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Acupuncture for Depression Really Works!

Summary and Comment |
October 11, 2013

Acupuncture for Depression Really Works!

  1. Peter Roy-Byrne, MD

Add-on acupuncture and counseling were each superior to usual care in moderately depressed primary-care patients.

  1. Peter Roy-Byrne, MD

Despite significant patient interest in nonpharmacologic depression treatments, few strong studies have examined acupuncture. In a new study taking place in 27 primary-care clinics, researchers randomized 755 depressed patients in a 1:2:2 ratio to 12 weeks of usual care only or usual care plus acupuncture or plus humanistic counseling. Participants had moderately severe depression that typically was recurrent, with early age at onset.

Almost two thirds of patients were already taking antidepressants. Uptake of active treatments was good, with 88% attending at least one acupuncture session and 76% receiving counseling at least once. Both add-on acupuncture and counseling produced significantly greater depression improvement on the Patient Health Questionnaire (PHQ-9) compared with usual care alone, with small-to-medium effect sizes (0.39 and 0.27, respectively). Response rates (PHQ-9 score, <10) were 33%, 29%, and 18%, respectively. Adverse events were few.

Comment

This extremely well-designed, pragmatic trial is free of the multiple biases found in a recent Cochrane review of studies of acupuncture and depression (Cochrane Database Syst Rev 2010; CD004046), and care was delivered in a real-world fashion without academic experts. Humanistic counseling has been superior in some studies to usual primary care but inferior in other studies to more evidence-based psychotherapies such as cognitive-behavioral therapy. Hence, we cannot know how acupuncture would fare against a more effective psychotherapy, although it clearly works better than usual care, with a highly respectable number needed to treat of 7 in a population containing many patients on medication yet continuing to be depressed. Acupuncture seems like an excellent second-line, and perhaps even first-line, treatment for primary-care patients preferring an alternative therapy.

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Treasurer)

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Reader Comments (2)

IsraelKrieger MD Physician, Psychiatry, public depression outpatient clinic

Unfortunately we do not no if the response is due to the acupuncture or just to the fact that patients were seen more than usual care, and got more time with a therapist...

STEPHEN RODRIGUES Physician, Family Medicine/General Practice, Solo private office

I am excited that my newly adopted discipline is in the news. Acupuncture has been a part of my office based practice for a decade and it is invaluable. Especially in complex pain conundrums. I would be blinded if I did not have my needles.

Acupuncture is not what I thought it was a decade ago so I wonder what aspect of acupuncture was really used to make these conclusion. Acupuncture is actually part of what I now call therapy which is a recipe of treatment all blended into an office visit.

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