Exploring the Role of Homeopathy in Reducing the Global Mental Health Burden

Excerpted from Dr. Manish Bhatia’s article in Homeopathy and Mental Health Care -Integrative Practice, Principles and Research. Ed- Christopher K. Johannes PhD /Harry van der Zee MD This book is available from : www.homeolinks.nl

Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to the community. A mentally healthy person can manage relationships with self and others and shows characteristics of hardiness, resilience, and freedom within ranges of experience and functioning. The concept of mental health is very broad and it is not restricted to the mere absence of mental illness. It is also related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders.

Mental disorders account for nearly 12% of the global burden of disease. The burden of mental disorders is maximal in young adults, the most productive section of the population. According to World Health Report 2001⁵, there are about 450 million people who suffer at a certain point from a neurological, psychiatric or behaviour related disease and about 25% of all the inhabitants in the world get a psychiatric or behavioural disorder at a certain moment in their life. About 20% of all patients who consult the primary health sector have a psychiatric disorder, but a considerable part of them are never diagnosed or treated properly. Four out of the ten most important diseases measured by YLD (Years of Life lived with Disability) are psychiatric conditions, namely unipolar depression, alcohol abuse, schizophrenia and bipolar disorder.

Worldwide, 121 million people suffer with depression, 70 million with alcohol-related problems, 24 million with schizophrenia and 37 million with dementia. According to estimates done in 2000, mental and neurological disorders accounted for 12.3% of disability-adjusted life-years, 31% of years lived with disability and 6 of the 20 leading causes of disability worldwide.

The National Alliance of Mental Heath (2008) estimates that in USA alone, one in four adults – approximately 57.7 million Americans – experience a mental health disorder in a given year. One in seventeen lives with a serious mental illness, such as schizophrenia, major depression or bipolar disorder, and about one in ten children have a serious mental or emotional disorder. About 2.4 million Americans, or 1.1 percent of the adult population, live with schizophrenia. Approximately 20.9 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a mood disorder. Bipolar disorder affects 5.7 million American adults, approximately 2.6 percent of the adult population per year. Major depressive disorder affects 6.7 percent of adults, or about 14.8 million American adults. According to the 2004 World Health Report, this is the leading cause of disability in the U.S. and Canada between the age of 15 and 44. Anxiety disorders affect about 18.1 percent of adults, an estimated 40 million individuals. Anxiety disorders frequently co-occur with depression or addiction disorders. An estimated 5.2 million adults have co-occurring mental health and addiction disorders. Alzheimer’s Disease (AD) affects an estimated 4.5 million Americans. The number of Americans with Alzheimer’s Disease has more than doubled since 1980. A recent study reported the prevalence of Autism in 3-10 year-olds to be about 3.4 cases per 1000 children.

The situation in Europe is equally grim. Today, almost 50 million European citizens (about 11% of the population) are estimated to experience mental disorders. In the European Union, psychiatric conditions constitute 25% of the total burden of disease. Neuropsychiatric disorders are the second leading cause of disability-adjusted life-years (DALYs) in the WHO European Region, accounting for 19.5% of all DALYs. According to the most recent available data (2002), neuropsychiatric disorders are the first-ranked cause of years lived with disability (YLD) in Europe, accounting for 39.7% of those attributable to all causes. Unipolar depressive disorder alone is responsible for 13.7% of YLD, making it by far the leading cause of chronic conditions in Europe. Alzheimer’s disease and other forms of dementia are the seventh leading cause of chronic conditions in Europe and account for 3.8% of all YLD. Schizophrenia and bipolar disorders are each responsible for 2.3% of all YLD. Suicide rates are high in the European Region. In the EU, there are about 58,000 suicides per year and the average suicide prevalence rate in Europe is 15.1 per 100000 population.

It is estimated that the burden of mental disorders will grow in the coming decades. By 2020 mental disorders are likely to account for 15% of disability-adjusted life-years lost. Depression is expected to become the second leading cause of disability in the world.

The Role of Homeopathy

In spite of this large-scale use, homeopathy has continued to receive criticism for its use of very high dilution “drugs” and relative lack of robust scientific evidence. However, particularly in the last 25 years, there has been a steadily growing interest in the plausible action and clinical effects of homeopathic potencies resulting in a large and growing body of research and clinical studies that have started providing valuable insights into the action and efficacy of homeopathic medicines, an accessible evidence base, and guidelines for advancing further research.

The available research data is still impressive enough to warrant serious consideration by the global health policy makers. There is a substantial and growing body of published research in good quality peer-reviewed journals showing that homeopathy has a positive effect. Between 1950 and 2008, 138 randomised controlled trials (RCTs) in homeopathy have been reported. This represents research in 71 different medical conditions. Of these 138 trials, only ten were negative. The rest were either positive (60 trials) or inconclusive (68 trials). The sections below list some of the research data that can help the policy makers and the professionals in judging the merit of using homeopathy as one of the primary therapeutic modality in the global mental health care program. (The portion below lists research related to only two conditions. For a full list of conditions and research information, please go through the book Homeopathy and Mental Health Care -Integrative Practice, Principles and Research)

Efficacy of Homeopathy in Various Diseases

ADHD
1997: John Lamont, a psychologist in Southern California, conducted a placebo-controlled, double blind, randomized trial of 43 children with attention deficit hyperactivity disorder (ADHD). The evaluations of improvement were based on parent or caretaker ratings of ADHD behaviours. A 5-point scale was used: Much worse (-2); a little worse (-1); no change (0); a little better (+1); much better (+2). Parents or caretakers were contacted by telephone 10 days after remedy/placebo taken and again after two months.

