Acupuncture for Depression in Denver

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Design

Randomized trial in 27 primary care practices. People with depression received acupuncture (302), counseling (302) or usual care alone (151).

Result

PHQ-9 scores at 3 months were lower than with usual care by 2.46 points for acupuncture and 1.73 for counseling. Over 12 months the differences were 1.55 and 1.50 points. Acupuncture and counseling did not differ significantly.

Limit

The trial was not designed to separate specific effects of needling from non-specific effects. No serious treatment-related adverse events were reported.

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Design

Review of randomized trials in adults with depression comparing acupuncture with control acupuncture, no treatment, medication, psychological therapies or standard care. Searched through June 2016.

Result

Versus no treatment, a waiting list or usual care, acupuncture may moderately reduce depression severity (5 trials, 488 people). Versus control acupuncture, it may lower Hamilton scores by 1.69 points (14 trials, 841 people). Both were low-quality evidence. Added to medication, benefit was seen in 11 trials, but the evidence was very low quality.

Limit

Most studies had a high risk of bias in how treatment was delivered. The effect compared with psychological therapy was unclear, and most trials did not report adverse events adequately.

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Design

Meta-analysis of higher-quality randomized trials comparing acupuncture plus antidepressants with antidepressants alone. Searched through December 2021.

Result

Acupuncture plus antidepressants lowered HAMD-17 scores more than antidepressants alone and gave higher remission (risk ratio 1.52) and response (risk ratio 1.35). Fewer people needed to raise their antidepressant dose.

Limit

Evidence was rated low or moderate quality, and there was no placebo-controlled comparison. The authors say the findings must be interpreted with caution.

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Design

A guideline update from the Canadian Network for Mood and Anxiety Treatments. It graded the evidence from systematic reviews on physical and meditative treatments (light therapy, sleep deprivation, exercise, yoga and acupuncture) and natural health products.

Result

For mild to moderate major depression, exercise, light therapy, St. John's wort, omega-3 fatty acids, SAM-e and yoga are recommended as first or second line. Other physical treatments and natural health products have less evidence but may be considered as third-line. The abstract does not give a separate line of treatment for acupuncture.

Limit

The authors note methodological limitations of the studies and little data on long-term outcomes and drug interactions. Because the abstract does not single out acupuncture, I do not present this guideline as an endorsement.

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Design

Network meta-analysis of randomized trials of acupuncture for postpartum depression, compared with waiting list, placebo, standard control or as an add-on. Seven databases were searched up to May 2024.

Result

Acupuncture, psychotherapy and antidepressants were comparable in clinical efficacy rate and in reducing Hamilton and Edinburgh Postnatal Depression Scale scores. Combining acupuncture with antidepressants raised efficacy and reduced stomach and bowel side effects from the drugs.

Limit

Evidence quality was very low to low because of risk of bias and small samples. The authors say current evidence does not support strong recommendations, and it remains unclear whether the effect is specific or non-specific.

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Design

Randomized trial in pregnant women with major depressive disorder: acupuncture specific for depression (52), control acupuncture (49) or massage (49). Raters were masked to treatment.

Result

The response rate was 63.0% with acupuncture specific for depression, versus 44.3% in the combined control groups (p < .05) and 37.5% with control acupuncture alone (p < .05). Massage reached 50.0%, and the two control groups did not differ significantly.

Limit

The abstract gives no separate test against massage alone. It is one trial, in pregnancy.

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Design

Randomized trial in adults aged 18 to 80 with mild or moderate major depression: electroacupuncture (28) or control acupuncture, needling at nonchannel scalp points with imitation electrostimulation (25). Twelve 30-minute sessions.

Result

Both groups improved, with Hamilton depression scores falling by 6.6 points with electroacupuncture and 7.6 with control acupuncture. There were no serious adverse events with either.

Limit

The authors could not demonstrate a specific effect of electroacupuncture. It is a small trial.

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Design

Feasibility trial in women with depression and poor sleep in perimenopause, comparing real with imitation acupuncture. Patients and assessors were blinded.

Result

Sleep quality scores fell more with real acupuncture than with imitation acupuncture after treatment and at 8 weeks of follow-up. Depression scores also fell with real acupuncture, but the change was not statistically different from imitation acupuncture. No serious adverse events were reported.

Limit

Only 41 of 70 women completed the 16-week follow-up, and at 16 weeks neither group differed from its starting scores for depression or sleep.

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Design

Randomized, blinded trial in three Shanghai hospitals in adults with depression and insomnia: electroacupuncture, imitation acupuncture or neither, each with standard care. Treatment was 3 sessions a week for 8 weeks.

Result

At week 8, sleep quality scores were 3.6 points better than with imitation acupuncture and 5.1 points better than with standard care alone (p < .001 for both), and the benefit lasted through the follow-up. Hamilton depression scores fell by 10.7 points in the electroacupuncture group. No serious adverse events were reported.

Limit

The main outcome was sleep, not depression, and the abstract gives no between-group depression comparison.

It may help as an add-on, with real limits. In a 2013 trial of 755 people with depression in primary care, scores on a standard depression questionnaire were 2.46 points lower with acupuncture than with usual care alone at 3 months, similar to counseling. The 2018 Cochrane review found low-quality evidence that acupuncture may moderately reduce depression severity compared with no treatment. Most trials were rated low quality, so I use acupuncture alongside your care, never in place of it.

The primary care trial averaged ten acupuncture sessions. Two other trials gave 12 sessions over 8 weeks in pregnant women, and 12 sessions of 30 minutes over 6 to 8 weeks in adults. I tell you at your first visit how many visits I expect, and we review your mood together after five. If it has not changed by then, I will tell you and encourage you to talk with your doctor or counselor.

Many people do, and your prescriber should know. A 2022 review of 16 trials found that adding acupuncture to antidepressants lowered depression scores more than antidepressants alone, and people were about 1.5 times as likely to reach remission. The authors rated the quality as low or moderate and urge caution. Please keep taking your medication as prescribed unless your prescriber tells you otherwise.

No. Acupuncture is an add-on to counseling, medication and medical care, and I do not provide psychotherapy. In the 755-person trial, acupuncture and counseling each did better than usual care alone, but they were tested as options, not as a reason to stop other treatment. Please do not change or stop medication without talking with your prescriber.

See your doctor first for thoughts of self-harm or suicide (call or text 988 right away, any time of day), low mood or loss of interest lasting two weeks or more that disrupts daily life, hopelessness, major changes in sleep or appetite, or a history of bipolar disorder. If you have any of these symptoms and have not already told your doctor, please let them know.

At The Subtle Point a 90-minute first visit is $150 and follow-ups are $60 for 30 minutes of acupuncture, $95 for 60 minutes of acupuncture with Tuina massage, or $130 for 90 minutes of acupuncture with Tuina massage and cupping. HSA and FSA cards work, and you receive a superbill for your insurer.

Rarely, and never the way an injection does. Acupuncture needles are about the width of a human hair. Most people feel a brief tap, then a dull, heavy or warm sensation that fades in a few seconds. If any point feels sharp, tell me and I will adjust or remove it.