The Crisis in Psychopharmacology Provides an Opportunity for NeuroRegulation Treatments to Gain Widespread Acceptance
AbstractPsychopharmacology is in crisis due to the increasing recognition that it does not work as claimed and has failed to meaningfully improve outcomes over what they were in the 1950s and ‘60s. Though still widely promoted to the public, the chemical imbalance theory of major mental health disorders is now openly acknowledged as not accurate by leading psychiatrists, thereby undermining the rational for this approach to care. A series of large comparative effectiveness studies funded by the National Institute of Mental Health (NIMH) were each essentially failed trials with disappointing results and found that second-generation psychotropic medications were no more effective than their first-generation cousins. The evidence from several of these studies are reviewed within the scope of major depression and attention-deficit/hyperactivity disorders, and then compared to research on promising neuroregulation treatments. The author then makes recommendations for neuroregulation clinicians to avoid a crisis similar to that experienced in psychopharmacology today.
Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180–189. http://dx.doi.org/10.1177/155005940904000311
Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, 108–115. http://dx.doi.org/10.1016 /j.biopsycho.2013.11.013
Bowden, C. L., Perlis, R. H., Thase, M. E., Ketter, T. A., Ostacher, M. M., Calabrese, J. R., … Sachs, G. S. (2012). Aims and results of the NIMH systematic treatment enhancement program for bipolar disorder (STEP-BD). CNS Neuroscience & Therapeutics, 18(3), 243–249. http://dx.doi.org/10.1111 /j.1755-5949.2011.00257.x
Cantor, D. S., & Stevens, E. (2009). QEEG correlates of auditory-visual entrainment treatment efficacy of refractory depression. Journal of Neurotherapy, 13(2), 100–108. http://dx.doi.org /10.1080/10874200902887130
Choi, S. W., Chi, S. E., Chung, S. Y., Kim, J. W., Ahn, C. Y., & Kim, H. T. (2011). Is alpha wave neurofeedback effective with randomized clinical trials in depression? A pilot study. Neuropsychobiology, 63(1), 43–51. http://dx.doi.org /10.1159/000322290
Currie, J., Stabile, M., & Jones, L. (2014). Do stimulant medications improve educational and behavioral outcomes for children with ADHD? Journal of Health Economics, 37, 58–69. http://dx.doi.org/10.1016/j.jhealeco.2014.05.002
DePaulo, J. R. (2006). Bipolar disorder treatment: An evidence-based reality check. The American Journal of Psychiatry, 163(2), 175–176. http://dx.doi.org/10.1176/appi.ajp.163.2.175
Fava, M., Rush, A. J., Trivedi, M. H., Nierenberg, A. A., Thase, M. E., Sackeim, H. A., ... Kupfer, D. J. (2003). Background and rationale for the sequenced treatment alternatives to relieve depression (STAR∗ D) study. Psychiatric Clinics of North America, 26(2), 457–494.
Fibiger, H. C. (2012). Psychiatry, the pharmaceutical industry, and the road to better therapeutics. Schizophrenia Bulletin, 38(4), 649–650. http://dx.doi.org/10.1093/schbul/sbs073
Gani, C., Birbaumer, N., & Strehl, U. (2008). Long term effects after feedback of slow cortical potentials and of theta-beta-amplitudes in children with attention-deficit/hyperactivity disorder (ADHD). International Journal of Bioelectromagnetism, 10(4), 209–232.
