Homeopathy 2018; 107(02): 081-089
DOI: 10.1055/s-0038-1636536
Homeopathy and Public Health
The Faculty of Homeopathy

Management of Anxiety and Depressive Disorders in Patients ≥ 65 Years of Age by Homeopath General Practitioners versus Conventional General Practitioners, with Overview of the EPI3-LASER Study Results

Karine Danno
1   Laboratoires Boiron, Messimy, France
Gérard Duru
2   Cyklad Group, Lyon, France
Jean Marie Vetel
3   Department of Geriatrics, Centre Hospitalier du Mans, Le Mans, France
› Author Affiliations
Funding LASER (a company specialising in Observational Research and Pharmaco-epidemiology) promoted the study. Boiron Laboratories, France, provided financial support for the EPI3 study. The sponsor had no role in the design, management, data collection, analyses, interpretation and writing of the manuscript or the decision to publish the results. However, the sub-analysis was performed at the Boiron Laboratories, France.
Further Information

Publication History

13 July 2017

23 January 2018

Publication Date:
20 March 2018 (online)


Background The increasing use of psychotropic drugs to treat anxiety and depressive disorders (ADDs) is concerning. According to the study, ‘Etude Pharmacoépidémiologique de l'Impact de Santé Publique des modes de prise en charge pour 3 groupes de pathologies’ (EPI3)-LASER, adult ADD patients who consult a general practitioner prescribing homeopathic medicines (GP-Ho) report less psychotropic drug use and are marginally more likely to experience clinical improvement than those receiving conventional care. We determined whether these observations also apply to patients ≥ 65 years old in the EPI3 cohort.

Methods The EPI3-LASER study, conducted in France between March 2007 and July 2008, was a nationwide, observational survey of the three most common reasons for primary care consultation, including ADD, and the impact of the GPs' prescribing preferences: homeopathy (GP-Ho), conventional medicines (GP-CM) or mixed prescriptions (GP-Mx). This sub-analysis included 110 patients ≥ 65 years old with ADD from the EPI3 cohort who consulted either a GP-CM or GP-Ho. Socio-demographic and medical data and details of any medications prescribed were collected at inclusion. Information regarding the patients' functional status (Hospital Anxiety and Depression Scale [HADS)]) was obtained via a telephone interview 72 hours after inclusion, and at 1, 3 and 12 months post-inclusion. Medication use and outcome were determined over the 12-month period. Differences between the GP-CM and GP-Ho groups were assessed by multivariate logistic regression analysis.

Results One hundred and ten patients were recruited and 87 (79.1%) with ADD (HADS ≥ 9) at the 72-hour interview were evaluated (age range: 65–93 years, 82.8% female). Patients who consulted a GP-Ho were more likely (odds ratio [OR] = 10.38, 95% confidence interval [CI]: 1.33–81.07) to have clinical improvement (HADS < 9) after 12 months than those in the GP-CM group. Patients who consulted a GP-Ho reported less psychotropic drug use (OR = 22.31 [95% CI: 2.20–226.31]) and benzodiazepine use (OR = 60.63 [95% CI: 5.75–639.5]) than GP-CM patients.

Conclusions Management of ADD patients aged ≥ 65 years by GP-Ho appears to have a real public health interest in terms of effectiveness and lower psychotropic drug use.

