Auricular acupuncture (AA) is a promising complementary treatment for mental health conditions, including depression. A randomized clinical trial recently published in JAMA Network Open explored the efficacy and safety of auricular acupuncture in treating depression, focusing on clinical outcomes for acupuncturists. The study’s results highlighted essential procedural details, including acupuncture points, techniques, and biomedical outcomes that inform treatment strategies for licensed practitioners.
Study Design and Patient Selection
The trial enrolled 74 participants aged 18-50 with moderate to moderately severe depression, as measured by the Patient Health Questionnaire–9 (PHQ-9). All participants continued their usual care, which primarily included pharmacotherapy. The study excluded individuals with previous experience with AA, severe depression, or suicidal ideation.
Participants were divided into two groups: specific auricular acupuncture (SA) and nonspecific auricular acupuncture (NSA). Each group received 12 treatment sessions over six weeks. Treatment involved semipermanent needles inserted into specific auricular points. Participants were instructed to stimulate the needles manually three times a day (morning, afternoon, and evening) to enhance therapeutic efficacy.
Acupuncture Points and Techniques
Specific Auricular Acupuncture (SA)
In the SA group, six specific auricular points were chosen based on traditional Chinese medicine (TCM) diagnostic principles for treating depression. The points included:
- Shenmen (TF4): Located in the triangular fossa, this point is commonly used to calm the spirit and is a critical point in treating psychological disorders.
- Subcortex (AT4): Found near the antitragus, this point is used for regulating brain function and reducing stress.
- Heart (CO15): Located in the cavum concha, the heart point is integral in treating emotional disorders, especially when linked to anxiety and depression.
- Lung (CO14): Also located in the cavum concha, the lung point is selected for its role in treating sadness and grief, emotions traditionally associated with lung energy in TCM.
- Liver (CO12): Positioned in the cymba concha, this point is chosen for regulating mood and stress, particularly when linked to frustration or anger.
- Kidney (CO10): Located in the cymba concha, this point supports the root of energy and resilience, making it crucial for treating long-standing emotional disturbances.
For needle insertion, the acupuncturists used 0.2 mm x 2.5 mm semipermanent needles placed to a depth of 2.5 mm, with a locator device (EL11) used to confirm the neuroreactivity of the selected points. Manual stimulation of the needles was encouraged as de qi (obtaining the qi) was considered a key factor in ensuring the treatment’s efficacy. Participants were instructed to stimulate the needles until a sensation of pressure or warmth was perceived.
Nonspecific Auricular Acupuncture (NSA)
The NSA group received needles in locations unrelated to mental health according to TCM. These points included the outer ear, the cheek and face area, and four nonspecific points along the helix. The needles used for the NSA group were 0.2 mm x 1.0 mm and inserted to a depth of 1.0 mm, chosen for their shallow placement to reduce neuroreactive stimulation.
Treatment Schedule and Follow-Up
Each participant received two AA treatments per week for six weeks, totaling 12 sessions. The acupuncturists alternated between the left and right ears to prevent overstimulation of one side. Each session lasted approximately 15 minutes, and follow-up assessments were conducted at 4 weeks, 6 weeks, and 3 months after treatment initiation.
At each follow-up, participants completed the PHQ-9 questionnaire to assess depressive symptoms. The primary outcome was a 50% reduction in PHQ-9 scores (indicative of depression recovery), while secondary outcomes included complete remission of symptoms (PHQ-9 score below 5) and the occurrence of adverse events.
Results and Efficacy
The study found that at the 3-month follow-up, 58% of the participants in the SA group achieved a 50% or greater reduction in PHQ-9 scores, compared to 43% in the NSA group. While this difference was not statistically significant, the SA group demonstrated a statistically significant higher rate of symptom remission at 3 months, with 46% achieving a PHQ-9 score of less than 5, compared to just 13% in the NSA group.
The results suggest that SA may offer delayed benefits, with sustained improvement seen over time. The study’s authors hypothesized that the SA group’s use of points linked to the auricular branch of the vagus nerve may have led to increased parasympathetic activity, resulting in reduced stress and enhanced mood regulation. Moreover, the liver, kidney, and Shenmen points, long regarded as critical in regulating emotional well-being in TCM, may have contributed to the clinical improvements observed.
Safety and Adverse Events
Safety assessments showed that both groups experienced mild and transient adverse effects. These included mild pain at the needle site (reported by 94% of the SA group and 91% of the NSA group), itching, and local tenderness. One participant in the SA group reported mild local inflammation. No severe adverse events were reported, and five participants (four from the SA group and one from the NSA group) withdrew due to discomfort from local pain or needle insertion.
Implications for Clinical Practice
This study underscores the importance of selecting appropriate acupuncture points based on TCM diagnostics when treating depression. The SA protocol—focusing on Shenmen, heart, and liver points—appears to offer clinical advantages, particularly when practitioners follow specific needle insertion depths and manual stimulation techniques.
The results also highlight the need for further studies involving larger sample sizes and extended treatment regimens, as the delayed effects of AA may require longer-term follow-up to fully assess the intervention’s impact. Practitioners should consider offering treatments beyond the initial six-week period to maximize therapeutic outcomes, especially in patients with chronic or treatment-resistant depression.
Conclusion
Auricular acupuncture (ear acupuncture), specifically when utilizing carefully selected points based on TCM, appears to be a safe and potentially effective intervention for managing depression. The study’s findings support the use of AA as part of a holistic treatment plan, particularly for patients seeking alternatives to pharmacotherapy or psychotherapy. Licensed acupuncturists using TCM protocols with extended treatment regimens ensure optimal outcomes for their patients.
Reference:
1. de Oliveira Rodrigues DM, Menezes PR, Silotto AEM, et al. “Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial.” JAMA Network Open. 2023;6(11):e2345138.
