Homeopathy for depression: a systematic review of the research evidence
19 July 2004
revised 08 December 2004
accepted 17 March 2005
29 December 2017 (online)
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, ClNAHL, 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 Additionally, efforts were made to identify unpublished and ongoing research using relevant sources and experts in the field.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Conclusions A comprehensive search for published and unpublished studies has demonstrated that the evidence for the effectiveness of homeopathy in depression is limited due to lack of clinical trials of high quality.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.
AbbrevationsRCT - Randomised-controlled trial - CCT - Controlled clinical trial - UC - Uncontrolled - DARE - Database of Abstracts of Reviews of Effects - H - Homeopathy - D - Diazepam - HAMD - Hamilton Depression Scale - P - Placebo - F - Fluoxetine - CGI - Clinical Global Impression - QoL - Quality of life - WSDS - Work and Social Disability Scale - BSPS - Brief Social Phobia Scale - SCL-90 - Outpatient psychiatric rating scale - HADS - Hospital Anxiety and Depression Scale - RSCL - Rotterdam Symptom Checklist - EORTCQLQ-30 - European Organisation for Research and Treatment in Cancer—Quality of Life Questionnaire—Core 30.
- 1 Eisenberg D.M, Davis R.B, Ettner S.L. et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 1998; 280 (18) 1569-1575.
- 2 Davidson J, Rampes H, Eisen M, Fisher P, Smith R, Malik M. Psychiatric disorders in primary care patients receiving complementary medical treatments. Compr Psychiat 1998; 39 (01) 16-20.
- 3 Unutzer J, Klap R, Sturm R. et al. Mental disorders and the use of the alternative medicine: results from a national survey. Am J Psychiatry 2000; 157 (11) 1851-1857.
- 4 Becker-Witt C, Lüdtkeb R, Weißhuhna T.E.R, Willicha S.N. Diagnoses and treatment in homeopathic medical practice. Forsch Kompl Klass Nat 2004; 11: 98-103.
- 5 World Bank. World Development Report: Investing in Health Research Development. Geneva: World Bank; 1993
- 6 Cassano P, Fava M. Depression and public health: an overview. J Psychosom Res 2002; 53 (04) 849-857.
- 7 Boyer W.F, Feighner J.P. The financial implications of starting treatment with a selective serotonin reuptake inhibitor or tricyclic antidepressant in drug-naive depressed patients. in: Jonsson B, Rosenbaum J. Health Economics of Depression. 1993. Chichester: Wiley;
- 8 Martinez C, Rietbrock S, Ashby D. et al. Antidepressant treatment and the risk of fatal and non-fatal self-harm in first episode depression. BMJ 2005; 330: 389-393.
- 9 Fergusson D, Doucette S, Glass K.G. et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 2005; 330: 396-399.
- 10 Sharples F, Van Haselen R, Fisher P. NHS patients’ perspective on complementary medicine. Complement Ther Med 2003; 11 (04) 243-248.
- 11 Knaudt P, Connor K, Weisler R, Churchill L, Davidson J. Alternative therapy use by psychiatric outpatients. J Nerv Ment Dis 1999; 187 (11) 692-695.
- 12 Demling J, Neubauer S, Luderer H-J, Worthmuller M. A survey on psychiatric patients’ use of non-medical alternative practitioners: incidence, methods, estimation, and satisfaction. Complement Ther Med 2002; 10 (04) 193-201.
- 13 Van Wassenhoven M, Ives G. An observational study of patients receiving homeopathic treatment. Homeopathy 2004; 93: 3-11.
- 14 NHS Centre for Reviews and Dissemination (CRD). Undertaking Systematic Reviews of Research on Effectiveness. 2nd ed. York: CRD; 2001. Report Number 4.
- 15 Kleijnen J, Knipschild P, ter Riet G. Clinical trials of homeopathy. BMJ 1991; 302: 316-323.
- 16 Heulluy B. Random trial of L.72 with Diazepam 2 in cases of nervous depression. [Essai randomisé ouvert de L 72 (spécialité homéopathique) contre diazépam 2 dans les états anxiodépressifs]. Metz: Laboratoires Lehning, Unpublished study, 1985.
- 17 Katz T, Fisher P, Katz A, Davidson J, Feder G. The feasibility of a randomised, placebo-controlled clinical trial of homoeopathic treatment of depression in general practice. Homeopathy 2005; 94.
- 18 Awdry R. Homoeopathy and chronic fatigue—the search for proof. Int J Alternat Complement Med 1996: 19–21.
- 19 Awdry R. Homoeopathy may help ME. Int J Alternat Complement Med 1996: 12–16.
