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

Homeopathy for depression? A previous review concluded that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality. But that was 13 years ago. Perhaps the evidence has changed?

A new review aimed to assess the efficacy, effectiveness and safety of homeopathy in depression. Eighteen studies assessing homeopathy in depression were included. Two double-blind placebo-controlled trials of homeopathic medicinal products (HMPs) for depression were assessed.

  • The first trial (N = 91) with high risk of bias found HMPs were non-inferior to fluoxetine at 4 and 8 weeks.
  • The second trial (N = 133), with low risk of bias, found HMPs was comparable to fluoxetine and superior to placebo at 6 weeks.

The remaining research had unclear/high risk of bias. A non-placebo-controlled RCT found standardised treatment by homeopaths comparable to fluvoxamine; a cohort study of patients receiving treatment provided by GPs practising homeopathy reported significantly lower consumption of psychotropic drugs and improved depression; and patient-reported outcomes showed at least moderate improvement in 10 of 12 uncontrolled studies. Fourteen trials provided safety data. All adverse events were mild or moderate, and transient. No evidence suggested treatment was unsafe.

The authors concluded that limited evidence from two placebo-controlled double-blinded trials suggests HMPs might be comparable to antidepressants and superior to placebo in depression, and patients treated by homeopaths report improvement in depression. Overall, the evidence gives a potentially promising risk benefit ratio. There is a need for additional high quality studies.

I beg to differ!

What these data really show amounts to far less than the authors imply:

  • The two ‘double-blind’ trials are next to meaningless. As equivalence studies they were far too small to produce meaningful results. Any decent review should discuss this fact in full detail. Moreover, these studies cannot have been double-blind, because the typical adverse-effects of anti-depressants would have ‘de-blinded’ the trial participants. Therefore, these results are almost certainly false-positive.
  • The other studies are even less rigorous and therefore do also not allow positive conclusions.

This review was authored by known proponents of homeopathy. It is, in my view, an exercise in promotion rather than a piece of research. I very much doubt that a decent journal with a responsible peer-review system would have ever published such a biased paper – it had to appear in the infamous EUROPEAN JOURNAL OF INTEGRATIVE MEDICINE.

So what?

Who cares? No harm done!

Again, I beg to differ.

Why?

The conclusion that homeopathy has a ‘promising risk/benefit profile’ is frightfully dangerous and irresponsible. If seriously depressed patients follow it, many lives might be lost.

Yet again, we see that poor research has the potential to kill vulnerable individuals.

6 Responses to Homeopathy for depression? No, certainly not!

  • Has Dana been yammering about this yet? This sort of research is properly dangerous, potentially encouraging those with mental illness to forgo their medication in favour of worthless sugar pills.

  • I do not like to shroud wave and claim lives might be lost unless there is evidence that is the case, and that death might reasonably be attributed to a patient’s use of or belief in homeopathy.

    On the other had, it most certainly is against medical ethics not to ensure all patients give fully informed consent to have any proposed treatment (which Dr Peter Fisher seems not to have done, I did ask him) – and lay practitioners who do not do so place themselves in the category of quacks and frauds with all the attendant harm attached thereto.

    Whether vulnerable and gullible patients who are attracted to CAM actually deteriorate, become ever more depressed and suicidal, deliberately avoid conventional therapies which might help them, I do not know.
    Is there credible evidence that is the case?

  • a cohort study of patients receiving treatment provided by GPs practising homeopathy….

    This refers to the famous (or infamous, depending on your point of view) EPI3 cohort study, trumpeted by among others Boiron as a success for homeopathy.

    … reported significantly lower consumption of psychotropic drugs and improved depression

    Ah, yes. People in the care of homeopathic ‘doctors’, i.e. practitioners who believe in the healing magic of sugar crumbs and shaken water, report less use of conventional medicine. Um, could this perhaps be because those homeopathic ‘doctors’ tend to prescribe far less conventional medicines? Well, my golly, yes! That would be a perfect explanation!
    And oh, about this ‘improved depression’, from the actual study:
    “Patients … who chose to consult GPs prescribing homeopathy … were marginally more likely to experience clinical improvement”
    Correct me if I’m wrong, but it would appear that this effect was below the significance threshold and thus does not deserve mentioning in the conclusions. Also, there is this caution from the authors:
    “Results may reflect differences in physicians’ management and patients’ preferences as well as statistical regression to the mean.”
    Indeed. Homeopathic treatment involves rather more (positive) personal time and attention for patients than a typical GP can afford, and this alone undoubtedly contributes to the effect of homeopathy being comparable to that of regular pharmaceutical treatment.

    • Patients who actually chose homeopathy are a self-selected group. They’re more likely to be optimistic about the degree of non-specific response they experience, and they’re more likely to be feeling less ill, even if they score the same on those scales.

  • “The conclusion that homeopathy has a ‘promising risk/benefit profile’ is frightfully dangerous and irresponsible. If seriously depressed patients follow it, many lives might be lost.”

    So who’s up for an unblinded trial on the efficacy of punching homeopaths in the face?

    /rage

  • Antidepressants are no better than placebo for mild to moderate depression. Their bigger study only recruited moderately depressed people, so they would find anything is as good as fluoxetine.

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