Acupuncture Equal to Talk Therapy for Recurring Depression

Caroline Cassels

September 26, 2013

Acupuncture appears to be equal to counseling and may offer an additional nonpharmacologic treatment option for patients with moderate to severe depression, new research suggests.

A randomized controlled trial of acupuncture and counseling showed that both treatments garnered a statistically significant symptom reduction when provided alongside usual care in patients with recurring bouts of depression at 3 months.

"We have provided evidence that acupuncture versus usual care and counselling versus usual care are both associated with a significant reduction in symptoms of depression in the short to medium term, and are not associated with serious adverse events," the investigators led, by Hugh MacPherson, PhD, University of York in the United Kingdom, write.

The study was published online September 24 in PLoS Medicine.

Demand for Nonpharma Treatment Options

It is estimated that depression affects more than 350 million individuals worldwide. In the United Kingdom, it is the third most common reason for primary care consultation.

In addition, the researchers point out that up to 60% of patients have an inadequate response to antidepressants, and 30% do not adhere to their medication regimen.

The researchers also note that there is a pent-up patient demand for nonpharmacologic treatment options.

They note that counseling is widely used in the United Kingom, mainly for mild to moderate depression, and although acupuncture is frequently used for the treatment of depression by acupuncturists, it is rarely used in mainstream medicine.

A recent Cochrane review recommended comparing counseling to other treatment modalities, including acupuncture.

With this in mind, the investigators sought to determine the clinical effectiveness of short courses of either acupuncture or counseling compared with usual care for patients with moderate to severe depression in a primary care setting.

The randomized, controlled trial included 755 patients from primary care practices in the United Kingdom who had a Beck Depression Inventory (BDI-II) score of 20 or greater.

Patients were randomly assigned to 1 of 3 study arms in a ratio of 2:2:1 to acupuncture plus usual care (n = 302), counseling plus usual care (n = 302), or usual care alone (n = 151).

Study participants received 12 weekly sessions of acupuncture plus usual care, 12 weekly sessions of counseling plus usual care, or usual care alone. Usual care was available according to need and was monitored for all 3 study groups for purposes of comparison.

The study's primary outcome measure was difference in mean Patient Health Questionnaire (PHQ-9) scores at 3 months, with secondary analyses at 12-month follow-up.

The final analysis included PHQ-9 data for 614 patients at 3 months and 572 patients at 12 months.

First Study of Its Kind

The results revealed that compared with usual care, there was a statistically significant reduction in mean PHQ-9 depression scores at 3 months for acupuncture (-2.46; 95% confidence interval [CI], -3.72 to -1.21) and counseling (-1.73; 95% CI, -3.00 to -0.45).

At 12 months, there was no significant difference between acupuncture (-1.55; 95% CI, -2.41 to -0.70) and counseling (-1.50; 95% CI, -2.43 to -0.58) compared with usual care.

The researchers note that they have also conducted an economic analysis of the 3 treatments to determine cost effectiveness, the results of which will be published in a separate article.

"To our knowledge, our study is the first to rigorously evaluate the clinical and economic impact of acupuncture and counselling for patients in primary care who are representative of those who continue to experience depression in primary care," the authors write.

The researchers note that further research into optimal treatment regimens for acupuncture and counseling in patients with depression is warranted.

"Although these findings are encouraging, our study does not identify which aspects of acupuncture and counselling are likely to be most beneficial to patients, nor does it provide information about the effectiveness of acupuncture or counselling compared with usual care for patients with mild depression," Dr. MacPherson said in a release.

The authors report no relevant financial relationships.

PLoS Med. Published online September 24, 2013. Full article

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