Important Warning: The
following web page is provided for information purposes only. It covers
possible complementary treatment approaches that may be used in concert
with antipsychotic (neuroleptic) medications. The adoption of any of
these complementary treatments should be done with a qualified psychiatrist or psychologist's
knowledge and approval as part of a person's complete treatment plan. This summary of possible complementary treatments is for informational purposes only.
For general information on dietary supplements, see the NIH website:
Supplements: Background Information
Complementary Schizophrenia Treatments - Table of Contents
Personal Therapy and CBT (Cognitive Behavioral Therapy) - Personal Therapy is a psychosocial intervention designed to help patients with schizophrenia recognize and respond appropriately to arousing stimuli improves function and reduces relapse. Personal therapy, as it is called, aims to create a therapeutic umbrella to protect the patients from undue personal stress. Recent studies have suggested that over the long haul, individual psychotherapy tailored to strengthen interpersonal skills and control social stress markedly helps many people suffering from the disorder.
This new form of schizophrenia treatment has resulted in lower relapse rates and progressively better social functioning over 3 years, at least for people able to live with family members and meet basic survival needs, contend social worker Gerard E. Hogarty of the University of Pittsburgh School of Medicine and his colleagues.
Cognitive Behavioral Therapy (CBT) has been judged by the Cochrane review as potentially positive for people with schizophrenia, stating that evidence suggests " that it [CBT] may well be of value, at least in the short term. Cognitive behavioural therapy should be further evaluated in various clinical settings and comparing effects for both expert and less skilled practitioners." Source; Cochrane Review
Family therapy and assertive community treatment have clear effects on the prevention of psychotic relapse and rehospitalization. However, these treatments have no consistent effects on other outcome measures (e.g., pervasive positive and negative symptoms, overall social functioning, and ability to obtain competitive employment). Social skills training improves social skills but has no clear effects on relapse prevention, psychopathology, or employment status. Supportive employment programs that use the place-and-train vocational model have important effects on obtaining competitive employment. Some studies have shown improvements in delusions and hallucinations following cognitive behavior therapy. Preliminary research indicates that personal therapy may improve social functioning.
Research suggests that relatively simple, long-term psychoeducational family therapy should be available to the majority of persons suffering from schizophrenia. Assertive community training programs ought to be offered to patients with frequent relapses and hospitalizations, especially if they have limited family support. Patients with schizophrenia can clearly improve their social competence with social skills training, which may translate into a more adaptive functioning in the community. For patients interested in working, rapid placement with ongoing support offers the best opportunity for maintaining a regular job in the community. Cognitive behavior therapy may benefit the large number of patients who continue to experience disabling psychotic symptoms despite optimal pharmacological treatment. (Source - psychosocial treatment, 2001 - see below)
- A Sample of Articles and Research and Books
More information on CBT and Schizophrenia (full list of news articles)
Glycine (an amino acid sold as a dietary supplement) has been a
subject of research for over 15 years as a potential treatment for
the negative symptoms of schizophrenia. Only a handful of human
clinical trials with fewer than 50 people in each trial, have been
completed (though one trial with 150 people has recently completed
and has not yet been published). The trials published to date
are reporting that the results have been quite positive, showing
a significant reduction (averaging around 24%) in negative and cognitive
symptoms based on the PANSS (Positive and Negative Schizophrenia
Symptoms) scale. The clinical trials have shown that Glycine did
not help people who are taking Clozapine, but it did help (in reducing
negative symptoms) in people who were taking risperidone (Risperdal),
and olanzapine (Zyprexa). The clinical trials suggest that the optimal
dosage may be in the range of 30 grams to 60 grams a day. The biggest
downside to taking glycine seems to be upset stomach and nausea
which, researchers tell us, is quite common in people who take 60
grams of glycine a day for a month or two. Approaches used by the
researchers to minimize this problem have been to start at lower
doses (e.g. 5 to 10 grams split into two doses per day) and then
to slowly phase up to higher doses over a period of weeks. Also
- taking it after meals may assist in reducing side effects.
One hypothesis of schizophrenia pathology suggests that NMDA-receptor
disfunction (a special kind of glutamate receptor in the brain)
may contribute to disordered synapses and brain atrophy, which ultimately
result in the visible symptoms. Glycine may turn out to be a very
beneficial supplemental treatment (when added to standard antipsychotic
medications) for some people with schizophrenia. We hope to see
longer and larger trials for glycine supplemental treatments. Talk
with your doctor if you think you may benefit (review the report
below for information on what glycine does and who it might help).