- 20 Clover A, Last P, Fisher P, Wright S, Boyle H. Complementary cancer therapy: a pilot study of patients, therapies and quality of life. Complement Ther Med 1995; 3 (03) 129-133.
- 21 Davidson J.R.T, Morrison R.M, Shore J, Davison R.T, Bedayn G. Homeopathic treatment of depression and anxiety. Altern Ther Health Med 1997; 3 (01) 46-49.
- 22 Davidson J, Morisson R.M, Shore J, Davidson R.T, Bedayn G. Homeopathic treatment of anxiety and depression. (Traitement homeopathique de l’anxiete et de la depression.). Homeopath Europ 1997; 5 (06) 8-12.
- 23 Thompson E.A, Reilly D. The homeopathic approach to symptom control in the cancer patient: a prospective observational study. Palliat Med 2002; 16 (03) 227-233.
- 24 Thompson E.A, Reilly D. The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast cancer patients. A prospective observational study. Homeopathy 2003; 92 (03) 131-134.
- 25 Zenner S, Weiser M. Homeopathic treatment of gynecological disorders: results of a prospective study. Biomed Ther 1999; 17 (01) 31-35.
- 26 Davidson J, Woodbury M, Morrison R, Shore J, Bedayn G. Multivariate analysis of five homoeopathic medicines in a psychiatric population. Br Homeop J 1995; 84 (04) 195-202.
- 27 Stevinson C. Evidence for the efficacy of complementary therapies in depression. Focus Alternat Complement Ther 1999; 4 (03) 111-1114.
- 28 Ernst E, Resch K.L. Clinical trials of Homoeopathy: A reanalysis of a published review. Forsch Komplementarmed 1996; 3: 85-90.
- 29 Linde K, Clausius N, Ramirez G. et al. Are the clinical effects of homoeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997; 350: 834-843.
- 30 Ernst E, Rand J.I, Stevinson C. Complementary therapies for depression: an overview. Arch Gen Psychiatry 1998; 55 (11) 1026-1032.
- 31 Linde K, Melchart D. Randomized controlled trials of individualized homeopathy: a state-of-the-art review. J Altern Complement Med 1998; 4 (04) 371-388.
- 32 Jorm A, Christensen H, Griffiths K, Rodgers B. Effectiveness of complementary and self help treatments for depression. Med J Aust 2002; 176 Suppl S84-S96.
- 33 Boissel J, Cucherat M, Haugh M, Gauthier E. Critical literature review on the effectiveness of homoeopathy: overview of data from homoeopathic medicine trials. Homoeopathic Medicine Research Group, Report to the European Commission, Brussels, 1996, pp. 195–210.
- 34 Cucherat M, Haugh M.C, Gooch M, Boissel J.P. Evidence of clinical efficacy of homeopathy: a meta-analysis of clinical trials. Eur J Clin Pharmacol 2000; 56 (01) 27-33.
- 35 Clover A. Patient benefit survey: Tunbridge Wells Homoeopathic Hospital. Br Homeopath J 2000; 89: 68-72.
- 36 Richardson W.R. Patient benefit survey: Liverpool Regional Department of Homoeopathic Medicine. Br Homeopath J 2001; 90: 158-162.
- 37 Dantas F, Rampes H. Do homeopathic medicines provoke adverse effects?. Br Homeopath J 2000; 89: S35-38 [Full text available at www.rlhh.org.uk/ conference (Proceedings 2)]
- 38 Fisher P, Dantas F, Rampes H. The safety of homeopathic products. J R Soc Med 2002; 95: 474-475.
- 39 Grabia S, Ernst E. Homeopathic aggravations: a systematic review of randomised, placebo-controlled clinical trials. Homeopathy 2003; 92: 92-98.
- 40 Thompson E, Barron S, Spence D. A preliminary audit investigating remedy reactions including adverse events in routine homeopathic practice. Homeopathy 2004; 93: 203-209.
- 41 Silverman W.A, Altman D.G. Patient's preferences and randomised trials. Lancet 1996; 347: 171-174.
- 42 Concato J, Shah N, Horwitz R.I. Randomized, controlled trials, observational studies, and the hierarchy of research designs. New Engl J Med 2000; 342: 1887-1892.
- 43 Aickin M. Participant-centered analysis in complementary and alternative medicine comparative trials. J Altern Complement Med 2003; 9: 949-957.
- 44 Thompson T, Owen D, Swayne J. Editorial: The case for cases: publishing high-quality case reports in homeopathy. Homeopathy 2002; 91 (01) 1-2.