Depression is projected by World Health Organization (WHO) to become the second leading contributor to the global burden of disease by 2020, affecting about 121 million people globally. Depression is classified as mild, moderate or severe based on the number of symptoms present. Diagnoses defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included single episode or recurrent major depressive disorder (APA, 2000). A major depressive disorder is defined as depressed mood or a loss of interest or pleasure in daily activities for at least 2 weeks.
Anxiety has been defined as a persistent feeling of dread, apprehension and impending disaster or tension and uneasiness. Anxiety disorders is used as an umbrella term for a number of conditions including panic disorder, phobias, obsessive–compulsive disorder (OCD), generalised anxiety, traumatic stress disorder and anxiety disorder due to a general medical condition. The WHO estimated in 2004 that 1% of all disability adjusted life years lost in the world is due to posttraumatic stress disorder, obsessive–compulsive disorder and panic disorder combined. The most prevalent condition according to the Office for National Statistics UK (2000) is mixed anxiety and depression.
Conventional treatment of these conditions is similar, usually involving tricyclic antidepressants, selective serotonin reuptake inhibitors and cognitive behavioural therapy. However, the first two have been associated with adverse effects and poor compliance while the last is not widely available. Consequently, other treatments options are sought by patients. Acupuncture has been increasingly used to treat both depression and anxiety. Here are some reports summarised the effectiveness of acupuncture therapy on anxiety and depression.
- Acupuncture treatment for depression during pregnancy
It is known that women are at greater risk of depression at certain time in their lives, such as puberty, during pregnancy, and during perimanopause. The hormonal and physical changes and added responsibility of new life can lead to postnatal depression, also called postpartum. It is characterized by feelings of sadness, indifference, exhaustion and anxiety. It affects approximately one in every ten women who have had a child. Pharmacologic treatments of depression during pregnancy increasingly raise the concerns about the safety for the developing foetus, and pregnant women are often reluctant to take antidepressant medication. Consequently there is a need for safe, effective alternative treatments for depression during pregnancy.
Dr. Manber and colleagues studied the therapeutic efficacy of acupuncture on pregnant women with depression. The results are particularly interesting. One hundred and fifty women were randomly assigned to 1 of 3 groups: (1) acupuncture, in which depressive symptoms were specifically addressed (n = 52); (2) valid controlled acupuncture, which was not specifically tailored for depression (n = 49); and (3) massage therapy (n = 49). The treatment consisted of 12 sessions (25 to 30 min each) over an 8-week period. Patients and the treating acupuncturist were blinded. Symptoms were assessed using the Hamilton Rating Scale for Depression-17 and Beck Depression Inventory. At the end of the treatment, women who received acupuncture specific for depression experienced greater rate of reduction in symptom severity compared with the control groups. They also had significantly greater response rate than control groups.
In conclusion, acupuncture treatment demonstrated symptom reduction and response rate comparable to those observed in standard medication. Acupuncture could be a viable treatment option for depression during pregnancy.
2.Can acupressure help to keep a positive mood?
Self-administered acupressure help get your mood better if you could keep this self-treatment a few time a day according to a report published in the Global Journal of Health Science.
As modern life is moving fast we all get stress sometimes. If the stress is building up it develops to anxiety and depression which affect our daily life and quality of life. How to maintain a positive mood and prevent the negative one is important for us.
Recently a group of scientists in Japan evaluated the effect of self-administered acupressure on the mood levels of university medical students. Fifty-four students were recruited for the study and they were divided into intervention group and control group. Students in intervention group were instructed to apply pressure on acupoint GB12, SI17 and LI18 on both sides for 5 seconds each 3 time a day for 2 weeks. Stimulating those acupoints is believed to have positive impact on the mood. Self-reported tension-anxiety, depression-dejection, anger-hostility, vigor, fatigue and confusion were measured before and after the study.
It was found that self-administered acupressure on GB12, SI17 and LI18 can significantly decrease the levels of tension-anxiety, depression-dejection, anger-hostility, fatigue and confusion and increase vigor. The study suggests that self-administered acupressure on GB12, SI17 and LI18 can have a positive impact on the levels of mood. This can lead to a better quality of life.
3. How does acupuncture alleviate major depressive disorder?
Major depressive disorder is a recurrent and debilitating mental disorder. Acupuncture is very effective to alleviate the symptoms of major depressive disorder, by increasing the level of serotonin in the brain, according to a report recently published in the journal Neuroscience Letter.
It is reported that major depressive disorder affects about 7% of the population over age of 18 in the United State, according to the National Institute of Mental Health. Psychological, physiological and social symptoms of the disorder persist for weeks and are bad enough to interfere with work, social life and family life. Although the exact cause of major depressive order is unclear it is believed that decreased level of serotonin, a neurotransmitter, in the brain area hippocampus is closely linked to the disorder. Up to 80% of patients with major depressive disorder were reported to be treated with selective serotonin reuptake inhibitors. Although the drugs produced temporary symptomatic relief, severe side effects occurred with long-term use. Although acupuncture is used to treat the disorder its mechanism of action is not known.
