Q:  Homeopathic Approaches

Dear Dr. Phelps,

Do you have any information about successful treatment of manic-depressive illness using homoeopathic medicine? I read the book ‘Beyond Prozac’ which says about long-term stabilization of MD after homoeopathic treatment. I am a little bit skeptical however, so I would like to know an independent opinion of a specialist about this.

Thank you.
 

Dear Anna -- 
Watch out for my knee jerking here.... you ask about "long-term stabilization", fair enough.  If we had a good definition of that then we could start asking for evidence of the homeopathic approach, perhaps even compared to other more possibly conventional approaches.  Not that the latter have great evidence to cite, but I think it's generally a good deal more than what can be cited for homeopathic approaches, which to my knowledge generally seem to skip over the "gathering evidence" process and rely primarily on the say-so of homeopathic experts.  That's a lot easier to do than generate data.  However, since the doses involved would in this case by small by definition, at least these approaches have the advantage of being unlikely to do harm in the meantime even if they are not effective -- which is more than can be said for some of the conventional approaches that I use!  However, I hope I'm making sense here, it really comes down to evidence for effectiveness, not just low risk.  And in my view there's a great deal more evidence that full doses of medications like mood stabilizers are more effective than placebo's (or homeopathic doses of things like Prozac).  I would admit, finally, that the data on antidepressants efficacy compared to placebo is pretty weak:  a lot of people get better while on placebo, at least 25% in many studies and often as high as 30 or 40%.  By comparison, the medication group (e.g. full dose Prozac or the many other antidepressants) generally only gets better at about a 40-50% rate -- not always very impressive as a relative improvement over placebo.  These kinds of numbers I think shed some light on why homeopathic doses might seem a good idea:  it's not hard to have pretty good success rates with a sugar pill; it's hard to demonstrate that a medication is clearly better -- at any dose!  

Finally, I'll add that in most studies of bipolar disorder, placebo response rates are not that high as the above numbers, which refer to studies of the treatment of plain depression.  So in bipolar disorder it's somewhat easier to show that active medication, as opposed to placebo, is actually doing something, and doing it at rates that are significantly better than a sugar pill.  It's one of the reasons why I rather focus on bipolar disorder:  if I'm going to be giving medications, I'd like to believe that they're really necessary and really going to make a difference (because they definitely carry risk at full doses, just like antidepressants do). 

Dr. Phelps

Published January, 2003