Depression is a common problem that is disabling, costly and often undertreated (Candy, Jones, Williams, Tookman, & King, 2009). As the largest source of non-fatal disease burden in the world, it accounts for 12% of years lived with disability and is associated with marked personal, social and economic morbidity, loss of functioning and productivity (Churchill et al., 2012, NICE 2009 in MacKinnon, 2013).
Clinical practice guidelines for the treatment of depression recommend antidepressants, cognitive-behaviour therapy (CBT) and interpersonal psychotherapy (IPT) as potentially effective interventions (APA 2000; NICE 2004; RANZCP 2004 in MacKinnon, 2013). However, there is a large gap between recommended best practice and what people with depression actually receive.
Literature Review for Acupuncture & Depression
Acupuncture for depression has mixed reviews; positive, inconclusive, and those that claim similar benefits as achieved by pharmacotherapy. Acupuncture combined with pharmacotherapy is a suggested treatment option for depression and acupuncture could reduce adverse side effects from pharmacotherapy for depression.
Current evidence from Stub et al.’s (2011) meta-analysis of four systemic reviews and twenty-six randomised controlled trials (RCT) shows that acupuncture reduces the severity of depression and that TCM and electroacupuncture (EA) may have similar effects as standard care.
More recent trials are investigating a combination of pharmacotherapy and acupuncture. Liu, Lu and Wang (2009) found that EA reduced the side effects that fluoxetine can cause like dry mouth, constipation, dizziness and headache while Duan, Tu, Jiao and Qin (2011) investigated a combination of EA and fluoxetine and reported a significant improvement in the Hamilton depression scale (HAMD) scores. Acupuncture and a low dose of fluoxetine was found to be as effective as the recommended dose of fluoxetine (Zhang, Yang & Zhong, 2009). There was also improvement to the side effects using the combined approach. Two other trials using a combination of acupuncture and paroxetine found that patient’s depression symptoms improved, especially their somatic symptoms and adverse effects from the medication (Guo, Wang, Sun, Zhang, & Ma, 2012; Zhang et al., 2007). In a study of 176 cases of depression treated with acupuncture and Prozac, the therapeutic effect was better or similar to Prozac with less side effects (Fu et al., 2009).
One meta-analysis of acupuncture for MDD (Zhang et al., 2010) involving twenty high quality RCTs found that the efficacy of acupuncture was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD. Adverse events from acupuncture were significantly lower than antidepressants. Smith et al. (2010) also reviewed acupuncture for depression with an analysis of thirty trials and 2,812 participants. A high risk of bias was found in the majority of trials which concluded in their being insufficient evidence. Two trials showed improvement of acupuncture and medication compared with medication on its own (Smith et al., 2010).