There is evidence that extracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders. Further studies comparing extracts with standard antidepressants in well defined groups of patients and comparing different extracts and doses are needed.

IGRAINE IS A COMMON AND disabling condition that typically manifests as attacks of severe, pulsating, 1-sided headaches, often accompanied by nausea, phonophobiaor or photophobia. Population-based studies suggest that 6% to 7% of men and 15% to 18% of women experience migraine headaches. 1,2 Although in most cases it is sufficient to treat acute headaches, many patients require interval treatment as attacks occur often or are insufficiently controlled. Drug treatment with ␤-blockers, calcium antagonists, or other agents has been shown to reduce the frequency of migraine attacks; however, the success of treatment is usually modest and tolerability often suboptimal. 3 Acupuncture is widely used for preventing migraine attacks although its effectiveness has not yet been fully established. 4 Since 2001, German social health insurance companies have reimbursed accredited physicians who provide acupuncture treatment for chronic pain. By December 2004 more than 2 million patients had been treated with acupuncture , about a third of these had migraine or tension-type headaches. In this study, the Acupuncture Randomized Trial (ART-Migraine), we investigated whether acupuncture reduced headache frequency more effectively than sham acupuncture or no acupuncture in patients with migraines.

In a pooled analysis of four randomized controlled trials of acupuncture in patients with migraine, tension-type headache, chronic low back pain, and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome. The 864 patients included in the analysis received either 12 sessions of acupuncture or minimal (i.e. sham) acupuncture (superficial needling of non-acupuncture points) over an 8 week period. Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment. After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving. Patients were classified as responders if the respective main outcome measure improved by at least fifty percent. Both univariate and multivariate analyses adjusted for potential confounders (such as condition, intervention group, age, sex, duration of complaints, etc.) consistently showed a significant influence of attitudes and expectations on outcome. After completion of treatment, the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 (95% confidence interval 1.20-2.32). For personal expectations and confidence after the third session, odds ratios were 2.03 (1.26-3.26) and 2.35 (1.68-3.30), respectively. Results from the 6-month follow-up were similar. In conclusion, in our trials a significant association was shown between better improvement and higher outcome expectations.

ISRCTN9737659.

No abstract