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Table of Contents
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 148-154

Acupuncture versus Western medicine drugs (antidepressant) to treat depression

Department of Acupuncture and Moxibustion, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Date of Web Publication24-Sep-2019

Correspondence Address:
Dr. Anggaraeni Krta
Department of Acupuncture and Moxibustion, Shanghai University of Traditional Chinese Medicine, Shanghai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CMAC.CMAC_34_19

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The aim of the study is to assess the beneficial effects of acupuncture compared with Western medicine in treating patientswith depression. Depression is a serious psychiatric illness that involves symptoms such as depressed or sad mood, loss ofinterest or pleasure in activities, changes in weight, difficult sleep or oversleeping, energy loss, feelings of worthlessness, psychomotorchanges, and thoughts of death or suicide. Acupuncture and Western medicine have been widely used to treat the patient with depression. The following electronic databases were searched: The Cochrane Central Register for Controlled Trials (Central),MEDLINE, EMBASE, AMED, PsycINFO, and PUBMED. The summary of this report was evaluated by using the Preferred Reporting Itemsfor Systematic Reviews and Meta-Analysis Checklist. Sixty-four journals on acupuncture, Western medicine drugs (antidepressant),and containing both in treating depression were identified and included in this review. In term of Western medicine, antidepressant may helpthe ego function in short term, and for long-term using, it may cause the patient to become addictive toward the drug. Acupuncture is relativelysafe to use and proven significantly effective to treat the depression and less side effect for long term used by the patient. Currentevidence from this summary literature review shows that acupuncture and Western medicine (antidepressant) drugs can treat depression. However, acupuncture therapies almost give none of side effect compared to antidepressant, and every patient with depression can try acupuncture notexcluding the pregnant woman.

Keywords: Acupuncture, antidepressant, depression, Western medicine

How to cite this article:
Krta A, Hu Z, Wang Y, Wang W, Wang R, Zhang A. Acupuncture versus Western medicine drugs (antidepressant) to treat depression. Chin Med Cult 2019;2:148-54

How to cite this URL:
Krta A, Hu Z, Wang Y, Wang W, Wang R, Zhang A. Acupuncture versus Western medicine drugs (antidepressant) to treat depression. Chin Med Cult [serial online] 2019 [cited 2019 Nov 16];2:148-54. Available from: http://www.cmaconweb.org/text.asp?2019/2/3/148/267705

  Introduction Top

Depression is a serious psychiatric illness that involves symptoms such as depressed or sad mood, loss of interest or pleasure in activities, changes in weight, difficult sleep or oversleeping, energy loss, feelings of worthlessness, psychomotor changes, and thoughts of death or suicide. Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Today, depression is estimated to affect 322 million people. This represents 4% of the global population.[1]

The World Health Organization stated in 2017 that more than 54 million people (4.2% of the population) suffer from depression in China. A nation-wide survey of 500,000 men and women in China shows that major depressive disorders (MDDs) are positively associated with rural residency and low-income status. A 2015 report from the United Nations Children's Fund shows that depression rates among adolescents in rural area are higher than the rate among city dwellers in the same age range. In China, depression costs the nation USD 7.8 billion every year in lost workdays, medical expenses, and funeral expenses.

In Western medicine, treatment for these patients varies from pharmacological interventions, psychosocial therapy, and electroconvulsive therapy, to light therapy for depression, etc.. Effective interventions to prevent and treat depression and anxiety are available and include psychotherapy, medication, and complementary treatments. In the last two decades, the use of complementary and alternative medicine, including acupuncture, as an odd-on treatment in Western medicine, been on the rise, especially among psychiatric patients. In many cases, current pharmacological treatment of anxiety disorders (AD) and MDD is not able to achieve remission.

Traditional Chinese medicine (TCM) has its own theoretical background in which its mechanism is explained. In TCM, the forces of nature are described in terms of yin, yang, qi, and the five elements.

In cases where these forces are not in harmony, disease occurs. Acupuncture treatment is increasingly in demand among psychiatric patients, and many people report subjectively helpful effects. Thus, it appears necessary to give more attention to complementary treatments. To answer the questions about the comparison among Western medicine and acupuncture treatment in curing depression, this paper will offer a systematic literature review on how acupuncture competes with Western medicine to overcome the depression.