Gevensleben, H., Holl, B., Albrecht, B., Schlamp, D., Kratz, O., Studer, P., … Heinrich H. (2010). Neurofeedback training in children with ADHD: 6-Month follow-up of a randomized controlled trial. European Child & Adolescent Psychiatry, 19(9), 715–724. http://dx.doi.org/10.1007/s00787-010-0109-5
Gøtzsche, P. C. (2015). Does long term use of psychiatric drugs cause more harm than good? Yes. British Medical Journal, 350, h2435. http://dx.doi.org/10.1136/bmj.h2435
Graham, J., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., Dittmann, R. W., ... Taylor, E. (2011). European guidelines on managing adverse effects of medication for ADHD. European Journal of Child & Adolescent Psychiatry, 20(1), 17–37. http://dx.doi.org /10.1007/s00787-010-0140-6
Greden, J. F. (2013). Workplace depression: Personalize, partner, or pay the price. The American Journal of Psychiatry, 170(6), 578–581. http://dx.doi.org/10.1176/appi.ajp.2012.13030382
Greenberg, G. (2013, September 3). The psychiatric drug crisis. The New Yorker. Retrieved from http://www.newyorker.com /tech/elements/the-psychiatric-drug-crisis
Hickey, P. (2014, June 6). Psychiatry DID promote the chemical imbalance theory. Mad in America. Retrieved from http://www.madinamerica.com/2014/06/psychiatry-promote-chemical-imbalance-theory/
Hyman, S. E. (2012). Revolution stalled. Science Translational Medicine, 4(155), 155cm11. http://dx.doi.org/10.1126 /scitranslmed.3003142
Insel, T. R. (2009). Disruptive insights in psychiatry: Transforming a clinical discipline. The Journal of Clinical Investigation, 119(4), 700–705. http://dx.doi.org/10.1172/JCI38832
Insel, T. R., & Quirion, R. (2005). Psychiatry as a clinical neuroscience discipline. Journal of the American Medical Association, 294(17), 2221–2224. http://dx.doi.org/10.1001 /jama.294.17.2221
Jensen, P. S., Arnold, L. E., Swanson, J. M., Vitiello, B., Abikoff, H. B., Greenhill, L. L., … Hur, K. (2007). 3-year follow-up of the NIMH MTA study. Journal of the American Academy of Child & Adolescent Psychiatry, 46(8), 989–1002. http://dx.doi.org/10.1097/CHI.0b013e3180686d48
John, E. R., Prichep, L. S., Friedman, J., & Eastman, P. (1988). Neurometrics: Computer-assisted differential diagnosis of brain dysfunctions. Science, 293(4836), 162–169.
John, E. R., Prichep, L. S., Winterer, G., Herrmann, W. M., diMichele, F., Halper, J., … Cancro, R. (2007). Electrophysiological subtypes of psychotic states. Acta Psychiatrica Scandinavica, 116(1), 17–35.
Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T., & Giovannucci, E. L. (2015). Trends in prescription drug use among adults in the United States from 1999–2012. Journal of the American Medical Association, 314(17), 1818–1830. http://dx.doi.org/10.1001/jama.2015.13766
Kelland, K. (2017, January 16). No new antidepressants in sight despite growing need, experts warn. Reuters. Retrieved from www.reuters.com/article/us-health-antidepressants-idUSKBN14V2AQ
Leins, U., Goth, G., Hinterberger, T., Klinger, C., Rumpf, N., & Strehl, U. (2007). Neurofeedback for children with ADHD: A comparison of SCP and Theta/Beta protocols. Applied Psychophysiology and Biofeedback, 32(2), 73–88. http://dx.doi.org/10.1007/s10484-007-9031-0
Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., … Hsiao, J. K. (2005). Clinical antipsychotic trials of intervention effectiveness (CATIE) investigators: Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. The New England Journal of Medicine, 353(12), 1209–1223. http://dx.doi.org /10.1056/NEJMoa051688
Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): A preliminary report. Biofeedback and Self-Regulation, 1(3), 293–306. http://dx.doi.org /10.1007/bf01001170
Mayer, K., Wyckoff, S. N. & Strehl, U. (2013). One size fits all? Slow cortical potentials neurofeedback. Journal of Attention Disorders, 17(5), 393–409. http://dx.doi.org/10.1177 /1087054712468053
Meisel, V., Servera, M., Garcia-Banda, G., Cardo, E., & Moreno, I. (2013). Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up. Biological Psychology, 94(1), 12–21. http://dx.doi.org/10.1016/j.biopsycho.2013.04.015
Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., … The MTA Cooperative Group. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 484–500. http://dx.doi.org/10.1097 /CHI.0b013e31819c23d0
Monastra, V. J. (2005). Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: Rationale and empirical foundation. Child and Adolescent Psychiatric Clinics of North America, 14, 55–82. http://dx.doi.org/10.1016/j.chc.2004.07.004
MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073–1086.
MTA Cooperative Group. (2004a). National Institute of Mental Health multimodal treatment study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics, 113(4), 754–761.
MTA Cooperative Group. (2004b). National Institute of Mental Health multimodal treatment study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113(4), 762–769.
