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October 23, 2008
The Western World is always looking for the quick fix, the easy solution. The treatment of mental disorders based on the Biological Model therefore has gained popularity with the use of Psychopharmacology (Cockerham, 2005). Drugs have become a major player in the treatment of disorders like depression, but does it come at a price? With each development and advancement of antidepressants like the ever-popular SSRIs, a corresponding study is published questioning the safety of such products, and individuals are thus forced to decide if the possible improvements are worth the side effects.
In the search
for alternatives, ancient practices have begun to achieve significant esteem
and appeal for their holistic approach in a generally physiologically driven
medical world. I plan to search the World Wide Web and present information from
credible sources that discuss the use of acupuncture in the treatment of
depression. While presenting the overall purpose of the treatment, I’ll discuss
the basic mechanisms of acupuncture, as well as the effectiveness of such
therapies. Using published scientific literature I will then compare both
supporting and opposing evidence of the claim that acupuncture is a legitimate
alternative in the treatment of depression.
Basics of Acupuncture
Brief History of Acupuncture
Originating in China more than 2,500 years ago and continuing to spread across the globe even today, acupuncture’s rich history illustrates the power and credibility of Oriental Medicine and its place in the Western society. Practiced in Asian countries for thousands of years, acupuncture was largely absent from Europe and the Americas until the 20th century. Mainstream acupuncture was not offered in the United States until the 1970’s when China opened to the West. As the market and demand for acupuncture has increased, regulations and stipulations over classifications, safety and efficacy have been sought after. Groups like the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Health (NIH) are constantly trying to test, modify, and research acupuncture. Three major events have been attributed to the dramatic expansion in America. In 1979 the World Health Organization published a list of diseases that lend themselves to acupuncture treatment based on clinical experience. Secondly, the US Food and Drug Administration’s reclassification of acupuncture needles to standard medical devices in 1994 helped with regulation. Lastly, in 1997 a panel of experts gathered and the National Institute of Health released a ‘Consensus Statement on Acupuncture.’ (http://www.amfoundation.org/acupuncture.htm)
Fundamentals of Acupuncture
Acupuncture is most commonly described as a “family of procedures involving the stimulation of anatomical points on the body using a variety of techniques.” Customarily this involves the insertion and manipulation of thin needles into the skin and can be carried out through the application of heat, pressure, or electrical stimulation to these acupuncture points. (http://www.holistic-online.com/Acupuncture/acp_what_is.htm) While the general principle of this ancient practice has remained the same, acupuncture in the West is usually based on a modified system of Chinese medicine (Traditional Chinese Medicine or TCM) and was introduced in the 1950’s. (http://nccam.nih.gov/health/acupuncture/)
In Traditional Chinese Medicine the body is seen as a delicate balance of Yin and Yang, two opposing yet inseparable forces. Yin represents the ‘cold’, passive side while Yang represents the active or ‘hot’ side. Keeping the body in a “balanced state” ensures good health and therefore an internal imbalance of these two forces will cause disease. Any imbalance “leads to blockage in the flow of Qi (vital energy) along pathways known as meridians and can be unblocked by using acupuncture at certain points on the body that connect with these meridians.” The exact number of meridians in the body is widely debated, but generally there are said to be 14 main channels with over 2,000 acupuncture points. (http://nccam.nih.gov/health/acupuncture/) Another important balance in one’s system involves the Five Elements in which “Chinese philosophy recognizes five distinct elements of cyclical change called water, wood, fire earth, and metal. These elements are related to our seasons, as well as colors, emotion, taste, voice, organs, food and herbs.” (http://www.holistic-online.com/Acupuncture/acp_five_elements.htm) Acupuncture, and Oriental Medicine in general, is seen as an alternative therapy that is used to promote health and well being through an energy-based approach to prevent illness and treat various medical conditions.
With more than 1 million Americans receiving acupuncture each year, issues of safety have been raised and are being thoroughly researched and tested. The National Institute of Health reports that “the occurrence of adverse events in the practice of acupuncture has been documented to be extremely low…[however] practices should be uniform and appropriate safeguards for the protection of patients and consumers need to be in place.”
