MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The two German authors start their article (it is in German but has an English abstract to which I refer here) by claiming that “homeopathy is steadily gaining in sympathy in the population.” This is a very odd statement, considering that the sales figures in Germany and elsewhere have, in fact, been declining. Any homeopathy-paper with such an opening is naturally of interest to me.

As I read on, I find further surprises: “the possible effectiveness and the modes of action are currently not scientifically elucidated.” These are two big assumptions which happen to be both untrue:

  1. The effectiveness of homeopathy has now been tested in about 500 clinical trials, and the totality of the reliable evidence from these studies fails to show that highly diluted homeopathic remedies are more than placebos.
  2. The mode of action of homeopathy isn’t “not scientifically elucidated“, but the relevant science tells us that there cannot be a mode of action that is in line with the laws of nature as we understand them today.

And the surprises keep on coming: “there is a whole series of positive evidence for the effects of homeopathic remedies for mental disorders, such as depression, anxiety disorders and addiction.” This statement is not in keeping with the results of a systematic review (which, by the way was authored by ardent homeopaths); here is the abstract:

_________________________________________________________________________________________

OBJECTIVE:

To systematically review placebo-controlled randomized trials of homeopathy for psychiatric conditions.

DATA SOURCES:

Eligible studies were identified using the following databases from database inception to April 2010: PubMed, CINAHL, PsycINFO, Hom-Inform, Cochrane CENTRAL, National Center for Complementary and Alternative Medicine grantee publications database, and ClinicalTrials.gov. Gray literature was also searched using Google, Google Scholar, the European Committee for Homeopathy, inquiries with homeopathic experts and manufacturers, and the bibliographic lists of included published studies and reviews. Search terms were as follows: (homeopath* or homoeopath*) and (placebo or sham) and (anxiety or panic or phobia or post-traumatic stress or PTSD or obsessive-compulsive disorder or fear or depress* or dysthym* or attention deficit hyperactivity or premenstrual syndrome or premenstrual disorder or premenstrual dysphoric disorder or traumatic brain injury or fibromyalgia or chronic fatigue syndrome or myalgic encephalitis or insomnia or sleep disturbance). Searches included only English-language literature that reported randomized controlled trials in humans.

STUDY SELECTION:

Trials were included if they met 7 criteria and were assessed for possible bias using the Scottish Intercollegiate Guidelines Network (SIGN) 50 guidelines. Overall assessments were made using the Grading of Recommendations Assessment, Development and Evaluation procedure. Identified studies were grouped into anxiety or stress, sleep or circadian rhythm complaints, premenstrual problems, attention-deficit/hyperactivity disorder, mild traumatic brain injury, and functional somatic syndromes.

RESULTS:

Twenty-five eligible studies were identified from an initial pool of 1,431. Study quality according to SIGN 50 criteria varied, with 6 assessed as good, 9 as fair, and 10 as poor. Outcome was unrelated to SIGN quality. Effect size could be calculated in 16 studies, and number needed to treat, in 10 studies. Efficacy was found for the functional somatic syndromes group (fibromyalgia and chronic fatigue syndrome), but not for anxiety or stress. For other disorders, homeopathy produced mixed effects. No placebo-controlled studies of depression were identified. Meaningful safety data were lacking in the reports, but the superficial findings suggested good tolerability of homeopathy. A funnel plot in 13 studies did not support publication bias (χ(2)(1) = 1.923, P = .166).

CONCLUSIONS:

The database on studies of homeopathy and placebo in psychiatry is very limited, but results do not preclude the possibility of some benefit.

___________________________________________________________________________________

And specifically for depression, another review (also by proponents of homeopathy) is available; here is its abstract:

OBJECTIVE:

To systematically review the research evidence on the effectiveness of homeopathy for the treatment of depression and depressive disorders.

METHODS:

A comprehensive search of major biomedical databases including MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Library was conducted. Specialist complementary and alternative medicine (CAM) databases including AMED, CISCOM and Hom-Inform were also searched. Additionally, efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field. Relevant research was categorised by study type and appraised according to study design. Clinical commentaries were obtained for studies reporting clinical outcomes.

