One of the two Monday all day seminars at the 1997 NCH conference was led by Andre Saine.He began his talk by noting that the title the NCH had chosen for it, "The Treatment of Depression," was incorrect. In homeopathy there is no treatment for any disease. Instead homeopathy treats the patient who has the disease. So the talk would have been better titled "The Treatment of the Depressed Patient." It is very rare, Andre said, to see a patient that is suffering solely form depression. Sometimes depression is secondary to some other pathology, such as multiple sclerosis or cancer. Most patients with depression also suffer from anxiety, or have substance abuse problems. About ten percent also show symptoms of psychosis. A large percentage of the population suffers from depression and it is not unusual for a patient to present himself to the homeopath with depression as the chief complaint. More often, the patient is a woman than a man. Metabolic and endocrine factors are implicated in depression. Often depression is associated with menstruation, either being worse before or relieved by menstruation. There are also cases of hereditary depression, where several generations within the family all suffer from depression
There are many remedies in the materia medica which cover depression. A quick search of Reference Works using the word depression brought up 733 remedies. Also many rubrics in the Mind section of the repertory are useful. First. there is sadness. This rubric has the largest selection of modalities. But other rubrics are also useful. First, there are the physical signs of depression: sighing, weeping, and complaining. Then there is the rubric despair, with the subrubrics of salvation and of recovery. Also indifference, with the subrubric to joy is useful. There are a number of aversion rubrics in the repertory: averse to laughing, jesting, amusement, business, company, to being spoken to, and averse to conversation. Other rubrics expressing similar states are: asks for nothing, desire to be quiet, desires tranquility, indisposed to talk, and estranged from her family. Depression is often associated with brain fag and such other rubrics as aversion to mental work, to writing, to thinking, deficiency of ideas and difficult concentration. Use of a materia medica search engine such as Reference Works is also useful to find the correct remedy, as only a small portion of the symptoms of our materia medicas can be found in the repertories.
The concomitants to depression are often the key to selecting the remedy. Depression is often associated with anxiety, and the fear rubrics can be useful in choosing the remedy. Useful rubrics are: fear of poverty, fear of insanity, and fear of misfortune. Andre finds the in patients with many fears, repertorizing the fears is not useful, but when the patient has one strong fear it is useful in choosing the remedy.
Depressed patients can also show anger or irritability. To repertorize anger it is important to get what circumstances make the patient angry. Irresolution and lack of self-confidence are also often associated with depression. Fatigue is another symptom of depression. As with anger, it is important to get the modality in order to use repertorize fatigue. It is also important to note the circumstances where the fatigue is ameliorated, such as exercise or walking in the open air. Depressed patients are often restless, and rubrics such as gestures, wringing the hands or bed, driven out of can be used. However, patients most typically will not confess to being restless. The homeopath needs to get this symptom by observing the patient or questioning the spouse, if possible.
Depression can disorder the appetite. The patient may either stop eating when depressed, or increase eating. Food cravings may develop when depressed. There are often sleep disorders and disorders of the libido. Decreased libido is common, but Andre finds increased libido is a more significant symptom when selecting the remedy.
About fifteen to twenty percent of the depressed show psychotic symptoms. These can include visual and auditory hallucinations or visions of deceased persons. Psychotic symptoms can be found under delusions in the repertory. Useful rubrics are delusions, is watched, is observed, is referred to, has incurable disease, and has shameful disease.
Depression is sometimes a symptom of bipolar disorder. Many rubrics in the repertory cover this state. Some are mania, alternating with sadness, euphoria, alternating with sadness, excitement alternating with sadness, exhilaration alternating with grief and sadness. Symptoms covering the manic phase of the disorder can be useful in selecting the remedy, such as loquacity, ecstatic, delusions, great person is, industrious, mania for work, passionate, vivaciousness, and senses, acute. Other rubrics are ideas, abundant, theorizing, extravagance, fancies, exaltation of, prophesying, work, desire for mental, writing, desire for, and verses, makes.