See special report below for more information:
- ECT (Electro-Convulsive Therapy)
Research suggests that Electroconvulsive therapy (ECT) has a modest
but definite role to play in the treatment of schizophrenia despite
the adverse publicity it has received. . In European countries it
has been used more widely for the treatment of schizophrenia than
in the United States.
- Research on the Efficacy of ECT
- Basic Information and Summaries
- Antioxidant Vitamins -
Researchers have found a positive correlation between superoxide generation
and the negative symptoms of schizophrenia, indicating a possible
role for oxidative stress in the development of the disease (and the
potential for antioxidants to help in decreasing the risk or severity
of the disease). "There are several lines of evidence to support
the contribution of oxygen free radicals in schizophrenia, including
increased lipid peroxidation, fatty acids, and alterations in blood
levels of antioxidant enzymes," note Pinkhas Sirota (Tel Aviv
University, Israel) and colleagues, in a recent research paper.
Note - one must be particularly careful in purchasing vitamin supplements
because it is an entirely unregulated industry and many less than reputable
organizations sell products that do not actually contain the specified
doses. We recommend that any source you choose have a certified "GMP" (Good Manufacturing Practices) certification and
approval. (Look for the GMP stamp on the label. Also, Look for products
that have a 'UPS' (United States Pharmacopeia) stamp on the label.
Higher than normal intake of foods known to have a high content
of antioxidants, as well as supplements of high antioxidant vitamins
Lipoic Acid, Vitamin E, Vitamin C) may have some beneficial
impact on the incidence and progression of the disease - anecdotal
evidence suggests as much as 5% to 10% improvement for some individuals.
Foods high in antioxidants include blue berries (frozen or fresh),
dried plums, spinach and strawberries.
One reliable provider we are familiar in the USA and that we've had
good experiences with is the Internet-store www.iherb.com - and specifically products from the "NOW
Foods" company. Other leading companies that are known to have
good manufacturing quality processes include Twinlab. We have no affiliation
with either of these organizations.
(Please note that there are no studies the schizophrenia researchers
we are in contact with are aware of that support the idea that
any type of vitamin or fatty acid (EFA) will cure schizophrenia. There
are currently no cures for schizophrenia.)
Supporting Research (a sample):
- Vitamin E and other Antioxidants (for Tardive
Dyskinesia) - Tardive dyskinesia is a neurological syndrome caused
by the long-term use of neuroleptic drugs - especially the older
"typical" medications. Tardive dyskinesia is characterized
by repetitive, involuntary, purposeless movements. Features of the
disorder may include grimacing, tongue protrusion, lip smacking, puckering
and pursing, and rapid eye blinking. Rapid movements of the arms,
legs, and body may also occur. Impaired movements of the fingers may
appear as though the patient is playing an invisible guitar or piano.
There is no standard treatment for tardive dyskinesia. Treatment is
highly individualized. The first step is generally to stop or minimize
the use of the neuroleptic drug. However, for patients with a severe
underlying condition this may not be a feasible option. Replacing
the neuroleptic drug with substitute drugs may help some patients.
Other drugs such as benzodiazepines, adrenergic antagonists, and dopamine
agonists may also be beneficial.
Treatments being Researched that are Showing
some Early Positive Results
In the last 10 years, preclinical studies of the administration of
antipsychotics to animals, as well as clinical studies of oxidative
processes in patients given antipsychotic medications, with and without
tardive dyskinesia, have continued to support the possibility that
neurotoxic free radical production may be an important consequence
of antipsychotic treatment, and that such production may relate to
the development of dyskinetic phenomena. In line with this hypothesis,
evidence has accumulated for the efficacy of antioxidants, primarily
vitamin E (mixed-tocopherols), in the treatment and prevention of
tardive dyskinesia. Early studies suggested a modest effect of vitamin
E treatment on existing tardive dyskinesia, but later studies did
not demonstrate a significant effect.
Because evidence has continued to accumulate for increased oxidative
damage from antipsychotic medications, but less so for the effectiveness
of vitamin E, especially in cases of long-standing tardive dyskinesia,
alternative antioxidant approaches to the condition may be warranted.
These approaches may include the use of antioxidants as a preventive
measure for tardive dyskinesia or the use of other antioxidants (for
Lipoic Acid) or neuroprotective drugs, such as melatonin, for
established tardive dyskinesia.
In schizophrenia.com's discussions with NIMH researchers it has been
suggested that up to 1,600 mg/day of vitamin E is safe for most people,
and up to 600 to 1200 mg/day of Alpha Lipoic Acid is also a safe maximum
dosage. We recommend you discuss these antioxidant plans with your
physician and psychiatrists before beginning any vitamin program because
of the potential for there to be negative interactions between different
drugs and vitamins (though the chances of this in general appear low).
