A novel acupuncture treatment strategy called dense cranial electro-acupuncture stimulation (DCEAS) has been shown to enhance anti-depressant efficacy in the early phase of selective serotonin reuptake inhibitor (SSRI) treatment for major depressive disorder (MDD). DCEAS involves the electrical stimulation of acupuncture points on the head (including Baihui DU-20, Yintang M-HN3, Sishencong M-HN-1, Toulinqi GB-15, Taiyang M-HN-9, Shuaigu GB-8 and Touwei ST-8), with the rationale that this may stimulate the release of serotonin (5-HT) and other neurochemicals in the brain. In a single-blind, randomised controlled study carried out in Hong Kong, 73 patients were randomly assigned to DCEAS or a control non-invasive electro-acupuncture (n-EA) procedure, in combination with the drug fluoxetine (FLX, Prozac) for three weeks. Patients treated with DCEAS displayed a significantly greater reduction in depression scores at days three and 21 compared with patients receiving n-EA.  (Dense cranial electroacupuncture stimulation for major depressive disorder-a single-blind, randomized, controlled study. PLoS One. 2012;7(1):e29651).

Practising tai chi can lead to a reduction in levels of inflammatory markers in the blood of older adults. American researchers randomised 83 healthy older adults to 16 weeks of either tai chi chih (TCC) or health education (HE). In subjects who showed elevated circulating levels of the inflammatory marker interleukin 6 (IL-6) at baseline, TCC was able to reduce IL-6 to levels comparable with the lowest baseline measurements. Decreases in depressive symptoms in the two groups were found to correlate with decreases in IL-6. (Mitigating Cellular Inflammation in Older Adults: A Randomized Controlled Trial of Tai Chi Chih. Am J Geriatr Psychiatry. 2011 Sep 19. [Epub ahead of print]).

Norwegian researchers have found that mindfulness-based stress reduction (MBSR) is an effective treatment for anxiety disorders. Seventy-six patients were randomised to an eight-week MBSR intervention or a wait-list control. Those who completed treatment (eight did not) improved significantly on all outcome measures compared to controls. MBSR had medium to large effect sizes on anxiety and a large effect size for symptoms of depression, and the effect was maintained at six months follow-up. (Patients with anxiety disorders: evaluation in a randomized controlled trial. Behav Res Ther. 2011 Apr;49(4):281-8).

An American study suggests that acpuncture may be an effective adjunct to medication in patients with depression who do not respond to anti-depressant medication. Thirty subjects with major depressive disorder (MDD) and partial or non-response after eight or more weeks of anti-depressant therapy assigned to eight weeks of standardised 30 minute acupuncture sessions on a weekly or twice-weekly basis. Twenty subjects (18 for weekly and two for twice-weekly treatment) completed the study. Depression scores decreased in both groups and improvement did not differ significantly between treatment arms (18.5 to 11.2 in the weekly group and 18.5 to 11.8 in the twice-weekly group). Response rates (defined as an improvement of 50% or more in depression scores) were 47% for all subjects – 50% for the weekly group and 33% for the twice-weekly group. (A pilot study of acupuncture augmentation therapy in antidepressant partial and non-responders with major depressive disorder. J Affect Disord. 2011 Apr;130(1-2):285-9).

Combining a weekly tai chi exercise class with standard depression treatment leads to greater improvement in depression symptoms for elderly adults. One hundred and twelve adults aged 60 or older with major depression were treated with the antidepressant escitalopram (Cipralex), for approximately four weeks. From among these participants, 73 who showed only partial improvement continued to receive daily medication and were also randomly assigned to ten weeks of either a tai chi class or a health education class for two hours per week. The researchers found that among those who participated in tai chi, 94% achieved depression scores of less than 10 on the Hamilton Rating Scale for Depression (a score of more than 10 indicates a diagnosis of depression), with 65% achieving remission (a score of six or less). By comparison, among participants who received health education, 77% achieved scores of 10 or less, with 51% achieving remission. Greater improvements in quality of life, memory and cognition, and overall energy were also seen in the tai chi group. (Complementary Use of Tai Chi Chih Augments Escitalopram Treatment of Geriatric Depression: A Randomized Controlled Trial. Am J Geriatr Psychiatry. 2011 Mar 6. [Epub ahead of print]

People who follow a Mediterranean diet rich in monounsaturated fats, vegetables, fruits, nuts, whole grains and fish) have a reduced risk of developing depression, according to Spanish research. A cohort of 10,094 healthy participants completed a food frequency questionnaire, on which basis researchers calculated their adherence to a Mediterranean diet. After four and a half years of follow-up, 480 new cases of depression were identified. Individuals who adhered to the Mediterranean diet most closely had a more than 30% reduction in the risk of depression than those who had the lowest Mediterranean diet scores. The authors speculate that components of the diet may improve blood vessel function, fight inflammation, reduce risk for heart disease and repair oxygen-related cell damage, all of which may decrease the chances of developing depression.

