages and associated side effects to be greatly decreased. In some cases, symptoms are completely eliminated without drugs.

Although Integrative Mental Health is showing great promise, it isn’t a silver bullet. We don’t know all the factors that influence mental distress and we can’t fully address all those we know. They also can take weeks or months to show full benefit and practitioners are hard to find.

But there is good reason to be hopeful. People who live in recovery overwhelmingly report that a combination of approaches was needed,6 and the growing number of integrative practitioners can help provide them.

Changing Awareness

There is significant work ahead if we are to reap the benefits of Integrative Mental Health. It starts with communication.

We must communicate the risk/reward profile of psychiatric drugs, so people know to look beyond them. But we must also communicate that some people find drugs necessary.

We must communicate the full menu of available recovery options, so people and their practitioners can craft the best path forward. We must communicate the remarkable stories of recovery to give hope to those in distress. And we must communicate that recovery is not only possible but should be expected.

That’s a lot of communication.

To make it easier, let’s use pictures. They’re worth a thousand words.

*****

Infographic footnotes:

Antidepressants [link]

Antipsychotics [link]

Benzodiazepines [link]

Show 6 footnotes

  1. Laughren T, Treating Depression: Is there a placebo effect?, CBS News, 60 Minutes broadcast, 2012, https://goo.gl/ug78Av.
  2. Khan, A et al, Antidepressants versus placebo in major depression: an overview. World Psychiatry, 2015, PMCID: PMC4592645.
  3. Fournier JC et al, Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA, 2010, PMCID: PMC3712503.
  4. Leucht S et al, Sixty Years of Placebo-Controlled Antipsychotic Drug Trials in Acute Schizophrenia: Systematic Review, Bayesian Meta-Analysis, and Meta-Regression of Efficacy Predictors, 2017, Amer J of Psychiatryhttps://goo.gl/bndxBq.
  5. Insel T, National Inst of Mental Health Director’s Blog: Antipsychotics: Taking the Long View, Aug 2013, http://goo.gl/LFmP0V.
  6. Duckworth K, Science Meets the Human Experience Integrating the Medical and Recovery Models, NAMI Advocate Magazine, Winter 2014, https://goo.gl/iF6EWy.

Support MIA

MIA relies on the support of its readers to exist. Please consider a donation to help us provide news, essays, podcasts and continuing education courses that explore alternatives to the current paradigm of psychiatric care. Your tax-deductible donation will help build a community devoted to creating such change.

$
Select Payment Method
Personal Info

Credit Card Info
This is a secure SSL encrypted payment.

Billing Details

Donation Total: $20

71 COMMENTS

  1. What is the number one cause of “mental distress” in the world today? Although the matter is certainly not beyond dispute, I would say that the number one cause of “mental distress” in the world today is the fact of being born into the physical universe, that is, corporal existence. Many peoples’ experience of life on this planet began with a slap on the rump.

    I like the graphs, and I think they must be very instructive, however I do have a little problem with how they were conceived. This is especially true with the one on what you call anti-psychotics, and I would call neuroleptics, drugs that I have heard referred to, with no small sense of irony, as psychotic drugs. The problem, as I see it, is this matter of envisioning “mental distress” as a form of “impairment” that would be corrected through the impairment of drug use. The reality is that what you really get are psychological, that is, psycho-somatic conditions supplanted by chemically induced physical injury.

    “Chronic psychosis” seems to me a much more mythological creature than say “chronic drug impairment” coupled, of course, with financial “impairment”/dependency. This web of causation starts with seeing a problem where no problem necessarily exists. The web of deception is further complicated by the x = unknown factor. Here, a cause is like the winning number in the lottery, all you have to do to get “mental distressed” is to reverse the odds.

    Curiously we don’t see “mental distress” as a winning position, mostly.

    • I would like to support that neuropetics are the better word.
      “In the 1950s, when the drugs we now call ‘antipsychotics’ first came along, psychiatrists recognised that they were toxic substances that happened to have the ability to suppress thoughts and emotions without simply putting people to sleep in the way the old sedatives did” (Joanna Moncrieff, MD 13. August 2013; Deniker P. Compr Psychiatry 1960 Apr;1:92-102.). Mainstream psychiatry was uncomfortable with the notion that its principle treatment worked by being a neurological toxin and transformed it into a sophisticated, treatment. At last the misleading expression “antipsychotics” was chosen.
      Breggin clls this medication neurotoxin.
      “Antipsychotics” do not cure psychisis as the word suggests but reduce symptoms for a small minority.