- Articles and Research:
EPA Omega-3 Fish Oils - While the research is somewhat conflicting (some positive studies, some negative studies) there is some early scientific research that suggests that people that have schizophrenia may benefit by a reduction in symptoms when they take fish oil capsules that are high in the EPA (a type of Omega-3 fatty acid) form of oil. If you do try fish oil, it is important to be careful about the type of fish oil you are using - because not all fish oils are effective. The researchers at the University of Scheffield tell us that "What people really need to be looking at is the amount of EPA in the fish oil they are buying. Our data from previous studies suggests that DHA is of little use in the treatment of schizophrenia but EPA is the substance that yield the best results. Dosage wise it is suggested that about 2,000 mg/day to 4,000 mg/day ( 2 to 4 grams/day) should help."
A research review article from Cochrane Review suggested that "The use of omega-3 polyunsaturated fatty acids for schizophrenia remains experimental and large well designed, conducted and reported studies are indicated and needed."
Some of our community members have have had good luck with the Now Foods "Super EPA" and "MaxEPA" vitamins purchased from iherb.com - but we encourage you to shop around for the best deal for you. We must be particularly careful in purchasing vitamin supplements because it is an entirely unregulated industry and many less than reputable organizations sell products that do not actually contain the specified doses or have other ingredients - this seems like a particular problem with vitamins coming from Canada. We recommend that any source you choose have a certified "GMP" (Good Manufacturing Practices) certification and approval. (Look for the GMP stamp on the label). Also, Look for products that have a 'UPS' (United States Pharmacopeia) stamp on the label
(Please note that there are no studies that the schizophrenia researchers we are in contact with are aware of that support the idea that any type of vitamin or fatty acid (EFA) will cure schizophrenia. There are currently no cures for schizophrenia.)
- N-methylglycine (also called Sarcosine)
One hypothesis of schizophrenia pathology suggests that NMDA-receptor
disfunction (a special kind of glutamate receptor in the brain)
may contribute to disordered synapses and brain atrophy, which
ultimately result in the visible symptoms. Glycine (or glycine-like
supplements such as Sarcosine) may turn out to be a very beneficial
supplemental treatment (when added to standard antipsychotic medications)
for some people with schizophrenia.
In a recent (2004) Harvard Medical School study with consumers
who suffer from schizophrenia it was revealed that patients who
received N-methylglycine (sarcosine) treatment had significant
(on the order of 10 to 15%) improvements in their positive, negative,
cognitive, and general psychiatric symptoms. This looks very promising,
but the research needs to be duplicated with some larger sample
groups of people. N-methyl glycine (Sarcosine) is apparently a
amino acid. We'll report
more on this potential treatment as more new trial results are published.
- Articles and Research:
- Animal-Assisted Therapy
Research has shown that pets (dogs and cats) may offer a low cost,
yet helpful type of therapy for people with schizophrenia. What the
researchers call "Animal-assisted Therapy" has been shown
to encourage mobility, interpersonal contact, and communication and
reinforced activities of daily living, including personal hygiene
and independent self-care.
We could only find a single study on this topic - so it remains to
be seen if this approach to therapy proves effective in larger, more
rigorous studies. It seems that a calm and friendly dog (not a puppy
that requires a lot of attention) could provide good companionship
for people who have schizophrenia and don't socialize much.
- Sample of Articles and Research:
- Gluten Free Diet for Schizophrenia
Some research has shown that people with celiac disease, a genetic
gluten (a type of protein found in wheat and other grains) intolerance
have up to a 300% increased risk for developing schizophrenia. While
the percentage of people that this impacts is small (less than 3%
of people that have schizophrenia are estimated to have this intolerance),
a wheat-free diet is theorized as potentially being helpful for
- Sample of Articles and Research:
- Trancranial Magnetic Stimulation (TMS)
- There's preliminary evidence that TMS offers a less drastic alternative
to electroconvulsive therapy (ECT), the treatment of last resort for
people with severe depression. At the same time, investigators acknowledge
that there's much they don't know about how TMS affects the brain.
Researchers propose that TMS may help treat schizophrenia, a brain
disorder for which few effective drugs exist.
In the March 25, 2003 Lancet, investigators at the Yale University
School of Medicine, report that repetative TMS (also called "rTMS",
significantly reduced auditory hallucinations experienced by a dozen
people with schizophrenia.