Dr. JJ Le and colleagues recently conducted a study to explore the potential mechanism of acupuncture treatment on major depressive disorder. The study was performed on major depressive disorder model. Electro-acupuncture stimulation was applied at acupoints ST36 bilaterally and CV4 for 20 min once daily for 14 consecutive days. Outcome included behavioural and biochemical assessments tested before and after acupuncture. Data showed that depressive behaviour was significantly improved by acupuncture compared untreated group. Biochemical studies showed that the concentration of serotonin in the hippocampus was markedly elevated following acupuncture stimulation.
The study suggested that acupuncture stimulation at acupoint ST36 and CV4 increased the level of serotonin in the brain leading to the symptomatic relieve in depressive model.
4. Acupuncture significantly reduced stress levels of professionals working with mistreated children
Professionals who worked with mistreated children typically showed high levels of stress due to the physical and mental overload caused by the excessive demands of their work, in terms of both quantity and emotional strain. One of the major consequences of chronic stress is the development of the syndrome of burnout. Burnout constitutes a sense of failure and exhaustion, caused by an excessive decrease in energy, which may especially affect professionals who work in direct contact with people.
Doctors in Brazil conducted a small clinical study to assess the effectiveness of acupuncture on reducing stress levels of professionals who worked with mistreated children. Nineteen subjects were recruited to study and were given 10 sessions of acupuncture treatment. Stress levels were monitored before and after acupuncture treatment using the Lipp’s inventory of stress symptom scale. It was found that a statistically significant reduction in mean stress levels was observed after acupuncture treatment.
The study just confirmed the results of many clinical studies that acupuncture is very effective in reducing stress levels and should widely be used to treat stress-related conditions.
5. Acupuncture therapy has a long-lasting effect in alleviating depression and anxiety
Therapeutic effect of 8-week acupuncture to psychologically distressed patients lasted 24 weeks according to a report published in journal BMC Complementary and Alternative Medicine.
Anxiety and depression are the most common psychological disorders. They have markedly impact on the quality of life of suffers and are a substantial source of medical economic costs. Conventional treatment is not always satisfactory and has many adverse effects. Acupuncture is getting increasingly popular in treating psychological disorders.
Researchers in Sweden conducted an open, randomized controlled clinical study to evaluate the intermediate effects (24 weeks) of 8-week treatment on depression and anxiety. One hundred fifty four patients with psychological distress were randomly allocated to three groups. One group was treated with acupuncture for 45 mins, another was treated with acupuncture plus a person-centred salutogenic dialogue for 60 mins and the third group was given conventional treatment. The treatment was once a week for 8 consecutive weeks. Anxiety and depression were measured by the Hospital Anxiety and Depression Scales. Mental health status was assessed with the standard Swedish version of Short Form-36. All assessments were performed before, at the end of treatment and 24-week follow-up.
It was found that all treatment groups showed improvement compared with baseline scores. Evaluation of 24-week follow-up demonstrated that acupuncture group and acupuncture plus dialogue group maintained the improvement seen after 8-week treatment; while conventional treatment showed a declined efficacy. The study suggests that acupuncture has a long-lasting therapeutic effect on anxiety and depression.
- T. Arvidsdotter, et al., Six-month effects of integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients – follow up from an open, pragmatic randomized controlled trial. BMC Complementary and Alternative Medicine 2014, 14:210.http://www.ncbi.nlm.nih.gov/pubmed/24980440
- S Horiuchi et al., Mood Changes by Self-Administered Acupressure in Japanese College Students: A Randomized Controlled Trial. Global Journal of Health Science; Vol. 7, No. 4; 2015. http://www.ccsenet.org/journal/index.php/gjhs/article/view/43413
- JJ Le et al., Electroacupuncture regulate hypothalamic-pituitary-adrenal axis and enhance hippocampal serotonin system in a rat model of depression. Neurosci Lett. 2016 Jan 7. pii: S0304-3940(16)30004-0. http://www.ncbi.nlm.nih.gov/pubmed/26773866
- R Manber et al., Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol. (2010), 115(3):511-20. http://www.ncbi.nlm.nih.gov/pubmed/20177281
- CC. de Oliveira, Impact of acupuncture on stress levels of professionals working with maltreated children.AcupunctMed. 2017 Feb 6. pii: acupmed-2016-011231. http://aim.bmj.com/content/early/2017/02/06/acupmed-2016-011231
Grateful acknowledgements are due to Drs Arvidsdotter, Horiuchi, Le, Manber and Oliveira and colleagues (This paper was based on their articles cited in above Reference section), as well as to Dr. Bai-Yun Zeng for his work in preparing this briefing paper.