Unipolar Depression During Pregnancy: Nonpharmacologic Treatment Options

Christopher Tjoa; Emmanuelle Pare; Deborah R Kim

Disclosures

Women's Health. 2010;6(4):565-576. 

In This Article

Acupuncture

Acupuncture is a treatment alternative with evidence of efficacy in MDD and one rigorous study in pregnancy. The most recent systematic review of acupuncture for depression included 20 trials of acupuncture meeting structured inclusion criteria, describing nearly 2000 nonpregnant patients with depression.[81] Including studies that employed multiple different diagnostic criteria to establish the presence of MDD (DSM, International Statistical Classification of Diseases or Chinese classification of mental disorders), Zhang et al. found that acupuncture had similar outcomes to antidepressant medications. The study was limited by high heterogeneity, inclusion of small studies, and poor characterization of illness. Previous meta-analyses have been plagued by similar problems, generally concluding that there are promising but insufficient data to determine the efficacy of acupuncture in MDD.[82–84]

Manber et al. looked at the antidepressant effect of acupuncture during pregnancy.[85] Study characteristics are summarized in Table 1. They randomly assigned 61 women to one of three interventions: active acupuncture with a treatment plan specifically targeting depression, acupuncture that was not tailored to treat depressive symptoms, and a massage condition included to control for 'attention, physical contact, relaxation and respite from daily stress'. Treatments consisted of 12 sessions over 8 weeks. A double-blinding of acupuncture treatments was established by utilizing two acupuncture providers: one provider was responsible for assessing and designing a treatment plan, another was responsible for needling the prescribed plan. Each plan had an equal number of acupuncture points in similar anatomic locations. Participants were recruited from obstetrician offices and local advertisements. Treatment response was monitored using the 17-itemHDRS,[86] and a classification of response required cessation of symptoms meeting DSM-IV criteria for a MDE, a HDRS reduction of 50% of baseline, and an absolute HDRS less than 14. Overall, they found efficacy for active acupuncture with 68.8% of patients responding to the treatment, while 47.4% of women responded to inactive acupuncture, and 31.6% of women responded to massage therapy. While active acupuncture differed significantly from massage treatment (p = 0.03), it was not statistically differentiated from inactive acupuncture treatment (p = 0.18). They did not report any adverse effects of treatment.

While these findings reflect a nonspecific therapeutic effect of acupuncture in depression during pregnancy, the paucity of evidence does not currently support acupuncture as a treatment recommendation. The safety of acupuncture during pregnancy remains unclear, and attitudes towards acupuncture during pregnancy vary from country to country, with malpractice considerations playing a role.

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