Acupuncture is an effective treatment for depression during pregnancy, according to a new American study. A hundred and fifty pregnant women with a diagnosis of major depression were randomised to receive 12 sessions of acupuncture consisting of a standardised point prescription specific for depression, or one of two active controls – control acupuncture or massage – over eight weeks. Women who received specific acupuncture experienced a greater rate of decrease in symptom severity compared with the combined controls or control acupuncture alone. They also showed a significantly greater response rate (63.0%) than the combined controls (44.3%) and control acupuncture alone (37.5%). Symptom reduction and response rates did not differ significantly between the controls. The authors conclude that the results achieved with acupuncture are similar to those achieved with standard depression treatments of similar duration. (Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol. 2010 Mar;115(3):511-20).
An update of a 2005 Cochrane systematic review concludes that there is currently insufficient evidence to recommend the use of acupuncture for people with depression, but notes that recommendations for practice cannot be made until further high quality research has been undertaken. Twenty-three new studies were added to the original pooled data, giving a total of 30 trials with 2812 participants in the meta-analysis. The authors concluded that there was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control. Despite this, acupuncture performed well in comparisons against medication – the majority of trials found them to be equally effective in reducing the severity of depression. Two trials found acupuncture may have additional benefit when combined with medication compared with medication alone. A subgroup of participants with depression as a co-morbidity experienced a reduction in depression with manual acupuncture compared with SSRIs (three trials, 94 participants). (Acupuncture for depression. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004046).

Acupuncture may offer a drug-free alternative for treating depression in pregnant women, researchers have found.  A study found that more pregnant women with depression benefited from acupuncture than those who had a sham treatment with needles or an ordinary massage.  Two thirds who had the genuine acupuncture reported a significant improvement in their symptoms, compared with less than half of those who had the other treatments.

The study of 150 women with depression was conducted by a team at Stanford University in California and is published in the Journal of Obstetrics & Gynaecology.  The approach may be particularly beneficial because depression in pregnancy can cause serious complications if untreated and yet women are reluctant to take drugs while carrying their child.  Prof Rachel Manber, the lead author, said: “This standardised acupuncture protocol could be a viable treatment option for depression during pregnancy.  “Because there is this concern about medication among pregnant women and their physicians, it’s important to find an alternative.”

Around 14 per cent of pregnant women may have depression and the condition is less well recognised than post-natal depression.  It is thought the extra hormones during pregnancy may play a role in causing the condition or women may feel overwhelmed by the major changes they are undergoing.

The Daily Telegraph, Tuesday 23rd February 2010

Adding acupuncture to medical treatment for depression can reduce the amount of drugs needed to treat the condition and therefore reduce the side-effects of medication. In a Chinese randomised, double-blind, sham-controlled study 80 patients with major depressive disorder (MDD) were randomised to two groups: one received standardised verum acupuncture, 10 mg/day fluoxetine and placebo (VA) and the other received sham acupuncture and 20-30 mg/day fluoxetine (SA). Acupuncture was applied five times a week over a period of six weeks. At the end of the treatment period, therapeutic response rates were not significantly different between groups (80.0% for VA and 77.5% for SA). Patients in the VA group also showed better improvement than the SA group in symptoms of anxiety and suffered fewer antidepressant side-effects. (Combination of acupuncture and fluoxetine for depression: a randomized, double-blind, sham-controlled trial. J Altern Complement Med. 2009 Aug;15(8):837-44).

A systematic review and meta-analysis of acupuncture for various depressive conditions has concluded that it is safe and constitutes an effective treatment for some forms of depression. Of 207 clinical studies of acupuncture retrieved from databases, twenty were considered o be of high enough quality to be subjected to meta-analysis. The results showed that the efficacy of acupuncture as monotherapy was comparable to antidepressants in improving clinical response and alleviating symptom severity of major depressive disorder, but not different from sham acupuncture. Acupuncture was also found to be superior to antidepressants and waiting-list controls in improving both response and symptom severity of post-stroke depression. The incidence of adverse events in acupuncture intervention was significantly lower than with antidepressants. (The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis. J Affect Disord. 2009 Jul 24. [Epub ahead of print]).