  • References

  • 1 Bongue B, Laroche ML, Gutton S. , et al. Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system. Eur J Clin Pharmacol 2011; 67: 1291-1299
  • 2 Laroche ML, Bouthier F, Merle L, Charmes JP. Potentially inappropriate medications in the elderly: a list adapted to French medical practice [Article in French]. Rev Med Interne 2009; 30: 592-601
  • 3 Grimaldi-Bensouda L, Begaud B, Lert F. , et al; EPI3-LA-SER Group. Benchmarking the burden of 100 diseases: results of a nationwide representative survey within general practices. BMJ Open 2011; 1: e000215
  • 4 Rossignol M, Begaud B, Engel P. , et al; EPI3-LA-SER group. Impact of physician preferences for homeopathic or conventional medicines on patients with musculoskeletal disorders: results from the EPI3-MSD cohort. Pharmacoepidemiol Drug Saf 2012; 21: 1093-1101
  • 5 Grimaldi-Bensouda L, Bégaud B, Rossignol M. , et al. Management of upper respiratory tract infections by different medical practices, including homeopathy, and consumption of antibiotics in primary care: the EPI3 cohort study in France 2007-2008. PLoS One 2014; 9: e89990
  • 6 Grimaldi-Bensouda L, Abenhaim L, Massol J. , et al; EPI3-LA-SER Group. Utilization of psychotropic drugs by patients consulting for sleeping disorders in homeopathic and conventional primary care settings: the EPI3 cohort study. Homeopathy 2015; 104: 170-175
  • 7 Grimaldi-Bensouda L, Abenhaim L, Massol J. , et al; EPI3-LA-SER group. Homeopathic medical practice for anxiety and depression in primary care: the EPI3 cohort study. BMC Complement Altern Med 2016; 16: 125
  • 8 Danno K, Joubert C, Duru G, Vetel JM. Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort. Clin Epidemiol 2014; 6: 333-341
  • 9 Lenze EJ, Mulsant BH, Shear MK, Houck P, Reynolds III CF. Anxiety symptoms in elderly patients with depression: what is the best approach to treatment?. Drugs Aging 2002; 19: 753-760
  • 10 McDougall FA, Kvaal K, Matthews FE. , et al; Medical Research Council Cognitive Function and Ageing Study. Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychol Med 2007; 37: 1787-1795
  • 11 Kvaal K, McDougall FA, Brayne C, Matthews FE, Dewey ME. ; MRC CFAS. Co-occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). Int J Geriatr Psychiatry 2008; 23: 229-237
  • 12 Doraiswamy PM. Contemporary management of comorbid anxiety and depression in geriatric patients. J Clin Psychiatry 2001; 62 (Suppl. 12) 30-35
  • 13 Klug G, Lacruz ME, Emeny RT, Häfner S, Ladwig KH, Huber D. Aging without depression: a cross-sectional study. Psychodyn Psychiatry 2014; 42: 5-22
  • 14 Kennedy GJ, Castro J, Chang M, Chauhan-James J, Fishman M. Psychiatric and medical comorbidity in the primary care geriatric patient - an update. Curr Psychiatry Rep 2016; 18: 62
  • 15 Ní Mhaoláin AM, Fan CW, Romero-Ortuno R. , et al. Frailty, depression, and anxiety in later life. Int Psychogeriatr 2012; 24: 1265-1274
  • 16 Braam AW, Copeland JR, Delespaul PA. , et al. Depression, subthreshold depression and comorbid anxiety symptoms in older Europeans: results from the EURODEP concerted action. J Affect Disord 2014; 155: 266-272
  • 17 Lapid MI, Rummans TA. Evaluation and management of geriatric depression in primary care. Mayo Clin Proc 2003; 78: 1423-1429
  • 18 Hummel J, Weisbrod C, Boesch L. , et al. AIDE-acute illness and depression in elderly patients. Cognitive behavioral group psychotherapy in geriatric patients with comorbid depression: a randomized, controlled trial. J Am Med Dir Assoc 2017; 18: 341-349
  • 19 Agence Française de Sécurité Sanitaire des Produits de Santé. Prévenir la iatrogénesè médicamenteuse chez le sujet âgé. Available at: http://ansm.sante.fr/var/ansm_site/storage/original/application/9641eb3f4a1e67ba18a6b8aecd3f1985.pdf . Accessed April 24, 2017