RESULTS:

Only two randomised controlled trials (RCTs) were identified. One of these, a feasibility study, demonstrated problems with recruitment of patients in primary care. Several uncontrolled and observational studies have reported positive results including high levels of patient satisfaction but because of the lack of a control group, it is difficult to assess the extent to which any response is due to specific effects of homeopathy. Single-case reports/studies were the most frequently encountered clinical study type. We also found surveys, but no relevant qualitative research studies were located.: Adverse effects reported appear limited to ‘remedy reactions’ (‘aggravations’) including temporary worsening of symptoms, symptom shifts and reappearance of old symptoms. These remedy reactions were generally transient but in one study, aggravation of symptoms caused withdrawal of the treatment in one patient.

CONCLUSIONS:

A comprehensive search for published and unpublished studies has demonstrated that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality. Further research is required, and should include well-designed controlled studies with sufficient numbers of participants. Qualitative studies aimed at overcoming recruitment and other problems should precede further RCTs. Methodological options include the incorporation of preference arms or uncontrolled observational studies. The highly individualised nature of much homeopathic treatment and the specificity of response may require innovative methods of analysis of individual treatment response.

____________________________________________________________________________________

Back to the new article I started discussing above. Its authors make a vague attempt at being reasonable: “It is clear that homoeopathic remedies can only be used as an add-on and not alone.” I find this statement slightly puzzling. If (as the authors assume) homeopathy is effective for mental disorders, why not on its own? Can a therapy that must not be used as a sole treatment be called effective?

The authors continue with another caveat:  “These remedies belong in the hands of physicians experienced in homeopathic and psychiatric psychopharmacology.” That’s actually quite funny! As the average homeopath has no experience in psychiatric psychopharmacology, they must not use homeopathy for mental conditions. I would agree with the conclusion but not with the reason given for it.

And now to the ‘grand finale’, the conclusion: “It would be advisable to at least try out homeopathy for the well-being of the patient not only in the case of very mild disorders but also in severe chronic cases, since due to the generally good tolerability, no avoidable disadvantage should result.” That sort of conclusion makes me almost speechless. The evidence fails to show that it works, yet it is ADVISABLE to use it in severe chronic cases!

Such articles suggest to me that homeopathy is a cult where logic and reason are irrelevant and need to be supressed. They also indicate that something is amiss with medical publishing. How can it be that, in 2018, ‘Der Nervenarzt’ (or any other medical journal for that matter) can be so bar of critical thinking to publish such dangerously misleading nonsense? ‘Der Nervenarzt‘, by the way, claims to be an internationally recognized journal addressing neurologists and psychiatrists working in clinical or practical environments. Essential findings and current information from neurology, psychiatry as well as neuropathology, neurosurgery up to psychotherapy are presented.

9 Responses to Homeopathy for psychiatric patients? Yes, apparently, it is ‘advisable’, even in severe cases!

  • Now now, let’s not throw the reality-bound baby out with the 10e23 bathwater! While homeopathy is useless, homeopaths could still prove highly therapeutic in treating stress-related conditions; a hypothesis I’d be happy to research with them soon as I dig out the ol’ Louisville Slugger.

    • homeopaths could still prove highly therapeutic in treating stress-related conditions

      Um, no. Or, to be more precise: NO!

      Yes, many homeopaths have skills in the field of giving positive, human attention to people, i.e. listening to people and asking questions about their health, their life etcetera. In fact, quite often these are their only skills, and yes, these are the only skills they actually need to succeed. This human attention is the main ingredient of the placebo treatment that is called homeopathy.

      But homeopaths are NOT trained to actually engage with patients on any therapeutic level. They are NOT psychotherapists, they are NOT psychologists, they are NOT health professionals in any serious meaning of the word. At best, they are trained to deal with health problems by selling magical solutions (or better: dilutions) served up with magical words and magical explanations (e.g. ‘like cures like’).

      An evening in the pub, telling your life’s story to a friendly stranger, is probably just as therapeutic and rather less expensive. Just make sure that you don’t take too much of the remedy offered (with the ethanol of course being the ‘inactive ingredient’). And I’ll have mine shaken, not stirred, thank you very much.

      • Bless you, sir, for your concern.

        Though as it happens, I could not find my baseball bat—do you think a chainsaw would do…?

  • Cynicism towards psychiatric patients at highest level.

