Mental Health, Stress, Anxiety & Depression

2021 Annals of General Psychiatry

Acupuncture therapy aimed at reducing anxiety in patients with generalised anxiety disorder has certain beneficial effects compared to controls.

Twenty RCTs were included in this systematic review and meta-analysis. All included studies were designed for patients with generalised anxiety disorder (GAD), and 18 studies were published in Chinese. Egger’s test showed that the asymmetry of the funnel plot in all studies was not significant. The meta-analysis of anxiety symptoms showed that acupuncture was more effective than the control condition, with a standard mean effect size of − 0.41, and that acupuncture intervention showed good tolerance and safety in the treatment of anxiety disorder.

Effectiveness of acupuncture on anxiety disorder: a systematic review and meta-analysis of randomised controlled trials Yang, Xy., Yang, Nb., Huang, Ff. et al.

2020 Neuropsychiatric Disease and Treatment

Acupuncture is associated with a reduction in the risk of depression during long-term follow-up in patients with trigeminal neuralgia.

In total, 776 patients with newly diagnosed trigeminal neuralgia in each cohort with similar baseline characteristics were enrolled in the study. The acupuncture cohort had a reduced risk of depression compared to the non-acupuncture cohort. Kaplan–Meier analysis also revealed that the cumulative incidence of depression was significantly lower in the acupuncture cohort during the 13-year follow-up period. In particular, the beneficial effect of acupuncture was a decrease in the risk of depression among TN patients aged 50– 69 years who had also used carbamazepine.

Long-Term Beneficial Effects of Acupuncture with Reduced Risk of Depression Development Following Trigeminal Neuralgia: A Nationwide Population-Based Cohort Study Liao CC, Lin CL, Liao KR, Li JM

2019 Frontiers in Psychiatry

Evidence indicates that acupuncture treatment may be of benefit in several neuropsychiatric disorders, including depression, anxiety, schizophrenia, and Alzheimer's Disease.

The pathophysiology of these disorders may be associated with glutamate dysregulation, marked by a high rate of glutamate release and elevated expression of glutamate receptors and glutamate transporters in the CNS. The ability of acupuncture stimulation to modulate glutamate receptor and EAAT expression suggests that the treatment effects of acupuncture are underpinned by its intervention in the dysregulated glutamate system. Further preclinical and clinical studies are needed to clarify the possible mechanisms of acupuncture in these neuropsychiatric disorders and to establish protocols for treatment guidelines.

The Effects of Acupuncture on Glutamatergic Neurotransmission in Depression, Anxiety, Schizophrenia, and Alzheimer's Disease: A Review of the Literature Cheng-Hao Tu, Iona MacDonald, Yi-Hung Chen

2018 Cochrane Database of Systematic Reviews

Acupuncture may result in a moderate reduction in the severity of depression when compared with treatment as usual or no treatment.

The 64 trials included in this review compared acupuncture alone or in combination with pharmaceutical therapy versus a range of comparator interventions. The reduction in severity of depression at the end of treatment was smaller when acupuncture was compared with control acupuncture than when acupuncture was compared with no treatment control, although we rated both sets of results as providing low‐quality evidence. The possible benefit of acupuncture provided alone or in conjunction with pharmaceutical medication such as a selective serotonin reuptake inhibitor (SSRI) compared with pharmaceutical monotherapy is uncertain owing to the very low quality of available evidence. The effect of acupuncture compared with psychological therapy is unclear. The risk of adverse events with acupuncture is also unclear, as most trials did not report these adequately. However, in general, the risk of adverse events associated with acupuncture is low (Melchart 2004;Witt 2009). Few trials reported on dropout, reduced use of medication, and quality of life. Evidence is insufficient to show the optimal type of acupuncture or characteristics of acupuncture dosage. Lack of medium‐term and long‐term follow‐up in clinical trials represents a significant limitation of the evidence base.

Acupuncture for depression Smith CA, Armour M, Lee MS, Wang LQ, Hay PJ.

2018 Acupuncture in Medicine

Acupressure seems to be effective in providing immediate relief of pretreatment anxiety among adults, and has a medium effect size.

Of 39 potentially relevant studies, seven RCTs met the inclusion criteria for review while five studies met the criteria for meta-analysis. All studies reported the positive effect of acupressure on relieving anxiety from the anticipation of surgery or treatment. EX-HN3 (Yintang), HT7 (Shenmen) were the commonest points selected and two studies used bilateral points. The acupressure procedure was generally well reported and studies had a low risk of bias. The combined results of the five trials showed a greater overall reduction in anxiety in the acupressure group than in the sham controls.

Effects of Acupressure on Anxiety: A Systematic Review and Meta-Analysis Au DW, Tsang HW, Ling PP, Leung CH, Ip PK, Cheung WM

2017 Programme Grants for Applied Research

For patients continuing to experience depression in primary care, there are statistically significant benefits at 3 months associated with both acupuncture and counselling interventions when provided as adjuncts to usual care.

