Role of Acupuncture in the Treatment of Depression

Use of acupuncture for menopause-related symptoms

Porzio and associates²³ evaluated the safety and efficacy of acupuncture for menopause-related symptoms associated with tamoxifen therapy in patients with breast cancer. Whether symptoms were induced by the drug or were a natural effect of menopause was unclear.

Acupuncture was associated with a significant decrease in anxiety (P < .001), depression (P < .001), and somatic (P < .001) and vasomotor symptoms (P = .001). Acupuncture did not modify the participants’ libido.

That study showed acupuncture to be a safe and effective treatment for tamoxifen-induced vasomotor symptoms, anxiety, and depression. The authors emphasized the role of acupuncture only as a complementary therapy—and not as an alternative treatment for breast cancer.²³

Acupuncture-associated biochemical and neurophysiological changes

Although acupuncture is becoming more integrated into Western medicine, we still have a very limited understanding of how it works. In a small, uncontrolled study, Dhar and Vasanti²⁴ investigated the effect of acupuncture on the status of thyroid hormones in endogenous depression.

Results showed significant improvement of assessed symptoms (insomnia, depression, restlessness, body aches, and loss of appetite) after acupuncture (P < .05). Baseline abnormal thyroid function tests returned to near normal range at the end of the treatment.

Pohl and Nordin²⁵ studied the effect of EAT on levels of neuropeptide Y (NPY) over 4 weeks in a small pilot study of 6 patients with major depression. During acupuncture therapy, NPY plasma levels decreased in 5 patients. This finding was associated with clinical improvement of depression.

In a trial conducted by Han and associates,²⁶ plasma levels of cortisol and endothelin-1 were studied as biological markers in patients with depression before and after treatment. Cortisol is involved in the “regulation, transcription, activity, and expression” of endothelin receptors. On the other hand, endothelin influences the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Dysfunction of the HPA axis has been implicated in pathogenesis of depression.

Thirty patients were treated with EAT and 31 patients were treated with maprotiline (a tetracyclic). Both groups showed symptom improvements after treatment (P < .01), and no significant difference was found between groups (P > .05). Montgomery-Åsberg Depression Rating Scale scores demonstrated a significantly better adverse-effect profile for acupuncture than for maprotiline. Normalization of the cortisol and endothelin-1 content was observed in both groups (P < .01) without a significant difference between them (P > .05).²⁶ The authors concluded that EAT had the same therapeutic effects as but fewer adverse effects than maprotiline.²⁶

Huang and colleagues²⁷ used positron emission tomography to demonstrate the association between clinical improvements of depression, normalization of cortex-limbic circuitry, and increase in glucose metabolism in different brain regions under the influence of scalp acupuncture.

CONCLUSION

As a therapeutic intervention, acupuncture has become integrated into Western medicine in the treatment of many different medical conditions. However, its practice in mental health is still limited and is often experimental. Despite objective deficiencies, most studies have shown acupuncture to be a safe and promising therapeutic option. It has a more favorable adverse-effect profile than psychotropic medications and is associated with low attrition rates.

Because of the significant number of patients who not respond to or who cannot tolerate conventional treatments for depression, other options must be explored. The data presented here suggest that acupuncture deserves further research as an alternative option for the treatment of depression.