  2. Hi Craig,
    my wife has d.i.d. I have shepherded her healing using attachment theory among other things. I get frustrated by her ignorance of how lucky we got as she never used any drugs nor got caught in the mental health system. I have struggled to show her how detrimental these drugs are while she defends all the women she knows who uses them. So I sent her your 4 charts and hope, maybe, a picture will be worth a 1000 words to her.
    Sam

  3. Wow, Thank you! This is so amazingly helpful for people trying to sort out what factors might be involved.

    Sadly the current system with its coercive methods make it excruciating difficult to explore all the biological and environmental factors (e.g hormonal imbalances etc.) if you are avoiding becoming tangled up in the ‘system’. Any tips on how to explore these things outside the system (e.g. places to send hair analysis or whatever).

  4. For my own part I frequently experienced tardive psychosis during mini-seizures brought on by the neuroleptics I took. So I refuse to call those drugs “antipsychotics.” They also caused obsessive patterns of thought that made everyone hate me. Thank goodness these went away when I was taken off my stelazine.

    Now the only thing I take is levothyroxin for my bad thyroid. And lots of supplements including a monthly iron infusion due to the number SSRIs played on my gut!

  5. I know that this article is meant to be helpful, and that the intentions are good.

    But the first problem is that there is no such thing as an “antidepressant” or and “antipsychotic.” Neurotoxic drugs might more appropriately be termed “depressants” or “psychotics,” because they induce depression and injuries that are often diagnosed as “psychosis.” I’m really tired of the phrase “more harm than good.” Can we just be honest. These neurotoxic drugs were DESIGNED with the explicit purpose to HARM in ways that people would not recognize. They only do harm, even though many who ingest them think that they “work,” as Breggin has noted in his analysis of neurotoxic “spellbinding.”

    These are not “meds,” no matter how many people find them indispensable. People find alcohol, tobacco, nicotine, and street drugs indispensable, but that no more makes them medicine than calling a dog’s tail a leg.
    Moreover, we need to honestly consider where the Black Box warning came from and why it is there. Do you think that Pharmaceutical companies were eager to put a Black Box warning on their neurotoxins? Of course not. How did it get there? Perhaps there are only a few people in the MIA audience who know the answer to this question.

    Finally, integrative psychiatry, just like the rest of the fraudulent, enslaving enterprise, needs to be abolished. Psychiatry IS the camel, and the whole camel is in the tent, not just the nose. Actually, it’s a dragon that must be slain. Psychiatry CREATES the very problems that it purports to cure, and it EXACERBATES any other problem. It medicalizes every day life, and markets madness. It is the science of lies, and it must be abolished.

    The abolition of psychiatry is the best path to recovery, and an even better path to prevention of debilitating iatrogenic harm. This is what needs to be communicated. The truth. As far as remarkable stories of recovery… that is a euphemism for survivors of psychiatry. Psychiatric survivors’ stories, as well as the stories of psychiatric martyrs, are sacred and must not be allowed to be appropriated by the very institution that took the lives of the martyrs and nearly took the lives of survivors.

    The best infographic for psychiatry would be the word “psychiatry” with a prohibition sign (circle-backslash symbol). And if you really want to use pictures, I highly recommend Auntie Psychiatry’s excellent drawings in her book “Of Course I’m Anti-Psychiatry, Aren’t You?” https://www.amazon.com/Course-Anti-Psychiatry-Arent-You-Illustrated/dp/0957313721

    • dragon slayer —this article is helpful because it talks and shows ways that people can be healthy…
      it shows ways that work…this article is more than good intentions…
      I have been helped with these ways…I want to focus on what helps me..
      just talking about the terrible things that don’t work just makes me sick..

    • Yeah. Pretty silly.

      Everyone knows consuming massive quantities of opium for 20 or 30 years never hurt anyone. How alarmist to think they are any more dangerous than gumdrops! 😀

      Those Benzo buddies are a bunch of radical conspiracy theorists no doubt.

      • “Everyone knows consuming massive quantities of opium for 20 or 30 years never hurt anyone.”

        Opium doesn’t hurt people, by the by. In fact, the evidence, as scant as it generally is for taboo psychoactives, suggests that frequent opium use lengthens life, rather than reduces it.

        What causes problems with opium isn’t the opium, it’s all the other shenenigans that tend to come with it, like prohibition, violent criminal supply lines, adulterants, narcissistic rock stars, violent crime, prostitution, and so on.

