Acupuncture and Depression: An Old Answer to an Old Problem

Depressive disorders affect almost 19 million Americans, or 9.5% of the population in any given one-year period and are estimated to cost the workplace over 40 billion dollars . At some point in their lives, 10%-25% of women and 5%-12% of men are likely to become clinically depressed. Even when depression is sub-clinical, the body™s immune system is compromised and the symptoms reduce functioning and impair work performance and social relationships.  Common symptoms of depressive disorders include: a decreased interest in most activities, insomnia, fatigue, and feeling empty and worthless. When depression is at its worst, hopelessness sets in and suicide becomes a desperate option for approximately 15% of people who suffer from severe depressive disorders. The personal and societal costs are staggering. Luckily, many people seek therapy and/or medications and now, Harvard Medical School reports that depression is one of the top 5 conditions for which people seek alternative care.

Research on Acupuncture™s Effectiveness
National Institutes for Health (NIH) have established the National Center for Complementary and Alternative Medicine which funds research studies in the holistic treatments. The results are hopeful. In 1998, Dr. John Allen and other researchers at the University of Arizona used acupuncture to treat a sample of women with depression. After a total of 12 sessions, 70% of the women experienced at least a 50% reduction of symptoms. This is promising, particularly because women are twice as likely as men to be diagnosed with depression. This research marked the first U.S. randomized, controlled, double-blind study of acupuncture™s effectiveness in treating depression. The NIH funded study concludes, Acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones in a good way.  

Rigorous scientific data is still small and just starting to come in, but results point to a bright future for acupuncture as a successful treatment. Stanford researchers, using a small sample of 61 pregnant women, found that those who were given acupuncture treatments had significantly fewer depressive symptoms. The researchers conclude that acupuncture holds promise for treatment of depression during pregnancy, and may help with the long term management of depression.  Another group found that menopausal women on tamoxifen had a significant reduction of anxiety and depressive symptoms.   A University of South Carolina study suggests that acupuncture be considered for treating depressed patients infected with HIV.  In other parts of the world, researchers seem to be even more actively engaged in learning about the benefits of acupuncture. Three Chinese studies reported that electro-acupuncture produced the same effects as certain anti-depressant drugs and had no side effects.  United Kingdom researchers reviewed the existing literature and suggest that electro-acupuncture warrants further trials.  In another study coming out of the United Kingdom, significant improvements were found in a small sample of depressed people and the report concludes that acupuncture contributed to the improvements.  Australian researchers used laser acupuncture for people with a fear of needles and found significant diminution of symptoms.  An Australian review of many complementary and alternative treatments studies, some of which are mentioned above, concludes that acupuncture appears promising as a treatment for depression, but requires further research.

How Acupuncture Works
Why acupuncture? Traditional Chinese Medicine (TCM) has addressed the link between the body, spirit and mind for more than 2000 years. TCM does not view people as a collection of segmented parts to be treated independently. Instead, our belief is that illness affects both the mind and body; there is no separation between the two. Therefore, emotional disturbances have associated physical symptoms and, in reverse, physical disorders evoke emotional responses. Emotions do not cause disorders because it is normal to experience different emotions. But when emotions are excessive, prolonged or both, they can become problematic and contribute to physical symptoms. In Chinese medicine, different emotions are thought to affect different organs. When an individual experiences strong emotion, there are physical symptoms associated with it. For example, the emotion of sadness can produce a lump in the throat, plum pit qi, or difficulty taking deep breaths. The goal of TCM is to bring all the human systems into a healthy balance, insuring that both the mind and body feel well.

Patterns of Depression
Traditional Chinese Medicine (TCM) diagnoses different patterns of depression, each with a set of symptoms and treats each pattern distinctly. Although there can be many combinations of the patterns, here are some common ones. Please keep in mind that the organs mentioned, such as the liver or heart, refer to their energetics according to TCM.

Generally, there are 2 main categories of symptoms - Deficient or Excess. Symptoms are both mental and physical and can be caused by different patterns.

In the Deficient category, symptoms are usually chronic rather than acute because they are indicative of depletion. They often include loss of appetite, fatigue, weight loss, and poor memory.
Examples of deficiency patterns and their symptoms are:

• Heart and spleen qi (pronounced chi™) deficiency " Physical symptoms may include palpitations, insomnia, poor memory, lack of appetite, and a pale tongue. Emotional symptoms include excessive worry and feeling timid.

• Yin deficiency " Physical symptoms may include absentmindedness, dizziness, insomnia, low back soreness, menstrual difficulty, and a red tongue with little coating. Emotional symptoms include sensitivity and irritability. Yin deficiency is more common during menopause.

In the Excess category, symptoms are those of overload. They may include high emotional reactions seen in mania, agitation, angry outbursts, or anxiety.
Examples of excess patterns and their symptoms are:

• Phlegm  - Physical symptoms may include obesity, feeling weighted down, congestion, dizziness, fatigue and a swollen tongue. Emotional symptoms include depression and feeling cloudy or experiencing dullness of thought.