(http://consensus.nih.gov/1997/1997Acupuncture107html.htm) Some of the risks involved with acupuncture include complications from ‘inadequate sterilization of needles and improper delivery of treatments.’ In these instances, infections and punctured organs can become serious health concerns. Overall though, one could argue that as a treatment acupuncture is far less intrusive and risky than some alternatives like medications that interact chemically. (http://nccam.nih.gov/health/acupuncture/)
How Does Acupuncture Treat Depression?
is commonly used to treat physical maladies like chronic pain and
gastro-intestinal disorders, but is now thought to treat mental disorders and
emotional conditions like depression. According to one quasi-credible website,
“depressive-syndrome is a disorder due to emotional upsets and stagnation of
qi, manifested as mental depression, susceptibility to anger and crying,
hypochondriac pain, obstructive sensation in the throat, insomnia, etc.” (http://www.acupuncture.com/conditions/depressive.htm)
When acupuncture needles are inserted into the body endorphins are released and
act as “natural calming and pain-relieving agents.” This helps with both the
physical and emotional symptoms of depression. In TCM the mind and body are
linked and therefore both elements must be addressed. Acupuncture also
stimulates the parasympathetic nervous system thereby ‘helping to relax the
body and mind.’ (http://triangleacupunctureclinic.com/learn/emotional/depression)
According to the National Institute of Health’s Consensus Statement, several
studies conducted in both animals and humans have shown acupuncture indeed
causes multiple biological responses. Just how these responses come about and
how they interact with the rest of the body however is still under scrutiny and
“much remains unknown regarding the mechanism(s) that might mediate the
therapeutic effect of acupuncture.” Several of the websites whose main purpose
is to inform and essentially advertise acupuncture stated that psychotherapy
should be utilized along with treatment and that in cases of severe depression,
acupuncture alone would not alleviate the symptoms. (http://consensus.nih.gov/1997/1997Acupuncture107html.htm)
The fairly recent use of acupuncture in the United States has posed some problems in regards to research and results. This is only intensified by the fact that mental health and disorders are still under debate themselves. The NIH Consensus Statement reports that “relatively few high-quality, randomized, controlled trials have been published on the effects of acupuncture.” The studies that have been conducted provide equivocal results because of design, sample size, and other factors [and] the issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups.” (http://consensus.nih.gov/1997/1997Acupuncture107html.htm) On the Triangle Acupuncture Clinic’s website they claim that “you can expect that after 1 to 2 months of weekly visits you will experience an overall change in your depression, as well as a change in any other symptoms you may be experiencing.” They also advise however, that to sustain the results, you may have to have some diet and lifestyle modifications. Acupuncture has become a topic of controversy because there appears to be no direct cause and solution; rather it seems to be a combination of undetermined factors. (http://triangleacupunctureclinic.com/learn/emotional/depression)
Is There Truth To The Claims?
In the Western world there is a tendency to ‘delineate sharply’ mental from physical disease. The ancient Chinese on the other hand understood the interplay between the mind and body and targeted both issues as if they were one. Felix Mann (2000) discusses his belief that a physiological dysfunction has caused mental symptoms and therefore a physiological treatment (i.e. acupuncture) may cure mental symptoms, with the reverse also being possible: a mental state causing a physical disease. The traditional Chinese approach, Mann states, is to treat not the physical brain but the physical organs of the body. The organ corresponding to depression is the liver, and therefore the symptoms most often alleviated by the treatment of the liver are those of depression and irrational anger. Mann points out though, that “acupuncture, generally speaking, only helps the milder mental diseases” (78) and that more severe cases will not benefit.
In his book Basics of Acupuncture, author Gabriel Stux (1998) remarks on the fact that acupuncture treatment for mental illnesses is on the rise and that “together with psychotherapy, acupuncture, with its various psychic and somatic effects, often replaces medication” (244). Stux goes on to discuss depressive disorders and how they are described in Chinese medicine as a deficiency of the kidney qi or yang, as well as liver yin, and therefore acupuncture to these specific areas would be the most beneficial in treatment.
