The feasibility of a randomised, placebo-controlled clinical trial of homeopathic treatment of depression in general practice.

UNLABELLED: Depression is common in general practice and lack of concordance is an important problem in its treatment. Homeopathy has few side effects and is generally associated with good compliance. We report a study investigating the feasibility of a trial to compare the effectiveness of homeopathy with a conventional antidepressant and placebo. OBJECTIVES: To assess the feasibility of a general practice-based clinical trial comparing the effectiveness of individualised homeopathic treatment vs Fluoxetine (Prozac) vs placebo in the treatment of major depressive episodes of moderate severity. DESIGN: Randomised, double-dummy, double-blind parallel group clinical trial. SETTING: Lower Clapton Group Practice, East London. METHOD: Patients were recruited through their general practitioners as they presented during a 9 month period. Recruitment target was 30 patients. Eligibility was confirmed by a consultant psychiatrist using standard criteria (DSM-IV) and instruments Hamilton Depression Scale (HAMD). Suicidal and psychotic patients were excluded, additional precautions against suicide were incorporated. There was a 1 week run-in period and patients showing spontaneous improvement were excluded. Homeopathic treatment was prescribed by a GP qualified in homeopathy, from a 'limited list' of 30 homeopathic medicines, with the help of decision support software. Patients were randomised to receive verum Fluoxetine and placebo homeopathy, or verum homeopathy and placebo Fluoxetine, or placebo homeopathy and placebo Fluoxetine. Treatment duration was 12 weeks. The outcomes were: adverse drug reactions, clinical global impression (CGI); HAMD; mini international psychiatric Interview; Pittsburgh sleep quality index; Side-effects checklist; Short Form 12; treatment credibility questionnaire; work and social disability scale. The primary outcome measures were HAMD and CGI. RESULTS: A recruitment calculation indicated that over 230 suitable patients would be expected to attend the practice during the recruitment phase. Thirty one patients were referred for possible inclusion in the trial by their GPs. Twenty three met the entry criteria, 11 were randomised and 6 completed the study. Of the completers, one received homeopathy, 2 placebo and 3 Fluoxetine. CONCLUSIONS: A trial of this design in general practice is not feasible, because of recruitment difficulties, many of them linked to patient preference. Different approaches are required to recruit adequate patient numbers to trials of this sort.

The management of pregnancy and labour with homoeopathy.

The problematic effects of many conventional medications indicated during pregnancy have prompted some women to turn to homoeopathy, as a safe and effective treatment option for pregnancy-related symptoms. Homoeopaths take into account both physical and mental symptoms in case-taking; and use medicines which have been clinically tested on healthy human beings in very low doses. There are no toxic effects of homoeopathic remedies due to the extremely low doses used. Homoeopathy can be used to enhance the patients overall well-being and for specific problems that may arise during pregnancy and labour (Castro 1992; Handley 1993; Webb 1992, Zaren 1987). There are probably more than 2000 homoeopathic remedies that could be useful for treating ailments during pregnancy (Jansen 1992; Murphy 1993; Webb 1992). This article will focus on the common problems that could occur during pregnancy and labour, and will give brief keynote features of a few of the possible homoeopathic remedies used in their treatment. Nurses and midwives may find a little knowledge about the homoeopathic treatments useful in managing patients during pregnancy, although all treatment used during pregnancy should be carried out by an experienced homoeopath in conjunction with an obstetric medical team.

Homoeopathic treatment during the menopause.

Nurses and midwives may not be directly involved in treating menopausal patients, nevertheless they are in a unique position to offer support and advice to patients concerned about the menopause. Many women want to know about ways of dealing with uncomfortable symptoms and fears associated with going through the menopause. Homoeopathic treatment is one form of therapy which can be used during the menopause, which takes into account both the physical symptoms and the emotional responses. Homoeopathic treatment can be used as an alternative to treatment with hormone replacement therapy (HRT), or alongside HRT, in the management of menopausal symptoms. As well as exploring homoeopathic approaches to the treatment of menopausal symptoms, the current trend of promoting HRT is questioned in this article.