by Eric Huseman, Pharm D student
The practice of inserting needles into the body, known as acupuncture, has long been used in China and Japan and is implemented in a variety of styles including classical/tradition acupuncture, trigger point acupuncture, and single point acupuncture.1 An article recently published in Express, a UK based news source, reports that acupuncture may show potential for treating anxiety and depression, offering a new source of hope to those suffering from these mental ailments.2 According to the article’s author, Laura Milne, acupuncture can help reduce anxiety because, as shown in prior research, it acts on parts of the brain known to decrease sensitivity to pain and stress and also serves as a relaxation promoter and a way of deactivating an area of the brain responsible for anxiety and worry, an area referred to in the article as the “analytical brain.”2 However, despite this potential for relief, according to a study conducted by the British Acupuncture Council and Anxiety UK, only ten percent of those suffering from anxiety look to acupuncture for relief.2
While the article itself does not provide much evidence supporting acupuncture’s usefulness in treating anxiety and depression, the British Acupuncture Council’s website (the link to which was provided by the Express article) provides a wealth of information concerning acupuncture and its use in treating a variety of diseases, including depression.3 According to the Council’s fact sheet on depression, some current evidence supports the use of acupuncture as adjunctive or stand-alone therapy for depression, but the current evidence cannot justify the recommendation of acupuncture as stand-alone therapy.4 The Council’s fact sheet also contains numerous summaries of systematic reviews and clinical trials examining the effectiveness of acupuncture in alleviating depression.5
One article examining the efficacy of acupuncture in the treatment of depression is a 2010 Cochrane review by Smith et al titled “Acupuncture for depression.”1 This review included and analyzed thirty separate trials examining the use of various types of acupuncture in the treatment of depression. This review found several instances of evidence that supported the effectiveness of acupuncture either in comparison to a control or as an adjunct to medication therapy.1 However, as acknowledged by the authors, the majority of the trials included in the review carried a high risk of bias.1 The authors concluded that the evidence was not sufficient to demonstrate acupuncture’s benefit over various controls or as an addition to mediation therapy.1 They ended the article by calling for further studies to be conducted using higher quality methods and procedures.1
In evaluating the article written in Express, the information found on the British Acupuncture Counsel’s website, and the review conducted by Smith et al, I do not disagree with the premise that acupuncture may provide a way of alleviating depression. However, I find myself in agreement with Smith et al that I am not yet convinced that acupuncture is a proven method of alleviating depression either as a stand-alone therapy or as an adjunct to medication therapy. As such, I would not feel confident telling my patients that acupuncture would definitely relieve their depression. However, I do not think that pharmacists should hesitate to inform their patients of acupuncture’s potential to help treat their depression as long as they counsel patients not to discontinue their usual course of depression treatment.
As health-care providers, pharmacists should be willing to learn and accept new forms of treatment outside the standard of care when provided with sufficient evidence to do so. Though research has not definitively determined the merit of acupuncture in treating depression, research has show St. John’s Wort to be an effective form of alternative therapy for patients suffering from mild to moderate depression.6 Unfortunately, because St. John’s Wart interacts with numerous medications, including drugs often prescribed for depression such as paroxetine (Paxil®) and sertraline (Zoloft®), the pharmacist must be cautious in recommending it to a patient.6 For patients seeking a more “natural” approach to tradition antidepressant medications, however, St. John’s Wart may be a viable treatment option as long as the pharmacist ensures the patient is not taking any medications that would may interact with this natural product
While one would need to conduct a more thorough review of published literature regarding acupuncture and depression to form a truly authoritative position regarding the use of acupuncture in treating depression, discussing the place of acupuncture and other nontraditional forms of care such as St. John’s Wart in the treatment of depression nevertheless requires pharmacists to take a closer look at alternative methods of medical practice and self-care, respectively. While the pharmacist should certainly evaluate such modes of treatment critically, he or she must constantly accompany this evaluation with the following question: “Am I allowing the evidence to guide my recommendations, or am I letting my preconceived notions of alternative methods of care, whether positive or negative, unduly influence my thoughts?” While providing an honest answer to this question may prove convicting, evaluating all treatment options with as little bias as possible will ultimately result in the best possible patient outcomes.
- Smith C, Hay P, MacPherson H. Acupuncture for depression. Cochrane Database Of Systematic Reviews [serial online]. November 11, 2009;(1)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed November 6, 2013.
- Milne, Laura. Acupuncture offers new hope in treating depression and anxiety. Express Web site. Available from http://www.express.co.uk/life-style/health/435324/Acupuncture-offers-new-hope-in-treating-depression-and-anxiety. Published October 9, 2013. Accessed November 5, 2013.
- Home page. British Acupuncture Council Web site. http://www.acupuncture.org.uk. Accessed November 19, 2013.
- Depression: Intro. British Acupuncture Council Web site. Available from http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html. Last modified December 2, 2013. Accessed November 6, 2013.
- Depression: The evidence. British Acupuncture Council Web site. Available from http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html. Last modified December 2, 2011. Accessed November 6, 2013.
- Krinsky D et al. Handbook of Prescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2012.