        Opium itself is a fairly benign substance if used sensibly by sensible psychonauts.

        Synthetic opioids are another matter entirely.

        But I was only pointing out to Mr Wagner that the evidence linking benzodiazepines to the unestablished disease of dementia is altogether uncompelling, and at turns, contradictory. All we can say is that there is a strong correleation in some studies and a very weak correlation in other studies. And that it is alarmist to cherrypick only the studies that support a causation claim.

        Mr Wagner agreed with me and altered his graphic a little bit, to tone down, as much as he felt was necessary, the alarmism.

  6. Having been through Mental Health, Inc., I am sad to say…a kinder, gentler, more humane psychiatry is still…psychiatry. There was a time when I thought Orthomolecular, maybe Orthomolecular plus psych drugs in low doses, maybe “talking treatments,” etc. might be the way (or at least…a way) forward. I was wrong.

    Give Mental Health, Inc. an inch, they’ll take a mile. Not only do I agree with Szasz and other critics that psychiatry is a belief system, I think psychiatry is such a dreadful, destructive belief system that one could quite accurately call it a modern day death cult.

    So…while a part of me still admires those who do intensive research on “mental illness” and Mental Health, Inc. and offer up humane ways of dealing with “psychosis,” etc…the bigger part of who I am simply wants to see more people work towards the abolition of psychiatry and everything else Mental Health, Inc. is selling us. The pills are toxic, the talk is nothing more than poisonous lies, and the entire industry is filled with prideful, mediocre, dangerous people who seem hell bent on lobotomizing the whole damn world.

  7. I’m warming a little to the graphics. Anyone who reads them should begin to get the idea. Neurotoxins aren’t good for your health. I feel if we go into “mental health”, anyway we put it, we’re actually dealing with an abstraction. The point is that doctors should be warning patients about these drugs rather than prescribing them, and doing so for life. Given that there are so very many people who have been completely duped, I think they have to be a positive step in a better direction.

    Antidepressants don’t relieve depression effectively, and taken long term, they may exasperate it.

    “Antipsychotics”, neuroleptics, atrophy the higher functioning of the brain, and they decrease brain mass (i.e. destroy brain cells).

    Benzodiazapines should never be prescribed long term. They are addictive, and they impair cognitive functioning.

    It’s not an information war that people are suffering from here so much as it is a disinformation war, and as such, reliable information can become a powerful inoculate to it, and an invaluable armor against it.

  8. Let us quantify “For many people, antipsychotics reduce psychosis.” from a patient perspectice.
    Reduction of 50% or more of psychotic symptoms are achieved according to Leucht et al 2009 effect of “(overall 41 versus 24% responded under SGA drugs and placebo, respectively) or an NNT of 6” i.e. for a small minority (1 in 6 patients) at the beginning of psychosis.
    What about longterm-effects?
    Leucht et al 2012 deals with maintenance treatment with neuroleptics. The studies range from 7 to 12 months. The results for preventing readmission are 1 in 5 patients (NNT = 5) and the conclusions for further research are “focus on outcomes of social participation and clarify the long-term morbidity and mortality.” “Nothing is known about the effects of antipsychotic drugs compared to placebo after three years “(Leucht et al. 2012, p. 27).
    There is no evidence of maintenance treatment for more than 3 years (FHI: ISBN 978-82-8121-958-8). Bjornestad, Larsen et al. 2017 admits that evidence of maintenance medication is missing: “Due to the lacking long-term evidence base (Sohler et al. 2016) …”
    From a patients perspective recovery is what we patients want.
    There is no evidence that antipsychotics promote “psychosocial functioning, professional functioning, and quality of life” (Buchanan et al 2010 PORT Treatment Recommendations). Recovery treatment still wins terrain and will be put into a historical context. Mike Slade et al. 2014 describes the implementation of recovery with both usage and abuse of the term. http://wkeim.bplaced.net/files/recovery-en.html

    Thank you for an article giving much valuable information, but “For many people, antipsychotics reduce psychosis” is obiously wrong. Psychosis is not reduced but only one in 6 patients get reduced symptoms (not psychosis) 50%.

  9. Thank you very much for these infographics.

    With regards to long-term treatment with neuroleptics may I suggest to include the issue of drug withdrawal leading to rebound psychosis (due to neurolpetic-induced dopamine receptor upregulation) with a high probability.