In 2008 a research team in China conducted a multi-center randomized controlled study that looked at acupuncture for the treatment of depressive neurosis. 440 cases were randomly divided into an acupuncture group, a prozac group and a non-acupoint needling group. The Prozac group was given 20mg/d, the non-acupoint needle group were treated with needling in points that deviated away from the acu-points, and finally the acupuncture points Hegu (LI 4) and Taichong(LR 3) were selected for the acupuncture group. The total effective rates for the groups were as following: 86.4% in the acupuncture group, 72.1% in the prozac group and 59.1% in the non-acupoint needling group. The research team also used Asberg’s anti-depressant side-effect rating scale (SERS) and found that the SERS scores were significantly lower in the acupuncture and non-acupoint groups than in the prozac group. Fu and Fan (2008) concluded that acupuncture is a safe and effective therapy for depressive neurosis, with it being slightly better or similar to that of Prozac but with significantly less side–effects.
A meta-analysis review performed by Hay and Smith (2005) examined the efficacy and adverse effects of acupuncture for depression by looking at the available evidence supporting the use of acupuncture to treat depression. They used several databases to search using terms like “depression,” “acupuncture” and “dysthymic disorder” and inclusion criteria included all published and unpublished randomized controlled trials comparing acupuncture with shame acupuncture, no treatment, pharmacological treatment, standard care and other structured psychotherapies. The subjects included both men and women with depression defined by the Diagnostic and Statistical Manual (DSM-IV) or the International Classification of Disease (ICD). Seven trials comprising of 517 subjects met the inclusion criteria and the main results concluded that there was no evidence that medication was better than acupuncture in reducing the severity of depression. The authors concluded that there is insufficient evidence in the efficacy of acupuncture in the treatment of depression due to poor study design and small numbers.
Hugh MacPherson’s (2004) exploration into the design of a clinical trial of acupuncture of people with depression highlighted the complexities of evaluating acupuncture for patients with depression. With few randomized controlled trials, MacPherson wanted to investigate why there haven’t been many successful studies in this area. In the study the team conducted a focus group with six volunteer participants with experiences of depression, and a prospective case series of 10 patients who received acupuncture treatment for their depression. These 10 patients had been referred by their general practitioner and received 10 acupuncture treatments. Acupuncturists recorded traditional acupuncture diagnoses and details of treatment. Measures of depression (Beck Depression Inventory and the Hospital Anxiety and Depression Scale) and health status (SF-36) were taken at baseline and then 10 weeks later with adverse events also being monitored. The results showed that only six patients in the case series both received treatment and completed 10-week questionnaires, however there were significant improvements in the levesl of depression. No serious adverse events occurred.
a once exclusively ancient practice, has had a significant explosion of use in
the United States over the past 20 years. This rapid growth brings about
questions and concerns regarding the safety and efficacy of such a therapy.
After reviewing the information presented on the World Wide Web and on the
findings of the scientific literature, it is a difficult task to make a black
and white decision in support or opposition of acupuncture. Promising results
were shown for the treatment of several physical diseases, but there is a lack
of evidence and mixed reviews for the effectiveness of acupuncture in the
treatment of mental disorders like depression. Better-designed studies and
clinical trials need to be formed before any real evidence is considered
credible. The nature of mental disorders, specifically depression, is a
complicated science in and of itself and therefore makes isolating a cause or
solution that much harder. One positive conclusion I can draw from the studies
and the research on the web is the lack of adverse effects from acupuncture.
The risk for injury or complications is extremely low when compared to
medications or other treatments. So I say why not give it a try, what could it
hurt? (Well except maybe your wallet!)
Cockerham, W.C. (2005). Sociology of Mental Disorder (7th ed.). New Jersey: Prentice Hall.
Fu, W.B., Fan, L., Zhu X.P., He Q., Wang, L., Zhuang, L.X., et al. (2008). Acupuncture for Treatment of Depressive Neurosis: A Multi-Center Randomized Control Study. Zhongguo Zhen Jiu, 28(1): 3-6.
MacPherson, H., Thorpe, L., Thomas, K., Geddes, D. (2004) Acupuncture for Depression: First Steps Toward a Clinical Evaluation. Journal of Alternative and Complementary Medicine, 10(6): 1083-1091.
Mann, F. (2000). Reinventing Acupuncture: A New Concept of Ancient Medicine (2nd ed.). Boston: Butterworth – Heinemann.
Smith, C.A., Hay, P.P.J. (2005). Acupuncture for Depression. Cochrane Database of Systematic Reviews 2005, Issue 2.
Stux, G., Pomeranz, B. (1998). Basics of Acupuncture (4th rev. ed.). New York: Springer.
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