    The first half of the article – which I read in German – resumes correctly where homoeopathy steams from and why it doesn’t work. This is followed by – one of the very few – wise remarks by Hahnemann saying: “Die Geistes- und Gemütskrankheiten sind keine von den übrigen scharf getrennte Klasse von Krankheiten.” (Mental and emotional disorders don’t belong to a class of diseases which are clearly separated from the others [translation CB]).

    But the rest of the article disregards this advise. The authors obviously tend to capitulate to the complexity of the human brain and its diseases. That they mention chaos theory as a possible explanation shows that they have no clue (chaos theory is applicable in well defined physical and mathematical systems only; the usable parts have become part of standard physics – chaos theory is no longer something special).

    So they propose to use the standard therapy for psychiatric patients and add homoeopathic remedies on the top. Between the lines they say psychiatric patients might have a somatic problem but also something else, lets cure the something else with something that is not explainable as well. If it doesn’t help it at least doesn’t harm.

    This is clearly disrespectful towards psychiatric patients. It reflects a paternalistic attitude towards patients, an attitude which should not exist any more.

    The article shows the severe problems of psychiatry. This medical field is still attracting mainly students who don’t feel too comfortable with sciences such as physiology, biochemistry and molecular biology. The consequences for future patients are severe: research is not moving fast enough.

    Being engaged as a computer specialist in this area, I haven’t heard of a serious research project in precision medicine / personalized health dealing with mental diseases. I could imagine the use of these new set of technologies to do the bare minimum: classifying symptoms into diseases with a common root cause.

    Instead psychiatric patients are still treated – reading between the lines again – as weird persons who can be treated with whatever as long as it doesn’t kill them.

    • …AND SOMETIMES IT DOES REGRETTABLY KILL THEM.

    • I could imagine the use of these new set of technologies to do the bare minimum: classifying symptoms into diseases with a common root cause

      I think your view of psychiatry is somewhat outdated. Efforts are under way to give psychiatry more solid, science-based and evidence-based foundations, even though technology still only plays a minor role compared to the rest of medicine. Just look at the development in the DSM: over the years, diagnostic criteria have been critically assessed and adjusted, being far more consistent now than even 25 years ago. And the fact that a lot of separate, specific diagnoses have been abandoned and brought under an ever widening spectrum of a smaller number of disorders is a good sign of this scientific approach: it removes false categorizations and fictitious boundaries between ‘normal’ and ‘abnormal’, and acknowledges that mental conditions can be just as varied and vague as physical conditions.
      Then again, psychiatry is indeed still not a ‘hard’ science in most respects. It is still largely an observational science, with little powers of prediction and deduction. I see the efforts I mentioned mostly as a good first step: admit that the whole field is still largely based on case descriptions, and not so much on solid theories.

      However, the point here is that homeopaths apparently try to hitch a free ride. They try to insert their proven ineffective pseudoscience into the regular system for treating mental disorders, in the hopes that they can get their hands on a piece of this pie, without anyone noticing that what they are contributing is literally nothing (it is homeopathy, after all). The main weakness of psychiatry, i.e. that it is still lacking good theoretical foundations, makes it an attractive target.

      This is in other words a classic example of parasitic behaviour.

      • I agree that this statement was somewhat bold and I acknowledge the progress in psychiatry. Nevertheless it is somewhat disappointing when you see that systematic collecting lab data such as analysis of metabolites did not happen, albeit it has been proposed by scientists more than 25 years ago.

        The discussion on homoeopathy not only in psychiatry reveals in my opinion also the cultural differences between medicine and science in the narrow sense of the word. I couldn’t imagine how deep this differences are before a became part of a big interdisciplinary project – as a computer technician (with a life science background) not as a scientist. I think these mostly obfuscated differences hinder the scientists to present there results in a way that makes it easier for medical person to accept them emotionally not only rationally. And it makes it possible that ideas which are hilarious for scientists, such as homoeopathy, are still seriously discussed in some medical circles.

  • A few years ago, in Germany the head of the “Gemeinsamer Bundesausschuss”, the steering board for the statutory health insurance, said that sometimes a beer would be better than a psychotherapy. Maybe some sugar too. But surely not if people are suffering with serious mental disorders.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you want to be able to edit your comment for five minutes after you first submit it, you will need to tick the box: “Save my name, email, and website in this browser for the next time I comment.”
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories