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Acupuncture And Depression

Acupuncture and Depression: Healing the Mind by Way of the Body

DeNean Hardman

Saybrook University

MBM5690: Complementary and Integrative Medicine

Dr. Kristin Jamieson

November 25, 2022



Abstract

Depression is mental health diagnosis that impacts a great portion of society and appears to be ever-increasing. There are much different treatment modalities that are used to combat depression, some have been proven to be more effective than others. The research presented will focus on the effectiveness of acupuncture in the treatment of depression. Acupuncture is an ancient Chinese treatment modality that utilizes tiny pins inserted into the skin on acupuncture points of the body. This ancient Chinese treatment has been adopted by and included in western medicine as a treatment approach to bring healing to one’s body and mind.

Keywords: acupuncture, depression, treatment approaches, healing




Acupuncture and Depression: Healing the Mind by Way of the Body

Depression is an all too prevalent mental health condition that affects more than 300 million individuals of all ages and all around the world (Leung et al., 2020). Depression is a disorder that has no prejudice, affecting all races, creeds, colors, all genders, as well as all social classes. Gao et al. (2019) defined depression as a disorder that is felt as persistent sadness, a loss of interest in activities, an inability to find pleasure, and a blockage of one’s ability to participate in daily activities. A great number of individuals who have depression suffer from increased or chronic levels of stress, and the rate of individuals with depression appears to be increasing (Wild et al., 2020). There are many influences in today’s society that are a contributor to depressive symptoms and the current societal culture may take some blame for the increase in depression, especially taking into account the recent pandemic. Societal changes such as the increase in crime rates and violence, as well as the exploitation of individuals that we see on social media are a few additional contributors to today’s increased level of stress.

Stress levels and the difficulty or inability to handle these stress levels are correlated with feelings of depression and the diagnosis of this disorder (Wild et al., 2020). According to Li et al. (2020), depression has a negative impact on the mental and physical quality of life of all those who suffer from this psycho-emotional disease. Depression may be compared to the dark cloud that hangs over one’s head, blocking out the opportunity for sunlight which brings a much-needed reprieve. Armour et al. (2019) go on to state that depression impacts the emotional, cognitive, and behavioral areas of an individual’s life as well as having a great impact on society. Depression feels insidious once it has seeped in and drained one’s life force. An individual who suffers from depression may be underperforming in their own life due to this affliction, and this underperformance may have a direct impact on all those whom they interact with on a regular basis.

Regarding the impact that depression has on society, Schroer & Adamson (2011) highlights the economic burden that is placed on society due to this diagnosis. This burden is comprised of the direct cost of treatment and the indirect costs which include the death of individuals from suicide and workdays missed because of the inability of diagnosed individuals to be able to function (Schroer & Adamson, 2011). Schroer & Adamson (2011) are speaking to the impact that one individual’s mental health may have on society because an individual does not operate alone, and human beings are social creatures. One person calling out of work affects the whole work environment, and one individual committing an act of suicide sends ripples through humanity.

While sadness is a feeling that everyone feels, depression is a state of being that may be debilitating and life-hindering. Many individuals who suffer from depression may seek to receive treatment from their primary care physician, a small percentage of this population may require hospitalization, and there remains yet another percentage that may opt to try alternative modalities of treatment to combat this diagnosis (Armour et al., 2019). There are also a few individuals who may not seek treatment at all, whether that be due to the diagnosis of depression itself, the stigma attached to the diagnosis, lack of financial resources, or the possibility of a lack of direction of where to begin to go for treatment.

It is important to consider that there are many different types of depression which include mild, moderate, major, postpartum, poststroke, perimenopausal, and subsyndromal depression (Zhange et al., 2021). Factoring in the different types of depression may provide an explanation as to why treatment for depression is not so clear-cut. According to Leung et al. (2020) symptoms of depression tend to include restlessness, worthlessness, fatigue, anxiety, loss of energy, and/or change in appetite. For some, depression may even manifest as self-harm or suicidal ideation (Leung et al., 2020). Depression appears to be ever-increasing and has increased by approximately 18% between 2005 to 2015, contributing to one of the major disabilities within developed countries throughout the world (Leung et al., 2020). While depression is a common mental health diagnosis though there lies a complexity in the treatment of this ailment.

Exploring depression even further, it can be noted that this disorder of the emotional state has a great impact on the physical body, on the spiritual being, and on the interpersonal relationships that individuals have with others. Just as the diagnosis has negative impacts on all functioning areas of an individual’s life, healing from this diagnosis, heals the self, and all other individuals with whom are directly connected with that individual. Hollon (2022) cited Beck when describing depression as not only an affective disorder, but a disorder that manifests as negatively impacting one’s behaviors, belief systems, and ability to process information.

Depression was believed to be the result of an individual’s anger being turned inward, according to Freudian theory, it is an unconscious rage against the individual’s parents for not meeting their infantile needs and desires (Hollon, 2022). According to research conducted by Roberts et al. (2020), depression is complex, and evidence has shown that those who suffer from depression also suffer from a deficiency of both serotonin and dopamine neurotransmitters. Depression can be due to a combination of causes, including genetic and psychological factors or both combined (Roberts et al., 2020). No matter the belief system behind what is the cause of depression, the importance is managing these symptoms so that the management may eventually, hopefully, lead to the cure of the diagnosis.

Treatments for Depression

Research conducted by Roberts et al. (2020), reports that there appears to be what they considered a gap in treatment for individuals who suffer from mental health ailments, depression falling into that category. Treatments for depression may range from psychotherapy to psychotropics, and many individuals who receive these types of treatments may be successfully treated (Cujipers, 2018). Psychological approaches for depression include interventions such as psychotherapy, cognitive behavioral therapy, interpersonal therapy, and counseling (Luo et al, 2020). Schroer & Adamson (2011) explain the drawback associated with the use of psychological treatments for depression being due to the level of impairment of some individuals who seek these treatment modalities.

There are patients whose mental health impairment from depression may be so significant that they are unable to participate or engage in this type of treatment (Schroer & Adamson, 2011). Zhang et al. (2021) also included neuroregulatory treatment as a modality used for treating individuals who are diagnosed with depression. Cujipers (2018) stated that many of the individuals who have been prescribed medication as a treatment regime may need to continue the medication for several months and those that utilize psychotherapy require many hours of treatment. Regarding medication, Luo et al. (2020) stated that the use of antidepressants is only effective for approximately 50 to 70% of individuals that they have been prescribed, and about 30% of patients experience negative or no impact from these prescriptions. The treatment for depression does not appear to be a cookie-cutter type approach, what works for one is not guaranteed to work for another. Even with the use of medication, there is not one magic pill and individuals often require attempting different types of medication until one is found to be more effective than the others. According to Cujipers (2018), regarding medication, the level of success diminishes for individuals for every new type of medication that is attempted.

Another type of treatment for depression is herbal treatments which are believed to have fewer adverse reactions than their psychotropic counterparts (Burstein et al., 2022). While Burstein et al. (2022) did not define what they considered to be “herbal treatments”, it was noted that herbal treatments do not carry the same risk of suicidality as some prescribed medications do. A reason that some individuals may opt for herbal treatment, as opposed to prescribed medication, may be due to their personal belief systems, though primary care physicians and health care professionals routinely prefer conventional treatments instead of the natural alternative (Burstein et al., 2022). This preference for conventional treatments may be due to many reasons, including the ability to regulate these practices and the medications that are being prescribed. The same level of oversight and regulations do not currently exist for herbal medicines.

Acupuncture for Depression

Alternative forms of treatment are often sought-after by individuals who suffer from depression and who have failed to find success in either talk therapies or medication (Armour et al., 2019). One of the complementary and alternative medicine (CAM) approaches that have been proven to be successful is acupuncture. Acupuncture is frequently sought after by individuals who suffer from depression, either combining this modality with other forms of conventional treatment approaches or in replacement of them (Roberts et al., 2020). Acupuncture is sought because of the belief that it will aid in alleviating symptoms of depression and to help the individual improve their own quality of life (Gao et al., 2019). Acupuncture is a traditional Chinese medicine modality that has been around for centuries and has been utilized for many different reasons including the treatment of mental health or stress-related disorders (Wild et al., 2020). Gao et al. (2019) described acupuncture as being one of the most important therapies within Chinese medicine with a history of being used for the treatment of emotional, spiritual, and psychological disorders. According to Muthmainah & Nurwati (2016), acupuncture is a safe treatment approach that is well-tolerated by its participants.

The use of acupuncture for the treatment of depression has been accepted in some western countries, including Norway and the United States (Lou et al., 2020). Schroer & Adamson (2011) stated that when acupuncture was introduced to western countries from China there was an interest in utilizing this practice for therapeutic purposes with a focus on the emotional and psychological well-being of patients. It has only been within the last 2 decades that Western medicine has begun to incorporate the use of acupuncture into treatments for mental health disorders (Muthmainah & Nurwati, 2016).

Armour et al. (2019) described acupuncture as the insertion of tiny needles into a variety of acupuncture points on the body which has been found to have a healing effect on the individual. Following insertion, these acupuncture needles may either be stimulated by the practitioner or an electric current that is connected to the needles (Armour et al., 2019). Electroacupuncture treatment is an effective form of acupuncture treatment due to its ability to decrease depression symptoms because of the current’s ability to increase the synaptic plasticity of the AMPAR gene (Zhange et al., 2021). Leung et al. (2019) included in their research the benefits of including cupping in the acupuncture sessions for individuals suffering from depression, anxiety, and even insomnia which may be a byproduct of depression.

Leung et al. (2020) stated that acupuncture has become a popular modality for mental health treatment and for individuals with co-occurring disorders. Many of the participants in Leung et al.'s (2020) research did not begin their practice of acupuncture for the sole purpose of treatment for depression, they entered this treatment for physical ailments, though they were able to see the benefit of the treatment on their mental health. Acupuncture has been proven to be effective in reducing the symptoms of depression in comparison to Western treatment approaches or no treatment at all (Leung et al., 2020). Despite Leung et al. (2020) stating that acupuncture has become a popular treatment modality, Roberts et al. (2020) stated that this is a rarely considered treatment approach, and acupuncturists have reported that only 10% of their clients utilize this treatment for mental health needs. The effectiveness of acupuncture is in fact comparable to the effectiveness of counseling according to Roberts et al. (2020). This may be because individuals who suffer from depression also suffer from physical pains, digestive issues, decreased energy, and possibly even insomnia (Roberts et al., 2020). Participation in acupuncture allows the individual to remain in a rested position, doing nothing, and allowing the results to take place (Schroer & Adamson, 2011). The positive to remain in a relaxed state or resting position is that minimal effort is required from the patient except for being present in the moment.

Some individuals who suffer from depression and who have utilized this treatment expressed the belief that acupuncture has added to their mental well-being due to there being minimal side effects combined with the relationship that forms between patient and practitioner (Roberts et al., 2020). Regarding the relationship that is formed between the patient and practitioner, Schroer & Adamson (2011) described the relationship dynamic between the patient and practitioner as a close relationship that involves both communication styles verbal and nonverbal. For an individual who suffers from depression, companionship, support, and comradery are therapeutic benefits in themselves. The patient has been offered the opportunity to work closely with someone who is positively vested in their progress and healing.

According to Zhang et al. (2021), acupuncture has proven to be effective due to its ability to maintain a level of balance between the Yin and Yang of the individual receiving its treatment. Wild et al. (2020) make a similar, yet more scientific assessment, stating that acupuncture provides balance to the parasympathetic and sympathetic nervous systems. Zhang et al. (2021) included in their research that the treatment of acupuncture, whether utilized alone or in combination with psychotropics, patients have demonstrated a significantly lower level of feelings of depression. Acupuncture has been proven to be effective in not only the treatment of depression but also in other mental health ailments including anxiety (Leung et al., 2019).

Drawbacks to the Use of Acupuncture as a Treatment Modality

With every positive, there exists a negative, and while acupuncture has been a provenly effective treatment approach by some, apprehension of this modality continues. There continues to be great uncertainty and a lack of evidence as to whether acupuncture can be considered an effective treatment approach for individuals who are diagnosed with depression (Schroer & Adamson, 2011). Gao et al. (2019) stated that according to research, there is a lack of evidence to provide proof of the effectiveness of acupuncture in the treatment of depression despite the increase in interest in this modality.

According to Roberts et al. (2020), many primary care physicians have expressed concern regarding this form of treatment for their patients suffering from mental health issues. The concern from physicians was based on the overall vulnerability of this population and the risk of increased harm instead of harm reduction (Roberts et al., 2020). It can possibly be argued that more education is required of the physicians pertaining to the area of CAM practices and how they may be incorporated into mainstream medicinal approaches. Roberts et al. (2020) expressed the sentiment that the reservations of these physicians may be due to their lack of knowledge or awareness regarding what acupuncture treatment consists of. Physicians who lack the knowledge of what acupuncture is or how it works may feel that it is just about the placement of tiny needles in different parts of the individual’s skin, while it is much more than that. Roberts et al. (2020) also described what they considered to be a barrier to collaboration between medical providers and acupuncturists which creates the ability to hinder the progress of treatment. There is no definitive way to state who is more resistant or hesitant to work with whom, though there is a lack of cohesiveness among providers.

Roberts et al. (2020) stated that acupuncturists were able to see many strengths in this treatment modality for differing health ailments though they felt as if they viewed the benefits of this treatment with mental health as being different from the physical health benefits, this too circled back to their expertise in treating mental health issues. Depression, just like other mental health-related disorders, is a complex disorder and works best with individualized treatment approaches (Roberts et al., 2020). Regarding mental health disorders and their treatment using acupuncture, mental health issues are viewed through a different lens than other health-related issues because there is no standard intervention (Schroer & Adamson, 2011).

It is not only physicians who have expressed concern regarding their patients utilizing acupuncture as a treatment approach, there have been some acupuncturists who have voiced concern regarding what they consider to be a deficit in their training related to mental health issues (Roberts et al., 2020). Roberts et al. (2020) stated that acupuncture practitioners may have reluctance to assume primary responsibility for the mental well-being of their patients. The concerns of both the general practitioner and the acupuncturists support the argument that a combined treatment approach may work best for this category of patients. As already mentioned, depression impacts the entire being of an individual, and there lies a complexity in the cause of this mental health ailment, the use of one sole treatment method may not always be what is best for the individual.

Zhang et al. (2021) stated that nonpharmacological treatment approaches, acupuncture falling into this category, have limitations due to the possibility of it being time-consuming, high cost of treatment or operation, high rates of recurrence, and a high nonresponse rate. Zhang et al. (2021) go on to express the belief that it is necessary to find alternative therapeutic approaches that will have a positive impact and decrease what they call the antidepressant effect.

Conclusion

There does not appear to be a clear or concise conclusion regarding whether acupuncture is effective in treating depression or if it is found to be effective, why that is. Leung et al. (2019) stated that the evidence regarding its effectiveness may be due to the utilization of antidepressant medications and their combination with acupuncture treatment. Research supports that acupuncture combined with medication is much more effective than the use of medication alone (Gao et al., 2019). Acupuncture appears to be a beneficial and safe complementary treatment approach when it is combined with psychotropics (Muthmainah & Nurwati, 2016). Schroer & Adamson (2011) described acupuncture as bordering the metaphysical and its ability to be an effective treatment is unable to be proven scientifically. There are also very few studies regarding the effectiveness of acupuncture in relation to stress, considering that stress is a contributor to depression, there is a lack of research providing evidence of the benefit of this treatment (Wild et al., 2020).

Leung et al. (2019) also make clear that an individual who is receiving acupuncture for their mental health treatment would best benefit if they were openly discussing their mental health ailments and concerns. The best course of treatment for mental health, including depression, is based on the severity of the disorder that the individual is suffering from and active engagement in treatment by that individual with a trained practitioner, whether that be a therapist, primary care physician, or a skilled acupuncturist trained in mental health. A theme though that has become evident is that acupuncture is a complementary treatment when combined with other treatment modalities (Leung et al., 2019). The research appears to remain limited and inconclusive regarding the effectiveness of acupuncture for depression though there remain many individuals who have benefited greatly from this type of treatment. While depression rates continue to increase, individuals and society benefit greatly from the incorporation of this type of treatment along with other proven therapeutic approaches. When one individual heals, we as a collective, heal.

The research reviewed appears to speak favorably regarding the benefits of including acupuncture in one’s healing regimen when combating depression despite the inability to scientifically prove its effectiveness. Whether acupuncture brings balance to the Yin and Yang, equalizes the nervous system, or just allows for a state of peace and rest for the individual to a moment of rejuvenation. The symptoms of depression can cloud the mind, body, and emotional state of the sufferer, acupuncture allows for a time of reprieve from those symptoms.


References


Armour, Smith, C. A., Wang, L.-Q., Naidoo, D., Yang, G.-Y., MacPherson, H., Lee, M. S., & Hay, P. (2019). Acupuncture for Depression: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 8(8), 1140–. https://doi.org/10.3390/jcm8081140

Burstein, Shamir, A., Abramovitz, N., & Doron, R. (2022). Patients’ attitudes toward conventional and herbal treatments for depression and anxiety: A cross-sectional Israeli survey. International Journal of Social Psychiatry, 68(3), 589–599. https://doi.org/10.1177/0020764021992385

Cuijpers. (2018). The Challenges of Improving Treatments for Depression. JAMA : the Journal of the American Medical Association, 320(24), 2529–2530. https://doi.org/10.1001/jama.2018.17824

Gao, Zheng, Q., Hou, T., Luo, Y., Shi, Y., & Li, Y. (2019). Acupuncture for depression: An overview of systematic reviews. European Journal of Integrative Medicine, 28, 1–13. https://doi.org/10.1016/j.eujim.2019.03.009

Hollon. (2022). Depression. Cognitive and Behavioral Practice, 29(3), 507–. https://doi.org/10.1016/j.cbpra.2022.02.016

Leung, Cheung, M., Hou, L., Webb, A. E., Chen, X., & Hune, N. (2020). Depression Reduction Among Acupuncture Patients in an Interprofessional Study. Research on Social Work Practice, 30(3), 298–305. https://doi.org/10.1177/1049731519863112

Li, Wei MD, PhDa,b; Sun, Manqinb; Yin, Xuanb; Lao, Lixing MD, PhDc,d; Kuang, Zaoyuan MD, PhDa,∗; Xu, Shifen MD, PhDb,∗. The effect of acupuncture on depression and its correlation with metabolic alterations: A randomized controlled trial. Medicine: October 23, 2020 - Volume 99 - Issue 43 - p e22752 doi: 10.1097/MD.0000000000022752

Luo, Long, Y., Xiao, W., Wang, X., Chen, R., Guo, Q., Liu, J., Shao, R., Du, L., & Chen, M. (2020). Risk of bias assessments and reporting quality of systematic reviews and randomized controlled trials examining acupuncture for depression: An overview and meta‐epidemiology study. Journal of Evidence-Based Medicine, 13(1), 25–33. https://doi.org/10.1111/jebm.12372

Muthmainah, & Nurwati, I. (2016). Acupuncture for Depression: The Mechanism Underlying Its Therapeutic Effect. Medical Acupuncture, 28(6), 31–307. https://doi.org/10.1089/acu.2016.1180

Roberts, Dowell, A., & Nie, J.-B. (2020). Utilizing acupuncture for mental health; a mixed‐methods approach to understanding the awareness and experience of general practitioners and acupuncturists. Complementary Therapies in Clinical Practice, 39, 101114–101114. https://doi.org/10.1016/j.ctcp.2020.101114

Schroer, & Adamson, J. (2011). Acupuncture for Depression: A Critique of the Evidence Base: Acupuncture for Depression. CNS Neuroscience & Therapeutics, 17(5), 398–410. https://doi.org/10.1111/j.1755-5949.2010.00159.x

Wild, Brenner, J., Joos, S., Samstag, Y., Buckert, M., & Valentini, J. (2020). Acupuncture in persons with an increased stress level—Results from a randomized-controlled pilot trial. PloS One, 15(7), e0236004–e0236004. https://doi.org/10.1371/journal.pone.0236004

Zhang, Li, S., Meng, H., Wang, Y., Zhang, Y., Wu, M., Chen, Y., Rong, P., & Wang, Y. (2021). Efficacy and safety of acupuncture in the treatment of depression: A systematic review of clinical research. Anatomical Record (Hoboken, N.J. : 2007), 2021, 304(11), 2436–2453. https://doi.org/10.1002/ar.24783

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