Researchers conclude that acupuncture increases the total effective rate of the drug paroxetine for the relief of mild to moderate depression. Researchers from the Affiliated Dongfang Hospital of Beijing University of Traditional Chinese Medicine combined acupuncture with standard drug therapy. The researchers conclude that the addition of acupuncture to a paroxetine treatment regimen increases the effective rate of paroxetine for depression relief while mitigating its adverse effects. [1] Paroxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant medication used for treating depression and anxiety disorders that is often known by the following brand names: Paxil, Pexeva, Brisdelle.
In research conducted by Ma et al., electroacupuncture plus drug therapy produced an 89.28% total effective rate. Using manual acupuncture plus drug therapy produced a 92.00% total effective rate. Drug monotherapy using paroxetine produced an 85.71% total effective rate. The results were measured with Measure Your Medical Outcome Profile (MYMOP) and 17-item Hamilton Rating Scale for Depression (HAMD-17) instruments at the completion of all medical treatments. MYMOP is a patient generated questionnaire for measuring treatment outcomes, including problem specific improvements as well as general wellbeing changes. The HAMD-17 is a widely used rating instrument used to assess the severity of depression.
Design
Ma et al. used the following study design. A total of 88 patients with mild to moderate depression were treated and evaluated in this study. All participants were patients diagnosed with depression. They were randomly divided into an electroacupuncture plus drug group, a manual acupuncture plus drug group, and a monotherapy drug group with 28, 25, and 35 patients in each group respectively. All group patients received identical drug therapy (paroxetine). On the first and second day, patients received 10 mg of paroxetine tablets, once per day, after breakfast. From the third day to the end of the treatment regimen, the dose was increased to 20 mg, once per day, after breakfast. The drug treatment lasted for 6 weeks.
The statistical breakdown prior to the beginning of the study for each randomized group was as follows. The electroacupuncture plus drug group was comprised of 18 males and 10 females. The average age in the electroacupuncture plus drug group was 45.52 (±13.64) years. The average course of disease was 3.50 (±2.69) months. The average HAMD-17 scores were 25.57 (±4.83). The manual acupuncture plus drug group was comprised of 17 males and 8 females. The average age in the manual acupuncture plus drug group was 47.68 (±12.82) years. The average course of disease was 3.44 (±2.81) months. The average HAMD-17 scores were 27.40 (±4.39). The drug control group was comprised of 20 males and 15 females. The average age in the drug control group was 38.30 (±14.71) years. The average course of disease was 3.89 (±3.56) months. The average HAMD-17 scores were 26.29 (±6.01). There were no significant statistical differences in terms of age, gender, course of disease, and HAMD-17 scores relevant to patient outcome measures.
Acupuncture Procedure
Patients in two treatment groups received acupuncture therapy, every two days, three times a week, for a total of 6 weeks (one treatment course). The primary acupoints used for treatment included the following:
- GV20 (Baihui)
- EX-HN-3 (Yintang)
- GV16 (Fengfu)
- GB20 (Fengchi, bilateral needle insertion)
- GV14 (Dazhui)
- PC6 (Neiguan, bilateral needle insertion)
- SP6 (Sanyinjiao, bilateral needle insertion)
Secondary acupuncture points were added based on diagnostic considerations. For patients with liver qi stagnation, the following acupoints were added:
- LV3 (Taichong)
- LI4 (Hegu)
For patients with qi depression transforming into fire, the following acupoints were added:
- LV2 (Xingjian)
- GB43 (Xiaxi)
For patients with anxiety and depression damaging the spirit, the following acupoints were added:
- EX-HN-22 (Anmian)
- HE7 (Shenmen)
For patients with heart and spleen deficiency, the following acupoint was added:
- ST36 (Zusanli)
For patients with yin deficiency with fire, the following acupoints were added:
- KI3 (Taixi)
- KI6 (Zhaohai)
Acupuncture treatment commenced with patients in a supine position. A 0.30 mm × 40 mm disposable acupuncture needle was inserted perpendicularly into each acupoint to a standard depth. For all acupoints, a deqi sensation was obtained and the needles were stimulated with manual manipulation techniques for 5 – 10 seconds during the 30 minute needle retention times.
Electroacupuncture involved the application of 2/15 Hz disperse-dense wave stimulation to Baihui, Yintang, and bilateral Fengchi. The intensity level was set to patient tolerance levels or until muscle contractions were observable. Once the electric stimulation began, the needles were retained for 30 minutes.
Independent Research
In a similar finding, Liu et al. from the psychiatry department of Hangzhou Seventh People Hospital conclude that “acupuncture enhances the clinical efficacy of SSRI antidepressants for the treatment of depression and reduces adverse drug reactions.” [2] Two groups were compared in the controlled study. Patients of both groups were given various SSRIs (e.g., fluoxetine, paroxetine) according to the severity of the disease. One group also received acupuncture with 0.30 mm × 40 mm acupuncture needles. The needle retention time was 30 minutes per acupuncture session. Acupuncture therapy was administered every two days, for a total of 4 weeks. The primary acupoints used in the study were the following:
- GV20 (Baihui)
- EX-HN-3 (Yintang)
- GV24 (Shenting)
- GB20 (Fengchi, bilateral needling)
- GV14 (Dazhui)
- EX-HN-1 (Sishencong)
Additional secondary acupoints were added based on diagnostic presentations:
- Liver depression transforming into fire: LV2 (Xingjian), LV3 (Taichong)
- Heart and spleen deficiency: BL15 (Xinshu), ST36 (Zusanli)
- Liver and kidney yin deficiency: KI3 (Taixi), BL18 (Ganshu)
- Heart and gallbladder qi deficiency: BL19 (Danshu), HE7 (Shenmen)
- Spleen and kidney yang deficiency: BL20 (Pishu), CV4 (Guanyuan)
- Phlegm qi binding depression: ST40 (fenglong), GB34 (Yanglingquan)
- Pain: Ashi points
All patients were assessed with the Hamilton Depression Rating Scale (HAMD), Visual Analogue Scale (VAS), and Asberg Side-Effects Rating Scale (ASERS) before treatment and 1, 2, and 4 weeks after completion of treatment. VAS was used to assess pain. ASERS was used to measure side effects.
HAMD scores and VAS scores at 1, 2, and 4 weeks after treatment in the acupuncture plus drug group were significantly lower than those in the drug only group (P<0.01), indicating that acupuncture plus drug therapy was superior to using only drugs. ASERS scores in the 1, 2, and 4 weeks after treatment in the acupuncture plus drug treatment group were markedly lower than those in the drug group (P<0.01), indicating that acupuncture plus drug therapy produces less adverse drug reactions than drug monotherapy.
Summary
Modern research indicates that combining acupuncture with SSRI antidepressants into an integrated treatment protocol is more effective than SSRI antidepressants as a monotherapy. Important features of the integrated protocol is that it produces a high total effective rate while lowering the adverse effect rate associated with drug therapy. Patients interested in learning more about acupuncture as a treatment option are encouraged to contact local licensed acupuncturists to learn more.
Notes
[1] Ma XH, Yang XY, Xu K, Pan L, Yang XJ, Wang SH, Tu Y. A Clinical Observation on Acupuncture Combined with Western Medicine for 88 cases of Mild to Moderate Depression [J]. Journal of Traditional Chinese Medicine, 2014, 55(6):493-496.
[2] Liu Y, Zhang YH, Jin M, Liu WJ. Study on Clinical Effect Enhancement of Acupuncture for Depression with Chronic Pain Treated with SSRI antidepressants [J]. Chinese Acupuncture and Moxibustion, 2013, 33(8):689-691.
