Does it work for depression?

by John McManamy

Karen had been taking Zoloft for three years, but was having trouble with its side effects. Serzone didn't help, and Paxil (40 mg) only seemed to get her right back where she started - grateful to feel human again, but not at all happy with her excess sleep, weight gain, and loss of sexuality. Karen had originally turned to acupuncture for her flu and bronchitis, and found it worked wonders. Now she wondered if acupuncture could help her depression.

What We Know About Acupuncture

Acupuncture originated in China at least 2,000 years ago, and moved to the west in the 1970s as part of a greater awakening that included yoga, meditation, new diets, and other so-called alternative fare. At first, its availability was limited by the scarcity of practitioners, but now there are an estimated 20,000 certified acupuncturists in the US, and one third of these are medical doctors. According to FDA figures from 1993, Americans are making 9 to 12 million visits a year and spending as much as $500 million to have needles strategically placed along the invisible latitude and longitude lines of their skins.

To paraphrase from the National Institutes of Health:

There are more than 2,000 acupuncture points on the body connecting with 12 main and eight secondary pathways called meridians, which conduct energy - chi or qi - between the surface of the body and the internal organs.

According to the NIH:

"Qi regulates spiritual, emotional, mental, and physical balance. Qi is influenced by the opposing forces of yin and yang. According to traditional Chinese medicine, when yin and yang are balanced, they work together with the natural flow of qi to help the body achieve and maintain health. Acupuncture is believed to balance yin and yang, keep the normal flow of energy unblocked, and restore health to the body and mind."

A western interpretation would be that the acupuncture points stimulate the central nervous system, releasing chemicals into the muscles, spinal cord, and brain, promoting the body's natural healing abilities. In the words of the NIH: "Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones in a good way."

An NIH consensus panel of scientists, researchers, and practitioners in 1997 determined that acupuncture has been clinically proven to be effective against nausea from surgery and chemotherapy, addiction, headaches, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, lower back pain, carpal tunnel syndrome, and asthma, and to assist in stroke rehabilitation. Since then, other studies have looked at pain, ADHD, pregnancy complications, and other diseases and conditions.

In 1996, the FDA approved acupuncture needles for use by licensed practitioners. Needles are either new or sterilized. Relatively few complications have been reported to the FDA, but bad results can happen from improper sterilization of needles and improper treatment. The needles are hair thin and don't cause the kind of pain associated with hollow hypodermic needles.

Acupuncture for Depression

Fine, but does acupuncture work for depression?

In 1998, the NIH's Office of Alternative Medicine funded a study at the University of Arizona. Working with acupuncturist Rosa Schnyer, John Allen PhD devised a 16-week trial on 34 seriously depressed women. First the two worked up a standard treatment plan that targeted certain "depression points" on the body. Then they devised a dummy treatment calling for needles in nonspecific places. The acupuncturists administering the treatment had no idea whether they were using the real plan or the dummy plan.

Then the subjects were divided into three groups. The first group received the depression-specific acupuncture, the second group got the dummy treatment, and the third group was put on a wait list before being placed on eight weeks of the real thing.

Following the treatment, the depression-specific groups experienced a 43 percent reduction in their symptoms compared with a 22 percent reduction for the dummy group. More than half no longer met the criteria for clinical depression. Only five people dropped out of the study - two who moved away, one who became pregnant, and two who didn't like the needles. The dropout rate was much lower than for studies using medications.

Two advantages of acupuncture, Dr Allen told a seminar at the National Depressive and Manic Depressive Association Conference in Boston, include no language barrier (a factor for patients who have difficulty speaking English), and its low cost compared to conventional treatment.

Something better than low cost was an inducement for Karen. She was able to swap free sessions by giving piano lessons to the acupuncturist's son. On the advice of Dr Chen, her acupuncturist, she did not quit her medication. She began the treatment in May - never going more than once a week - and gradually, she says, she began to recover. "For a few days I felt a little better," she recounts, "then after that I felt bad days. But the better days got better oh so gradually and the bad days less bad."

Karen would lie on a table as Dr Chen put some needles into her ear, arm, and leg - always on the right side (except for a few needles in the other leg). One time he put the needles in similar areas on the left side. He would also point a heat lamp where he left needles in the leg. The needles prick, according to Karen, "just the littlest bit." Then she would remain on the table while Dr Chen left the room for 20 minutes. Finally, Dr Chen would take out the needles and rub some areas of the back and neck.

Karen thinks the first few visits were critical, but her follow-up visits were important, too.

In July, Karen switched to St John's wort before slowly reducing her Paxil in August (she is now down to 10 mg). According to Karen: "I believe both acupuncture and St John's wort have helped me. I think the acupuncture enabled the Saint John's wort to work more effectively. I like the idea of making the body work its best with acupuncture."

She goes on to say: "I have always had to take higher doses of any antidepressant in order to get the best results. Why not get my immune system working better so that I might not need such a high dose or, even better, take St John's wort instead with minimal side effects?"

Dr Chen, says Karen, works on the principle that it's all about helping the body's immune system function in an optimal way so that it keeps the disease in check, resulting in fewer bad symptoms. In Karen's words:

"The body takes time to heal and the acupuncture guides the body to heal itself. Heal from what? I don't think our bodies are working optimally. The body does its best under any circumstances but after years of medications, ravages of depression and stress, excesses in food and drink - sugar, chemicals, smog - acupuncture helps the body recover from these assaults. I have more respect for the working of the body now and the strength of it."

Now, after four and a half months, Karen feels ready to discontinue treatment. As well as easing her depression, she also credits acupuncture for helping her go off sugar. And there is the spiritual side: "I really believe in meditating on God. It spiritualizes the mind which in turn uplifts the mood. Regular meditation is important to me."

If you are thinking of acupuncture for yourself:

Your doctor is a good resource for referrals to licensed acupuncturists. You can also do a search for practitioners in your area at the websites of the American Academy of Medical Acupuncture.

Some 70 to 80 percent of insurers in the US cover acupuncture treatments. Cost per treatment tends to range between $30 and $100. Physician acupuncturists may charge more than non-physician practitioners.

Finally, if you are on medication, don't expect to flush your pills down the toilet after your first visit. This is a matter you will have to work out between you and your doctor or psychiatrist. Fortunately, Karen had an acupuncturist who recognized this. In her words: "I appreciated Dr. Chen's discretion in advising me about the medication. He told me that since he's not a medical doctor he couldn't tell me how much to take or when to quit. He just made me feel comfortable that the acupuncture would still do its job whether I went off the medication or not."

First published in 2000, reviewed in 2008

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