    This issue should be adressen at the beginning of neurolpetic long-term treatment so patients and their friends and families all know that it will be very difficult for them to get off these meds in case they don’t work (which is in the majority of cases).

    In addition, the lack of psychiatrists willing and knowledgeable in helping patients stay safe in the neuroleptic treatment withdrawal process is another huge issue in and of itself.

  10. I want to make some graphs of my own.

    1. A line graph. One dark, solid line for the number of mass shootings in America. Several lighter, divided lines for numbers of various psych drugs consumed.

    2. A pie chart divided to show how people get diagnosed and enter the mental health system. X% who got in through “losing it” for no easily discernible cause. Y% who were severely traumatized from rape or veterans with battle fatigue. Z% who took SSRIs for depression, nerves or off label purposes and wound up with nice little Bipolar labels. And we mustn’t forget kids who start out by fidgeting in class, get put on ritallin and are accused of bipolar as young adults.

    3. A bar chart depicting life expectencies of those diagnosed with schizophrenia and bipolar throughout the past hundred years. Contrasting those in the 1900’s with the 1960’s and the present when all these Safe and Effective Treatments are so readily available. Whether we want them or not.

  11. Good idea to use the graphics indeed.
    Just noting that:
    Health Canada issues a 2005 warning stating that AD’s carry the same risk of suicidal ideation in ADULTS, as they do in other populations. This fact gets missed repeatedly.
    the risk of completed suicide is 12X higher for Prozac than other AD’s.
    And that the most important fact of all is missing, which is that the DSM is junk science – rendering the ‘treatment” of imaginary “diseases” mass medical malpractice, insurance fraud and defamation of character to slander and accuse people of being “mental ill” with no scientific evidence supporting the claim.

  12. Hi Craig,

    I met and briefly spoke with Robert Whitaker here in Australia a couple of weeks ago.

    This is a very good article and very useful – Well done!

    I have found 6 of the references. Are the rest available? It looks like there should be a total of 11.

    FYI: I am the co-author of several Papers on ‘The Situational Approach…” to Suicide Prevention and Mental Health Literacy’. I emailed links to these Papers to Robert Whitaker following our chat.

    http://malesuicidepreventionaustralia.com.au/wp-content/uploads/2017/06/Situational-Approach-Document_web.pdf

    http://malesuicidepreventionaustralia.com.au/wp-content/uploads/2017/06/Mental_Health_Literacy_Paper_web.pdf

    Thanks Craig

    Anthony

  13. I live in Canada. I have had the worst care. I got myself off of quetiapine with the help of a naturopath and a compounding pharmacist. After years of complaining about side effects I finally had had enough when my dentist consulted an expert and he said my tongue swelling must be a drug side effect. Funny thing. Noting happened. I got off the toxic stuff and was fine. My psychiatrist retired (she’s going blind – I do have compassion but can’t help but see the irony). She said she was not referring me to anyone else because I was FINE. I am not though. Physically. I am 100% chronically constipated and 100% dependent on colonics. That is after three years of trying every other therapy. Not so funny is the response I get from every specialist I see. They will not confirm that any of my side effects are related to the meds I took. I took clonazepam also. I have had nerve conduction done, two colonoscopies, four MRIs, etc. etc. As soon as I mention the quetiapine they shut my file and get up out of the chair and start walking to the door. I was told there is no point trying to sue because there is no way to win. I can’t enjoy my grandchildren ad I can’t afford my medical care. I am trying to heal my nervous system and this is helping me cope but I get hopeless often. The psychiatrist mentioned that I have tardive dyskinesia in a letter to my family doctor but never bothered telling me about it. I only found out because I asked for a copy of the letter. I am trying to “let go” but I am too angry. I should add that when my psychiatrist agreed that I could discontinue the drug she told me to come back when I was done. That is all the “help” she offered.

  14. I was told by a lawyer I consulted that because of information in a paper titled “Up to Date” which gives doctors impunity basically I would not be able to sue. I think it is time to expose this company that produces this “Up to Date” information for what it is. If a doctor consults this company (which is U.S. based) then as long as they follow the “latest” guidelines they cannot be held accountable for any harm. We hear all the time that we are too litigious. I would like to know how much money this company makes and if any of my tax dollars (in Canada) are going to this company. There is absolutely no incentive for doctors to even try something new if they can just carry on without fear of a lawsuit. This company must have a lot of employees. I started to think that my doctor was a psychopath since she chose to keep me on drugs despite the side effects but now I believe anyone who would work according to this “Up to Date” information will never be up to date. Why bother?