  • 20 Pariente A, de Gage SB, Moore N, Bégaud B. The benzodiazepine-dementia disorders link: current state of knowledge. CNS Drugs 2016; 30: 1-7
  • 21 Billioti de Gage S, Pariente A, Bégaud B. Is there really a link between benzodiazepine use and the risk of dementia?. Expert Opin Drug Saf 2015; 14: 733-747
  • 22 Thase ME. Achieving remission and managing relapse in depression. J Clin Psychiatry 2003; 64 (Suppl. 18) 3-7
  • 23 Gasquet I, Nègre-Pagès L, Fourrier A. , et al. Psychotropic drug use and mental psychiatric disorders in France; results of the general population ESEMeD/MHEDEA 2000 epidemiological study [Article in French]. Encephale 2005; 31: 195-206
  • 24 Gandek B, Ware JE, Aaronson NK. , et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 1998; 51: 1171-1178
  • 25 Organisation mondiale de la Santé Manuel de la classification statistique internationale des maladies, traumatismes et causes de décès, fondé sur les recommandations de la Conférence pour la 9e révision, 1975. Geneva: Organisation Mondiale de la Santé; 1977
  • 26 Grimaldi-Bensouda L, Rossignol M, Aubrun E, El Kerri N, Benichou J, Abenhaim L. Agreement between patients' self-report and physicians' prescriptions on cardiovascular drug exposure: the PGRx database experience. Pharmacoepidemiol Drug Saf 2010; 19: 591-595
  • 27 Grimaldi-Bensouda L, Rossignol M, Aubrun E, Benichou J, Abenhaim L. ; the PGRx Study Group. Agreement between patients' self-report and physicians' prescriptions on nonsteroidal anti-inflammatory drugs and other drugs used in musculoskeletal disorders: the international Pharmacoepidemiologic General Research eXtension database. Pharmacoepidemiol Drug Saf 2012; 21: 753-759
  • 28 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370
  • 29 Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52: 69-77
  • 30 Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 2002; 53: 737-740
  • 31 HAS. IPC pour prévenir la iatrogénie des psychotropes chez le sujet âgé. Available at: http://www.has-sante.fr/portail/jcms/c_1250626/indicateurs-de-pratique-clinique-ipc . Accessed April 24, 2017
  • 32 Lecadet J, Vidal P, Baris B, Vallier N. Psychotropic medications: prescription and use in Metropolitan France. I. National data for 2000. Rev Méd Assur Maladie 2003; 34: 75-84
  • 33 Semoun O, Sevilla-Dedieu C. Psychotropic drug consumption among older people enrolled in a French private health insurance plan. Drugs Real World Outcomes 2015; 2: 217-225
  • 34 Henschel F, Redaelli M, Siegel M, Stock S. Correlation of incident potentially inappropriate medication prescriptions and hospitalization: an analysis based on the PRISCUS list. Drugs Real World Outcomes 2015; 2: 249-259
  • 35 Fried LP, Tangen CM, Walston J. , et al; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156
  • 36 Sirven N, Bourgeuil Y. , Eds. La prévention de la perte d'autonomie. La fragilité en questions - Apports, limites et perspectives. Available at: http://www.irdes.fr/recherche/rapports/563-la-prevention-de-la-perte-d-autonomie-la-fragilite-en-questions.pdf . Accessed April 24, 2017
  • 37 Ní Mhaoláin AM, Fan CW, Romero-Ortuno R. , et al. Depression: a modifiable factor in fearful older fallers transitioning to frailty?. Int J Geriatr Psychiatry 2012; 27: 727-733
  • 38 Vaughan L, Corbin AL, Goveas JS. Depression and frailty in later life: a systematic review. Clin Interv Aging 2015; 10: 1947-1958
  • 39 Trivalle C. L'intérêt du dépistage de la fragilité des personnes agées. Available at: https://www.vidal.fr/actualites/13753/dr_christophe_trivalle_geriatre_l_interet_du_depistage_de_la_fragilite_des_personnes_agees/http://www.chu-toulouse.fr/-qu-est-ce-que-l-hopital-de-jour-d-evaluation-des . Accessed April 24, 2017