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Acupuncture in the Treatment of Depression
Stephanie J. Tiedemann
Acupuncture is an alternative therapy procedure which originated in China several thousand years ago. The practice is aimed at stimulating the body to promote its natural healing mechanisms and improve overall functioning, as well as to treat and prevent disease and pain. (http://www.holistic-online.com/Acupuncture/acp_home.htm)
Acupuncture, which literally means “needle piercing,” consists of inserting very thin needles into the skin at precise points all over the body. The process can also be performed through the application of heat, pressure, or electrical stimulation to these acupuncture points. The stimulation “used to regulate or correct the flow of qi (or chi) to restore health.” (http://www.holistic-online.com/Acupuncture/acp_what_is.htm)
Chinese Philosophy and Acupuncture
In order to understand acupuncture more completely, it is beneficial to learn about the ideas behind it. These ideas include the philosophy of the Dao and the three treasures, yin and yang, and the five elements. (http://www.holistic-online.com/Acupuncture/acp_what_is.htm)
Philosophy of the Dao
Dao is “described as ‘the path’ or ‘the way of life’ in Traditional Chinese Medicine,” and it “advocate[s] moderation, living in harmony with nature, and striving for balance.” Humans function through the “three treasures” known as Qi, Shen, and Jing. Qi is the energy or “life force” of every living thing. “In the body, Qi is found in the heart and lungs in circulating blood and oxygen.” Shen is known as a person’s soul or spirit, and “is responsible for consciousness and mental abilities.” Similar to genetic inheritance, Jing “is responsible for growth, development, and reproduction.” Humans are born with a particular amount of Jing, and it is lost if we “live a wrong or careless life.” The Chinese believe that “acupuncture can reduce the loss of Jing.” (http://www.holistic-online.com/Acupuncture/acp_philosophy.htm)
Yin and Yang
The Dao brings forth ideas of harmony and balance. Yin and yang also center on these things. The idea behind yin and yang “is that there are two sides to everything- happy and sad, tired and energetic, cold and hot.” However, “they cannot exist without each other and nothing is ever completely one or the other.” The body becomes imbalanced and unhealthy when one force overpowers that which it opposes. Acupuncture works to keep yin and yang in balance, whether as a restorative or preventative treatment. (http://www.holistic-online.com/Acupuncture/acp_yin_yang.htm)
Deeper within the yin and yang philosophy is the idea of the five elements. Cycles are a way of describing changes in nature, according to the Chinese. “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.” Individuals have different combinations of these elements which in turn determine a person’s personality. A balance of the five elements is said to be ideal, and connections among them help to determine “yin-yang imbalances.” In this way, the imbalanced element can be treated. (http://www.holistic-online.com/Acupuncture/acp_five_elements.htm)
How Does Acupuncture Work?
The original idea behind acupuncture explains “that channels of energy (Qi) run in regular patterns through the body and over its surface.” These channels (called meridians) can become blocked and cause imbalances in many of the body’s processes. The insertion of needles is thought to reopen the channels and restore the flow. (http://www.medicalacupuncture.org/acu_info/articles/aboutacupuncture.html)
Twelve main meridians are found in the body: six are yin, and six are yang. Each of the twelve is directly related to a particular organ of the body. Over 400, and perhaps up to 2,000, different acupuncture points are found along the Qi channels. The location of the points may not necessarily be located at the site in which the person is having problems. (http://www.holistic-online.com/Acupuncture/acp_meridians.htm)
Today, scientists believe that “needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain,” which “results in stimulating the body’s natural healing abilities, and in promoting physical and emotional well-being.” (http://www.medicalacupuncture.org/acu_info/articles/aboutacupuncture.html)
What is Acupuncture Used to Treat?
In the past, acupuncture has been used primarily for chronic pain. In recent years, it has been expanded and put to use for a multitude of conditions. According to the World Health Organization, via the American Academy of Medical Acupuncture, the treatment is used for digestive, respiratory, neurological and muscular disorders, as well as urinary, menstrual, and other reproductive problems. In addition, acupuncture is claimed to be “useful in resolving physical problems related to tension and stress and emotional conditions.” (http://www.medicalacupuncture.org/acu_info/articles/aboutacupuncture.html)
Thoughts Regarding Acupuncture Treatment for Depression
Recently, these “emotional conditions” have included depression. According to one website, depression “is a disorder due to emotional upsets and [the resulting] stagnation of qi, manifested as mental depression, susceptibility to anger and crying, hypochondriac pain, obstructive sensation in the throat, insomnia, etc.” Assuming this belief, it is claimed that depression can be treated through the “release of stagnated qi… supplemented by the therapy of activating blood circulation, suppressing fire, eliminating phlegm and dampness and relieving dyspepsia.” However, the authors of the site also acknowledge that acupuncture may not work alone: “psychotherapy is also essential for the treatment.” (http://www.acupuncture.com/conditions/depressive.htm)
The web-site of Dr. Daniel Lee claims, “When patients with depression receive acupuncture, they generally experience improvement in the reduction of anxiety, insomnia, as well as more energy, and over all well-being. Best of all there is no side effect from acupuncture treatments. On top of these benefits, once patients get well, they will remain well even when they stop taking the herbs and acupuncture treatments.” (http://acupuncturebydrlee.com/Acupuncture-Depression.html)
Does Acupuncture Really Treat Depression Effectively?