When taking the case where the patient complains of depression, always ask the patient to explain what they mean by depression. When they are finished explaining, ask them to tell more about it. Be patient and ask non-specific questions and at some point the patient will begin to open up their old luggage. When the patient has been "squeezed out," go back to what they have said previously and fill in the blanks. Ask about the onset of the depression. Often there is more than one onset, where a life circumstance will trigger a deeper level of depression. Be sure and observe how the patient acts when describing the onset of the depression. Observe theirs expression. If they are smiling, it is a symptom of denial, which needs to be investigated further. Ask the patient what sort of person they were before their depression.
In addition to asking about the onset of the depression, ask the patient about the modalities. Typical modalities are time of day, of year, weather, open air and activity. When asking the patient for modalities ask them if they've noticed that a specific modality affects their depression. Do not settle for a simple yes or no answer. If they say yes, ask them to describe the modality in detail and only include it as a genuine symptom if their statements indicate it is so. After questioning the patient in this way about their depression, then search for the concomitants by doing a review of the patient's symptoms (a head to toe). Then ask for the medical history of the patient's family.
The amount of information you can get by taking a proper case is enormous. In the majority of situations, you should get a good case if you follow this method of case taking. However, in a certain percentage of cases, perhaps about ten percent, the patient will not respond to the homeopath or will say "I don't know" when questioned. In these cases, a relative can sometimes supply the information needed to analyze the case. In other cases, the homeopath will have to wait for the patient to open up enough to give a full case. This can sometimes take two, three, four, or five years. Often the patient will come down with an acute illness and the symptoms of the acute illness will indicate what remedy the patient needs for their chronic case.
The method for analyzing a case is essentially the same as Andre Saine presented in his talk on handling difficult cases. Often the mental symptoms alone will not clearly indicate a single remedy. The concomitants of the depression, especially their modalities, are often the key to the case. In each case the homeopath must ask, what is the striking feature of this case.
In the treatment of depression by homeopathy, the prognosis is as good as the doctor. If the patient show psychotic symptoms, the prognosis must be more guarded, depending on the length of the psychosis. If the depression stems from endogenous (organic) rather than exogenous causes, the prognosis also must be more guarded. But many of these cases can still show significant improvement with homeopathic treatment. The great majority of cases with suicidal tendencies respond to proper homeopathic treatment. However, there are rare cases where an elderly patient has decided to die and the patient shows no other pathology. In these cases Andre Saine finds that the case cannot be cured.
Many patients suffering from depression are also on allopathic medicines. These patients cannot be taken off their allopathic medicines immediately, as they will experience rebound symptoms. This is especially true of patients with bipolar disorder. Andre says that cases of these patients can be taken as if they were not on medication. The allopathic medicines do not change the patients' symptoms, but only suppress them to a certain extent. Andre finds that is very rare that he cannot find the proper homeopathic prescription for a patient because they are on allopathic medicines. Allopathic medicines will not antidote the homeopathic prescription as long as the patient was on the allopathic medication before receiving homeopathic treatment. However, they can sometimes antidote if the patient goes on allopathic medicines after receiving homeopathic treatment. And the response of a patient to a dose of a homeopathic remedy is often shorter lived if the patient is on allopathic medicines. After the patient shows improvement from homeopathic treatment, they can ask their allopathic doctor to decrease the dosage of their allopathic medicines.
Andre Saine thinks that psychotherapy is not helpful for patients if their depression is organic, but can be helpful for depression from an external cause. The best form of psychotherapy, he feels, is more like education, teaching the patient to find out about themselves. But often psychotherapists put ideas in peoples' heads and change the expression of their depression. The more I practice, Andre said, the less I want interference from other therapies, as it changes the expression of the depression. Andre wants to see the expression of the illness in as pure a form as possible.
During the remainder of the Afternoon, Andre Saine presented several cases for analysis, which I will not discuss here. All in all it was a very useful and informative seminar on a common medical problem.
NCH Summer School