• Liver qi stagnation " Physical symptoms may include nausea, bloating, premenstrual symptoms, belching and possibly insomnia. Emotional stress affects the liver and includes irritability, resentment, and anger (especially if it is held inside).

• Liver fire " Often caused by prolonged Liver qi stagnation. Therefore, the symptoms are the same as above and also include a bitter taste in the mouth, red eyes, red face and a quick temper.

Diagnosis is usually more complicated. Prolonged Excess patterns can lead to Deficiency patterns and visa versa, and symptoms of both Deficiency and Excess can exist in the same problem at different times. For example, a person with bi-polar disorder would have deficient symptoms while depressed and excess symptoms during mania.

Treatment
Because people and their bodies are unique, treatments depend on the symptoms each person presents. For example, an older frail man who has been diagnosed with depression comes in with a pale tongue, little energy, and sadness. He is deficient and given herbs and treated with acupuncture points to boost his system. In contrast, if overweight woman with a red face, bad temper and a heavily coated tongue comes in diagnosed with depression, she is more excess in nature and is given herbs and treated with acupuncture to clear her phlegm heat. Had the woman been treated identically to the man (both with western diagnoses of depression), her symptoms would become exacerbated. Generally, results are cumulative, improving with each session. Treatment begins with one or two sessions per week and tapers off as the condition improves.

Each year, more and more people decide that complementary medicine provides treatments they desire, particularly acupuncture. Why? One study noted that individuals want to try available options and have a treatment with fewer adverse side effects. Patients also found alternative medicine to be less authoritarian and more empowering than conventional medicine.   People identify with complementary medicine™s holistic view of the individual and they want the ability to have some control over their health care. They yearn to be treated as individuals and appreciate the greater amount of time that practitioners spend with them. These are some of the motivations that explain the appeal and ever-increasing popularity of alternative treatments. Most importantly, acupuncture works!

References:

1. National Institute of Mental Health; US News & World Report, www.usnews.com/usnews/health/brain/depression/de.about.htm.
2. Allen, J., Schnyer, R., Hitt, S. The Efficacy of Acupuncture in the Treatment of Major Depressive Disorder in Women. Psychol. Sci. 1998:9:397-401.
3. Manber, R., Allen, J., Morris, M. Alternative Treatments for Depression:Empirical Support and Relevance to Women. J. Clin. Psychiatry 2002:63(7):628-40.
4. Porzio, G. Trapasso, T., Martelli, S. et al. Acupuncture in the Treatment of Menopause-related Symptoms in Women Taking Tamoxifen. Tumori. 2002:88:12-130.
5. Fulk, I., Kane, B., Phillips, K., Bopp, C., Hand, G. Depression in HIV-infected Patients:Allopathic, Complementary, and Alternative Treatments. J Psychosom Res 2004:57(4):339-351.
   
6. Han, J.. Electroacupuncture: An Alternative to Antidepressants for TreatingAffective Diseases? Int J Neurosci 1986:29:79-92  ; Han, C., Li X., Luo, H., Zhao, X., Li, X., Clinical Study on Electro-acupuncture treatment for 30 Cases of Mental Depression. J Tradit Chin Med. 2004:24(3):172-176.; Luo, H., Meng, F., Jia, Y., Zhao, X. Clinical Research on the Therapeutic Effect of the Electro-acupuncture in Patients with Depression. Psychiatry Clin Neurosci 1998:52(suppl):S338-340.
7. Mukaino, Y., Park, J., White, A., Ernst, E. The Effectiveness of Acupuncture for Depression " A Systematic Review of  Randomised Trials Acupunt Med 2005:23(2):70-76.
8. MacPherson, H., Thorpe, L., Thomas, K., Geddes, D. Acupuncture for Depression: First Steps Toward a Clinical Evaluation. Altern Complement Med 2004:10(6):1083-1091.
9. Quah-Smith, J., Tang, W., Russell, J. Laser Acupuncture for Mild to Moderate Depression in a Primary Care Setting " a Randomised Controlled Trial. Acupunt Med 2005:23(3):103-111.
10. Jorm, A.F. Christensen, H., Griffiths, K., Rodgers, B. Effectiveness of Complementary and Self-help Treatments for Depression. Med J Aust 2002 May 20:176 Suppl:S 84-96.
11. Weier, K. and Beal, M. Complementary Therapies as Adjuncts in the Treatment of Postpartum Depression. J Midwifery and Women™s Health 2004, 49(2):96-103.

About the Author

Jennifer Dubowsky, L.Ac., M.S.O.M. is a licensed acupuncturist who works in Chicago, Illinois. Jennifer earned her Masters of Science Degree in Oriental Medicine from Southwest Acupuncture College, an accredited four year graduate program in Boulder, Colorado. She received her diplomat from the NCCAOM, the National Certification Commission for Acupuncture and Oriental Medicine and completed an internship at the Sino-Japanese Friendship Hospital in Beijing, China. Jennifer has also completed a Bachelor of Science degree in Kinesiology.

If you have any comments or questions, she can be reached at 312-399-5098 or tcm007(at)aol.com

Website: http://www.tcm007.com