In this report we present what is to our knowledge the first study to rigorously evaluate the clinical and economic impacts of acupuncture and counselling for patients who are representative of those who continue to experience depression in primary care. Our evidence on acupuncture compared with usual care and counselling compared with usual care shows that both treatments are associated with a statistically significant reduction in symptoms of depression in the short to medium term, with no reported serious adverse events related to treatment. Acupuncture is cost-effective compared with counselling or usual care alone, although the ranking of counselling and acupuncture depends on the relative costs of delivering these interventions.

Acupuncture, Counselling or Usual Care for Depression (ACUDep): a randomised controlled trial MacPherson H, Vickers A, Bland M, et al.

2015 Explore: The Journal of Science & Healing

Acupuncture seems to be an effective add-on treatment in patients with depression and, to a lesser degree, in patients with schizophrenia.

The overall clinical results on using acupuncture to treat depression are promising, but only limited evidence for its effectiveness in treating schizophrenia was found. Acupuncture improves the quality of life, particularly that of sleep, in psychiatric patients. Brain research has revealed that acupuncture has a modulating and normalizing effect on the limbic–paralimbic–neocortical network (LPNN), including the default mode network. Because the LPNN is related to sleep and emotions, this might explain the improved qualities of life and sleep after acupuncture.

Schizophrenia and Depression: A systematic Review of the Effectiveness and the Working Mechanisms Behind Acupuncture Bosch P, van den Noort M, Staudte H, Lim S.

2014 Medical Care

Improvement in post traumatic stress disorder severity was significantly greater among those receiving acupuncture than in those receiving usual PTSD care.

Mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving usual PTSD care (PCLΔ=19.8±13.3 vs. 9.7±12.9, P<0.001; CAPSΔ=35.0±20.26 vs. 10.9±20.8, P<0.0001). Acupuncture was also associated with significantly greater improvements in depression, pain, and physical and mental health functioning. Pre-post effect-sizes for these outcomes were large and robust.

Acupuncture was effective for reducing PTSD symptoms. Limitations included small sample size and inability to parse specific treatment mechanisms. Larger multisite trials with longer follow-up, comparisons to standard PTSD treatments, and assessments of treatment acceptability are needed. Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment.

Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder Engel CC, Cordova EH, Benedek DM, Liu X, Gore KL, Goertz C, et al.

2014 PLOS One

Acupuncture is cost-effective compared with counselling or usual care alone in treating patients with depression.

The results of this analysis suggest acupuncture is cost-effective compared with counselling or usual care alone. This result is strongly influenced by the cost of acupuncture which only remains cost-effective when the cost of providing the intervention is lower than that of counselling. For patients in whom acupuncture is unavailable and perhaps inappropriate, counselling has an ICER less than a range of estimates of NICE’s cost-effective threshold. However, further research is needed to determine the most cost-effective treatment pathways for depressed patients when the full range of available interventions is considered.

Cost-effectiveness analysis of acupuncture, counselling and usual care in treating patients with depression: the results of the ACUDep trial Spackman, E., Richmond, S., Sculpher, M., Bland, M., Brealey, S., Gabe, R., Hopton, A., Keding, A., Lansdown, H., Perren, S., Torgerson, D., Watt, I., & MacPherson, H.

2013 Evidence-Based Complementary and Alternative Medicine

Evidence of effectiveness of acupuncture for PTSD is encouraging but not cogent. Acupuncture may be a relatively safe alternative for PTSD in contrast to SSRI, if long-term therapy is needed for treatment.

This is the first systematic review and meta-analysis of prospective clinical trials on the effectiveness of acupuncture for treatment of PTSD. Only 4 RCTs and 2 UCTs met the inclusion criteria for this review. Our main finding of this review is that acupuncture is effective for PTSD based on one high-quality RCT and a meta-analysis.

Acupuncture has positive effects in PTSD patients, although the evidence is still lacking as to its true efficacy for this condition.

Acupuncture for Posttraumatic Stress Disorder: A Systematic Review of Randomized Controlled Trials and Prospective Clinical Trials Young-Dae Kim, In Heo, Byung-Cheul Shin, Cindy Crawford, Hyung-Won Kang, Jung-Hwa Lim,

2011 European Journal of Integrative Medicine

Current evidence from this meta-analysis of randomized trials shows that acupuncture is effective in reducing severity of depression.

Four systematic reviews and 26 RCTs on acupuncture for treatment of depression were identified and included in this review. The methodological quality of the trial reports was generally low in terms of generation of the allocation sequence, allocation concealment, blinding and intention to treat. A significant beneficial effect was found for acupuncture in improvement of depression compared to pooled control measured by Hamilton Rating Scale for Depression. Subgroup analysis suggested that electro-acupuncture and TCM acupuncture, were not statistically different from medication. Acupuncture was regarded as generally safe in the clinical trials included in this review.

Acupuncture treatment for depression—A systematic review and meta-analysis Trine Stub, Terje Alræk, Jianping Liu