The hallucinations, usually perceived as voices in the head, afflict
50 to 70 percent of such people and are often difficult to eliminate
with antipsychotic drugs. "These voices can be very disruptive
and produce some really bad consequences," noted study leader
Ralph E. Hoffman.
Brain scans of people with schizophrenia suffering auditory hallucinations
have revealed abnormal activity in a speech-related brain regionthe
left temporal parietal cortex. Scientists suspect, says Hoffman, that
"these auditory hallucinations arise from parts of the brain
that are ordinarily involved with processing spoken speech."
To test that theory, Hoffman and his colleagues directed magnetic
pulses at the left temporal parietal cortex of schizophrenia patients
for up to 16 minutes daily for 4 days.
In most cases, the severity and frequency of auditory hallucinations
decreased more with the real TMS treatment than with sham applications.
In one person, the improvement lasted 2 months.
Additional TMS validation studies are needed and are underway. For
more information, or to participate in the studies, contact Yale
University PRIME TMS Research. or Other
Groups working with TMS.
Music Therapy - Music therapy is a type
of psychotherapy in which the patient is encouraged to utilize music
to improve interpersonal and communication skills in ways that regular
dialogue is limited. Forms of music therapy generally are based around
cognitive/behavioral, humanistic or psychoanalytic frameworks or a mixture
of approaches. There are usually both active and receptive parts of
the therapy, meaning that at times music is listened to and at other
times there is the use of musical improvisation or creation. There have
not been many studies on music therapy and schizophrenia, but the Cochrane
review looked at the data available for a recent review.
There were 4 studies included in the review. These studies looked at
short term benefits of music therapy when used in addition to more conventional
pharmaceutical treatments. The authors combined the results of these
4 studies in a “meta-analysis” meaning that the studies were similar
enough that the data could be combined and form a larger sample. The
number of sessions used in these studies varied from 7 to 75 and the
length of time studied ranged up to 3 months duration.
The results were encouraging. In one study, it was shown that the global
state in the short term was frequently improved. Using a statistic called
“number needed to treat (NNT)” it was described that to show an improvement
in one patient, you only needed to put two patients through the therapy.
(This compares with NNT in many situations of several hundred patients
needed to be given a treatment in order to notice benefits in one person.)
It was shown that the number of sessions had a direct impact on the
success of the treatment with more sessions being better.
It was also seen that active participation was better than a more passive
approach to treatment. However, the length of treatment in theses studies
was short and the benefit in the long term was unknown.
Tharyan P, Adams C. Electroconvulsive therapy for schizophrenia. Cochrane
Database Syst Rev. 2005 Apr 18;(2):CD000076.
Click here for article 1 on PubMed
Gold C, Heldal T, Dahle T, Wigram T. Music therapy for schizophrenia
or schizophrenia-like illnesses. Cochrane Database Syst Rev. 2005 Apr
here for article 2 on PubMed
Simpling listening to music listening may also, however, be useful
as a means of relaxation or group discussion stimulus. A medical
review article (April 2005) has indicated that music therapy may
be beneficial for people already on a standard treatment for schizophrenia.
Music therapy should in no way replace a standard treatment regimen.
Future research may reveal more positive results.
Chinese herbal medicine for schizophrenia
In January, 2006 The Cochrane Review (a leading medical publisher) published a review article of all the studies that have been done so far on chinese herbal medicine use in treatment for schizophrenia. In their review article they stated:
"Traditional Chinese medicine (TCM) has been used to treat mental health disorders, including schizophrenia, for more than 2000 years. Chinese herbs may also have antipsychotic properties when used in a Western biomedical context. In this review we sought and found trials relevant to the effects of both approaches for schizophrenia. Traditional Chinese medicine methodology has been evaluated for schizophrenia, but the one included study was too limited in terms of sample size and study length to guide good practice. However, this pioneering study does show that TCM can be evaluated for its efficacy for people with schizophrenia , and should encourage trialists to undertake further, more comprehensive trials in this area.
The use of Chinese herbs in a Western medicine context, without incorporating TCM methodology, has been evaluated in six trials, although again these are limited by their sample size and study length. The results of these six trials suggest that using Chinese herbs alone for psychotic symptoms may not be indicated, but if used in conjunction with Western antipsychotic drugs, they may be beneficial in terms of mental state, global functioning and decrease of adverse effects. However, further trials are needed before the effects of TCM for people with schizophrenia can be evaluated with any real confidence."
Source: Cochrane Review: Chinese herbal medicine for schizophrenia (2006)
Future Potential Therapies