At the time when Manber, Allen, and Morris (2002) published their review article, only one double-blind, randomized, placebo-controlled study of acupuncture had been available. The study assigned 38 women, all of whom met criteria for major depressive disorder, to three different groups: “a specific treatment designed to treat the energetic imbalance thought to underlie the patient’s depression; a nonspecific treatment designed to treat a pattern of disharmony that was not related to the patient’s depression, but that was characteristic of the patient; or a wait list.” The specific treatment’s reduction in depression scores was not significantly different than the control group, but based on self-report and clinical interviews it was determined to be significantly more beneficial than the non-specific group (Manber, Allen, & Morris, 2002).
Acupuncture versus Pharmacology
Larzelere and Wiseman (2002) reviewed two studies which studied acupuncture versus antidepressant treatments. The first showed that the effects of both acupuncture and tricyclic antidepressants in 41 patients with Hamilton Depression Rating Scale (HAM-D) scores of 25 or higher were judged to be equal. However, acupuncture was effective in decreasing anxiety symptom prevalence.
The second reviewed the effects of electro-acupuncture versus the antidepressant amitriptyline. Forty-seven patients with a HAM-D score greater than 20 were randomly assigned to receive amitriptyline or electro-acupuncture for five weeks. After the five weeks, “electro-acupuncture and amitriptyline were equally effective in decreasing depression, with significantly fewer side effects reported in the electro-acupuncture group.” One follow-up study using amitriptyline, electro-acupuncture plus amitriptyline, or electro-acupuncture plus placebo treatments groups, and another studying amitriptyline or electro-acupuncture plus placebo both displayed nearly equal improvement, but there “were no differences in effectiveness among the groups” (Larzelere & Wiseman, 2002).
Another research team investigated the effects of acupuncture in combination with medications in order to determine the efficacy of acupuncture. Over a period of two years, the researchers randomly assigned 70 depressed patients to a treatment of mianserin anti-depressant medication, mianserin plus acupuncture, or mianserin plus placebo acupuncture. “In all cases, there was greater improvement when acupuncture (placebo or verum) was applied compared to plain pharmacological treatment.” No difference was found between the effects of the placebo versus verum acupuncture (Roschke, Wolf, Muller, Wagner, Mann, Grozinger, & Bech, 2000).
Comparative Acupuncture Trials of Monotherapy and Medication
A seven trial meta-analysis performed by Smith and Hay (2004) included “all published and unpublished randomized controlled trials comparing acupuncture with sham acupuncture, no treatment, pharmacological treatment, psychotherapies, or standard care.” The studies included both men and women who could be clinically diagnosed with depression. The analysis of the 517 subjects included in these studies determined that there is “no evidence that medication was better than acupuncture in reducing the severity of depression, or in improving depression, defined as remission versus no remission” (Smith & Hay, 2004). One thing to keep in mind with this study in particular, is the fact that although acupuncture was not proven to work better than medication, it also does not provide evidence to state that acupuncture does not help with symptoms.
Based on the findings of these studies, the efficacy of acupuncture to treat depression has received mixed reviews. Many of the trials have found that acupuncture works at least as effectively as medication concerning reduction of symptoms, yet placebo trials have had the same effect. Controlled acupuncture studies of depression are difficult considering the severity and range of symptoms affecting each individual. Nearly all of the studies reviewed here have encouraged further research through controlled studies in order to truly understand acupuncture’s potential benefits as an effective treatment for
Larzelere, M.M., Wiseman, P. (2002). Anxiety, depression, and insomnia. Primary Care, 29(2), 339-360.
Manber, R., Allen, J.J., Morris, M.M. (2002). Alternative treatments for depression: empirical support and relevance to women. Journal of Clinical Psychiatry, 63(7), 628-640.
Roschke, J., Wolf, Ch., Muller, M.J., Wagner, P., Mann, K., Grozinger, M., Bech, S. (2000). The benefit from whole body acupuncture in major depression. Journal of Affective Disorders, 57, 73-81.
Smith, C.A., Hay, P.P.J. (2004). Acupuncture for depression. The Cochrane Database of Systematic Reviews, 3.
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