Challenges in acupuncture research
Acupuncture is widely used in Asian and Western countries to treat diverse mental health problems. Evaluating the clinical efficacy of acupuncture in depressed mood and other mental health problems poses many methodological challenges because of differences in the severity and comorbidity of mental, emotional, and physical symptoms in study populations; concurrent use of other conventional or CAM treatments; conceptual differences between Chinese medicine and biomedical diagnoses; and the use of individualized acupuncture treatment protocols reflecting the patient’s “energetic” balance. This post concisely reviews the evidence for acupuncture as a treatment of depressed mood, anxiety, post-traumatic stress disorder (PTSD) and alcohol abuse. A subsequent post will review the evidence base for acupuncture for smoking cessation, narcotic abuse and insomnia.
Electroacupuncture may have superior efficacy compared to conventional acupunture
Sham-controlled studies suggest that conventional needle acupuncture, electroacupuncture, and computer-controlled electroacupuncture (CCEA) have consistent beneficial effects on depressed mood. Findings of a double-blind, sham-controlled study support that traditional manual acupuncture (i.e., needles in the absence of electrical current) is an effective treatment of severe depressed mood. By the end of the 8-week study, 68 percent of 33 female outpatients being treated with a specialized acupuncture protocol directed at depressed mood had achieved full remission. However, matched depressed women in a wait-list group showed equivalent improvement. In a large 6-week, multicenter study (241 subjects) depressed inpatients randomized to receive electroacupuncture plus placebo versus electroacupuncture plus the antidepressant amitriptyline experienced equivalent improvements in mood. Electroacupuncture was superior to amitriptyline in patients who did not report comorbid anxiety. Patients treated with electroacupuncture had significantly elevated plasma norepinephrine concentrations following a 6-week course of treatment, suggesting that the mechanism of action of electroacupuncture involves stimulation of norepinephrine release.
Inconclusive findings require confirmation by large well designed studies
CCEA uses computer-guided modulation of the frequency and waveform of electrical current delivered through acupuncture needles. Preliminary findings suggest that high frequencies (up to 1,000 Hz) yield responses in depressed patients that may be superior to both conventional acupuncture and electroacupuncture. A narrative review of controlled studies, outcomes studies, and published case reports on acupuncture as a treatment of anxiety and depressed mood supported that sham-controlled studies yielded consistent improvements in anxiety using both regular acupuncture and electroacupuncture. Research findings on acupuncture in depressed mood and anxiety should be regarded as inconclusive because of methodological flaws including the absence of standardized symptom rating scales in most studies, limited follow-up, and poorly defined differences between protocols used in different studies.
A review of prospective trials on acupuncture as a treatment of post-traumatic stress disorder (PTSD) identified four quality sham-controlled studies and two quality uncontrolled trials that met inclusion criteria. One high-quality trial included in the review showed statistically significant differences between the acupuncture and wait-list group but non-significant differences between the acupuncture and individuals receiving cognitive-behavioral therapy (CBT). Patients receiving acupuncture or CBT continued to report clinical improvements in PTSD symptoms 3 months after study endpoint. These findings are limited by the small number of trials that met inclusion criteria (only one study reviewed was included in the analysis), the absence of sham-controlled studies, the use of different study designs across trials examined, and poor methodological quality of many studies.
Inconsistent findings for acupuncture in relapse prevention
Research findings on acupuncture for relapse prevention in alcohol abuse are inconsistent, reflecting differences in the selection of acupuncture points, the treatment protocol used (i.e., conventional vs. electroacupuncture), frequency of treatments, the duration of total treatment, and the relative skill or specialized training of practitioners. Positive findings of two controlled trials supported the hypothesis that specific acupuncture protocols significantly reduced alcohol craving and reduced relapse rate in recovering alcoholics. However, a subsequent randomized controlled trial found no significant differences in craving or relapse rates between an acupuncture protocol traditionally used to treat addiction, sham transdermal stimulation on random points, and a wait-listed group.