Half of the children were given an individualized homeopathic medicine and half were given a placebo that resembled a homeopathic medicine for ten days. After this, the half that was given a placebo was given an individualized homeopathic medicine. The mean improvement scores after ten days were .35 for the placebo group and 1.00 for the homeopathically treated group (p=.05). The greatest improvements were noticed by the third day, while a smaller number showed improvement after ten days.

Children who were initially given a placebo were given a homeopathic prescription after ten days and then compared with their earlier score. The mean improvement scores were .35 for the placebo group and 1.13 after a homeopathic medicine was given (p=.02). When parents reported that improvement from the treatment was not obvious, the homeopath prescribed a second or a third remedy. When comparing the results after these remedies, improvement from the homeopathic group was 1.63 and from the placebo group was .35 (p=.01).

Follow-up interviews done ten days after the homeopathic medicine, observed that the majority of children who were treated homeopathically experienced sustained and increased improvement in their condition. After two months, 57% of children experienced continued improvement; 24% showed improvement for several days or weeks following homeopathic treatment, but relapsed by the two-month interview. 19% said that they only observed improvement while taking homeopathic treatment (one could guess that this improvement was primarily from the placebo effect). This study indicates that the effects of the homeopathic medicine were relatively rapid and a significant proportion (57%) of children experienced sustained and increased improvement at two months follow-up.

2001: Frei & Thurneysen report a trial to assess the efficacy of homeopathy in 115 hyperactive patients (mean age 8.3 years, range 3-17 y) compared to methylphenidate. 75% of the children responded to homeopathy, reaching a clinical improvement rating of 73%. Children who did not respond to homeopathic treatment were prescribed methylphenidate (after an average period of 22 months of homeopathic treatment). The children were also evaluated according to the Conners Global Index (CGI), a scale that measures the degree of hyperactivity and attention deficit symptoms. The children who responded to the homeopathic medicine experienced a 55% amelioration of the CGI, while the children who responded to Ritalin experienced a 48% lowering of the CGI.

2005: Frei et al reported a randomized double blind placebo controlled crossover trial of 62 children, aged 6-16 years, with ADHD diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria, showed significant improvement of visual global perception, impulsivity and divided attention. The responders received either verum for six weeks followed by placebo for six weeks (arm A), or vice-versa (arm B). At the beginning of the trial and after each crossover period, parents reported the CGI and patients underwent neuropsychological testing. The CGI rating was evaluated again at the end of each crossover period and twice in long-term follow-up. At entry to the crossover trial, cognitive performance such as visual global perception, impulsivity and divided attention, had improved significantly under open label treatment. During the crossover trial, CGI parent-ratings were significantly lower under homeopathic treatment (average 1.67 points) than under placebo (P =0.0479). Long-term (defined as fourteen weeks) CGI improvement reached 12 points (63%, P <0.0001). This indicates significant improvement under homeopathic treatment. The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of ADHD, particularly in the areas of behavioural and cognitive functions.

2007: A Swiss randomised, placebo controlled, cross-over trial in ADHD patients was designed with an open-label screening phase prior to the randomised controlled phase. During the screening phase, the response of each child to successive homeopathic medications was observed until the optimal medication was identified. Only children who reached a predefined level of improvement participated in the randomised, cross-over phase. Although the randomised phase revealed a significant beneficial effect of homeopathy, the cross-over caused a strong carryover effect diminishing the apparent difference between placebo and verum treatment. During the screening phase, 84% (70/83) of the children responded to treatment and reached eligibility for the randomised trial after a median time of five months (range 1-18), with a median of three different medications (range 1-9). Five months after treatment start, the difference in Conners Global Index (CGI) rating between responders and non-responders became highly significant (p = 0.0006). Improvement in CGI was much greater following the identification of the optimal medication than in the preceding suboptimal treatment period (p< 0.0001).

Drug Abuse

1990: The govt. of India conducted a double-blind study on 60 heroin addicts, of whom 30 were given individualized homeopathic medicines and 30 were given placebo. The number and intensity of the symptoms during withdrawal were significantly less in patients given an individualized homeopathic medicine than those given a placebo. The number of days for the resolution of complaints was also less in the homeopathically treated group. There was a difference in the adherence too – 35% of patients on the placebo left the study prior to its completion due to lack of therapeutic benefit, while only 5% of those taking the homeopathic medicine left the study.

1993: A double blind, placebo-controlled trial applying homeopathy to chemical dependency was done by the Hahnemann College of Homeopathy, Albany, California. The results showed decreased relapse rate of recovering alcoholics and drug addicts undergoing homeopathic treatment.

1994: A study was carried out by Central Council for Research in Homoeopathy (CCRH) at its Clinical Research Unit, Varanasi, India. Out of 261 drug dependent patients referred from a Drug De-addiction centre at Varanasi, 20 cases dropped out whereas 241 were followed up from September 1988 to March 1994. All the cases were in the age group of 12-52 years and all, except one, were male. The medicines were administered usually 8-12 hours after abstinence of drug substance abuse, where withdrawal symptoms became obvious. Prescription was made on the basis of totality of symptoms of the individual case.

Out of 241 cases followed up regularly, 209 cases showed improvement in withdrawal symptoms whereas 32 cases did not improve. Rhus toxicodendron (n=85) was found to be the most effective medicine. Other medicines found effective were Avena sativa (n=43), Nux vomica (n=34), Arsenicum album (n=26), Bryonia alba (n=8) and Chamomilla (n=7).

The outcome of the study shows that homeopathic medicines are efficacious in the management of withdrawal symptoms of drug dependents and can check the menace of the chemical dependency. The results have prompted CCRH to take up this study in collaboration with Society for Promotion of Youth and Masses (SPYM) from April 2008.