Olfson, M., Blanco, C., Liu, S.-M., Wang, S., & Correll, C. U. (2012). National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Archives of General Psychiatry, 69(12), 1247–1256. http://dx.doi.org/10.1001/archgenpsychiatry.2012.647
Peeters, F., Oehlen, M., Ronner, J., van Os, J., & Lousberg, R. (2014). Neurofeedback as a treatment for major depressive disorder—A pilot study. PloS ONE, 9(3), e91837. http://dx.doi.org/10.1371/journal.pone.0091837
Pies, R. W. (2011, July 11). Psychiatry’s new brain-mind and the legend of the “chemical imbalance.” Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatry-new-brain-mind-and-legend-chemical-imbalance
Pigott, H. E. (2011). STAR*D: A tale and trial of bias. Ethical Human Psychology and Psychiatry, 13(1), 6–28. http://dx.doi.org/10.1891/1559-43184.108.40.206
Pigott, H. E. (2015). The STAR* D trial: It is time to reexamine the clinical beliefs that guide the treatment of major depression. Canadian Journal of Psychiatry [Revue Canadienne De Psychiatrie], 60(1), 9–13.
Pigott, H. E., & Alter, G. S. (2011). In response to ‘Do pharmacotherapy and/or psychotherapy work in depression? It depends!’ and ‘Widespread methodological problems limit validity of meta-analytic results’. Psychotherapy and Psychosomatics, 80(4), 247–248. http://dx.doi.org/10.1159 /000323614
Pigott, H. E., & Cannon, R. (2014). Neurofeedback is the best available first-line treatment for ADHD: What is the evidence for this claim? NeuroRegulation, 1(1), 4–23. http://dx.doi.org /10.15540/nr.1.1.4
Pigott, H. E., Leventhal, A. M., Alter, G. S., & Boren, J. J. (2010). Efficacy and effectiveness of antidepressants: Current status of research. Psychotherapy and Psychosomatics, 79(5), 267–279. http://dx.doi.org/10.1159/000318293
Riddle, M. A., Yershova, K., Lazzaretto, D., Paykina, N., Yenokyan, G., Greenhill, L., ... Posner, K. (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 52(3), 264–278. http://dx.doi.org/10.1016/j.jaac.2012.12.007
Rush, A. J. (2002). Sequenced Treatment Alternatives to Relieve Depression (STAR*D) research protocol. Received October 1, 2010, from the National Institute of Mental Health, following a request under the Freedom of Information Act. Mad in America. Retrieved from https://www.madinamerica.com/wp-content/uploads/2011/12 /STAR-D%20Protocol%20with%20Analytic%20Plan.pdf
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., ... Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR* D report. American Journal of Psychiatry, 163(11), 1905–1917. http://dx.doi.org /10.1176/appi.ajp.163.11.1905
Shouse, M. N., & Lubar, J. F. (1979). Operant conditioning of EEG rhythms and ritalin in the treatment of hyperkinesis. Biofeedback and Self-Regulation, 4(4), 299–312. http://dx.doi.org/10.1007/bf00998960
Steiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014). In-school neurofeedback training for ADHD: Sustained improvements from a randomized control trial. Pediatrics, 133(3), 483–492. http://dx.doi.org/10.1542 /peds.2013-2059
Sterman, M. B., & Wyrwicka, W. (1967). EEG correlates of sleep: Evidence for separate forebrain substrates. Brain Research, 6(1), 143–163.
Strehl, U., Leins, U., Goth, G., Klinger, C., Hinterberger, T., & Birhaumer, N. (2006). Self-regulation of slow cortical potentials: A new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics, 118(5), 1530–1540. http://dx.doi.org/10.1542/peds.2005-2478
Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Nierenberg, A. A., Warden, D., Ritz, L., ... STAR*D Study Team. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR* D: Implications for clinical practice. The American Journal of Psychiatry, 163(1), 28–40. http://dx.doi.org/10.1176/appi.ajp.163.1.28
Trivedi, M. H., Stegman, D., Rush, A. J., Wisniewski, S. R., & Nierenberg, A. A. (2002, July 31). STAR*D clinical procedures manual. Retrieved from https://www.madinamerica.com/wp-content/uploads/2011/12 /STAR_D Clinical Procedures Manual.htm
Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. New York, NY: Crown Publishers.
Whitaker, R., & Cosgrove, L. (2015). Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. London, UK: Palgrave Macmillan.
Wigton, N. L., & Krigbaum, G. (2015). Attention, executive function, behavior, and electrocortical function, significantly improved with 19-channel z-score neurofeedback in a clinical setting. Journal of Attention Disorders. Advance online publication. http://dx.doi.org/10.1177/1087054715577135
Copyright (c) 2017 Ed Pigott
This work is licensed under a Creative Commons Attribution 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).