Abstract
BackgroundDespite controversy regarding homeopathy, some patients consult homeopaths for depression. Evidence is required to determine whether this is an effective, acceptable and safe intervention for these patients.MethodsA pragmatic trial using the “cohort multiple randomised controlled trial” design was used to test the effectiveness of adjunctive treatment by homeopaths compared to usual care alone, over a period of 12 months in patients with self-reported depression. One third of patients were randomly selected for an offer of treatment provided by a homeopath. The primary outcome measure was the Patient Health Questionnaire (PHQ-9) at 6 months. Secondary outcomes included depression scores at 12 months; and the Generalised Anxiety Disorder (GAD-7) outcome at 6 and 12 months.ResultsThe trial over-recruited by 17% with a total of 566 patients. Forty percent took up the offer and received treatment. An intention-to-treat analysis of the offer group at 6 months reported a 1.4-point lower mean depression score than the no offer group (95% CI 0.2, 2.5, p = 0.019), with a small standardized treatment effect size (d = 0.30). Using instrumental variables analysis, a moderate treatment effect size in favour of those treated was found (d = 0.57) with a between group difference of 2.6 points (95% CI 0.5, 4.7, p = 0.018). Results were maintained at 12 months. Secondary analyses showed similar results. Similar results were found for anxiety (GAD-7). No evidence suggested any important risk involved with the intervention.ConclusionThis trial provides preliminary support for both the acceptability and the effectiveness of treatment by a homeopath for patients with self-reported depression. Our results provide support for further pragmatic research to provide more precise estimates of treatment effect.Trial registrationISRCTN registry, ISRCTN02484593. Registered on 7 January 2013.
Highlights
Despite controversy regarding homeopathy, some patients consult homeopaths for depression
At 6 months, 458 patients (81%) returned a follow-up questionnaire, with 125 (68%) in the offer group and 333 (87%) in the no offer group. Among those in the offer group who took up the offer of treatment, 88% responded (n = 65/74), compared to only 54% of those who did not take up the offer (n = 60/111)
The intervention Over the 12 months of the trial, the 74 patients who took up the offer of treatment received a total of 490 consultations with a homeopath, with a median of 7.5 consultations over 6.5 months (IQR 4.1–8.9)
Summary
Some patients experience partial or no benefit of psychological interventions or pharmacotherapy, or have experienced or are concerned about side effects of antidepressants Some of these consult homeopaths [3]. Goldacre suggested unblinded trials comparing visits to a homeopathy clinic against a General Practitioner’s (GP’s) treatment as usual might be the way forward for homeopathy research, as this is of more interest to patients [11]. This is the first pragmatic randomised controlled trial assessing the effectiveness of treatment provided by homeopaths for depressed patients
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