Search

Self Care Pharmacy Blog

 

Acupuncture: Treatment for Depression?

November 23rd, 2013

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.

 

References

  1. 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.
  2. 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.
  3. Home page. British Acupuncture Council Web site. http://www.acupuncture.org.uk. Accessed November 19, 2013.
  4. 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.
  5. 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.
  6. Krinsky D et al. Handbook of Prescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, DC: American Pharmacists Association; 2012.

 

Tags: , ,

5 Responses to “Acupuncture: Treatment for Depression?”

  1. Rachel Kunze Says:

    I thought this was a well-thought out blog with helpful insight. As a future pharmacist, I can already see how tough it is to balance the beliefs of the patients, your professional opinion, and the well-being of the patient. However, all health care providers should put the well-being of the patient first. From what I read, acupuncture is a safe method for treating depression, it becomes a question on whether or not it is effective. I liked the comment about St. John’s wort because this supplement does not prove to be safe, but it does prove to be effective. Considering acupuncture has been around for a while and has proven to be safe, I would support a patient who wanted to try it. However, I would encourage them to take their medications along with acupuncture instead of letting acupuncture substitute for them.

  2. Andrea Bashore Says:

    I thought you gave a lot of good insight on acupuncture, and I feel like I am more informed on this topic. I have heard of acupuncture, but before reading this I would not know whether or not to inform a patient on if it is actually effective. The information you gave in this blog has encouraged me to do further research. I liked your references and analysis of this topic. I would agree that this may not be an effective form of treatment. I know that St. John’s wort has been proven effective but has many drug interactions so it is not recommended. I think that this could be a good recommendation for those not on many medications.

  3. Trevor Stump Says:

    I think people’s perceptions on different treatments is a very interesting topic. Looking at acupuncture as an example, the literature shows its potential as a treatment for depression and anxiety, and while these results are not conclusive, some benefits seem to exist. Yet, as the author notes, only 10% of UK patients looked to acupuncture for relief. I think it would be interesting to look into similar statistics for some of the Eastern countries where acupuncture originated to see if there is any difference in the number of patients that look to acupuncture. I think as pharmacists it’s important to at least keep an open mind when it comes to treatments we may be less familiar with. Alternative and complementary therapies have been used for such a long time, and certain examples have certainly shown promise in the treatment of various disorders.

  4. Jinwon Byun Says:

    As Asian, I am familiar with acupuncture, and sometimes I use acupuncture as treatment. Among the East Asia (I do not know about other Asian courtiers), acupuncture is one of famous treatments. It was interesting to hear about acupuncture in the Western culture. With personal experiments, I think acupuncture works, but I do not know whether acupuncture has good scientific evidence. I like how the author brings St. John’s wort to compare with acupuncture. Even though St. John’s wort is effective to treat depression, many people do not recommend because of many drug interactions. Since acupuncture does not have serious side effects, and it can be used with other medication, as a future pharmacist, I will recommend to my patients, but I will not force them to try acupuncture. I will let them to decide to try or not. I think a pharmacist needs to accept a new treatment as long as the treatment is safe enough to be recommended.

  5. Eric Huseman Says:

    Jinwon, thank you for bringing your personal experience with acupuncture into this discussion. I think that one’s own personal experience with both pharmaceutical and non-pharmaceutical treatments can provide valuable insight into how one counsels a patient. Additionally, I think that bringing different personal experiences and backgrounds into the world of pharmacy can allow one to expose their colleagues to different aspects of patient care than they would have been exposed to without interacting with such fellow pharmacists.

Leave a Reply