  Conceptual Discussion Top

Here, we focus on the treatment of depression with Western medicine and compare it with acupuncture. In the psychiatry department, there are some ways to treat patients with depression. One of the ways we can name as psychiatric management. This means to establish and maintain a therapeutic alliance including antidepressant, complete psychiatric assessment, and to evaluate safety of the patient, establish the appropriate settingfor treatment, evaluate functional impairment and quality of life, coordinate the patients with other clinicians, monitorthe patient's psychiatric status, integrate measurements intopsychiatric management, enhance treatment adherence, and provide education to the patient and his or her family.

We stated in earlier discussions that antidepressant medications in Western medicine have been proven to be clinically effective. On the other hand, their use has been limited by potentially serious side effects. For example, Monoamine Oxidase Inhibitors (MAOIs) interact with certain foods or medications, causing high fever, disseminated intravascular coagulation, muscle rigidity, convulsions, or even coma. Increased suicidal ideation is another possible side effect of antidepressant medications. Moreover, the currently used antidepressants provide only temporary relief of symptoms but are not curative.

We also believe that TCM is already a time-honored practice in China and many Asian countries and the effect of TCM (in this case specifically acupuncture) to treat depression. While Western medicine adopts a reductionist approach to elucidating the biochemical basis of a disease, TCM views body function holistically of more abstract theories. One way to treat depression in TCM is by acupuncture.

In acupuncture, we can use some specific points to treat the depression based on TCM diagnostics and by first identifying the underlying cause or “syndrome.” In this regard, TCM treatment can be curative rather than merely symptom-relieving. The overall results on using acupuncture to treat depression seem promising. Acupuncture was found to be an effective and safe therapy in treating depression disorder. However, the effectiveness of acupuncture treatment of depression is too premature because more and larger methodologically better design on acupuncture and depression are needed.

  Methods/literature Search Top

This systematic review largely adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.[2] We searched both Web of Science and PubMed for studies that referenced them without imposing language restriction. Duplicates and nonobtainable studies were excluded. Based on title and abstracts, studies were excluded which (i) did not focus on individuals with depression, (ii) were not empirical, (iii) were of study types not expected to be useful for the purpose of this review, or (iv) focused on the evaluation of some association or cause-effect relation between variables.

The remaining articles were scrutinized for data that could validate the theory behind treatment of depression using Western medicine and treatment of depression using acupuncture. Studies using different methodologies were included. Criteria to define the effectiveness of therapy between Western medicine and acupuncture treatment on depression should be maximally described. Therefore, we sought studies that show the treatment of depression using Western medicine and acupuncture. References of included articles were searched for additional relevant studies.

  Results Top

The 64 identified journals are included in this literature review and have been checked to cover up all of the inclusion criteria of treatment of depression using Western medicine and acupuncture [Flow Chart 1].

Treatment of depression using Western medicine

Western medicine describes the etiology of depression in terms of biological, psychological, social, and sociocultural factors. Biologists attribute depressive symptoms to genetic factors, disturbances in circadian rhythm, high cortisol levels, defective negative feedback in the hypothalamic–pituitary–adrenal axis, and abnormalities in neurotransmission and brain structure. Specifically, it is believed that deficient serotonergic signaling has pathological implications in depression.[3] Effective interventions in Western medicine to prevent and treat depression and anxiety are available and include psychotherapy, medication (antidepressants), and innovative e-health technologies.[4]

Antidepressants are some of the most commonly used pharmaceuticals. Many people use them long term, some take two or even three different brands simultaneously, all in the pursuit of the elusive goal of happiness.[5] Antidepressants have the advantage of not causing significant cardiovascular or anticholinergic side effects, but they have a wide variety of other energetic effects. Some research stated that antidepressantsare the most effective treatment for depression. Curiously, whether antidepressants work at all is a matter ofdebate. Thomas J Moore, an investigating journalist, reviewed the scientific evidence on some selective serotonin reuptakeinhibitors (SSRIs) and concluded that the popularity of antidepressants is largely a manufactured hyperbole. More scholars noted that SSRIs are highly addicted and although initial studies showed an increase in the suicide rate, they were marketed as if this were not the case. Insufficient response to initial antidepressant pharmacotherapy is a major problem in the therapy of depression, occurring in up to approximately two-thirds of depressed patient. To date, there is no effective biological marker to predict the antidepressant response and tolerability.[6]

Vortioxetine is a novel antidepressant with a distinctpharmacodynamic profile, its efficacy and safety in mitigating depressive symptom severity patients with depression have been established in a number of randomized controlled trial by Chen in the early 2018. Chen claimed that the proportion of patients who had moderately severe-to-severe depressive symptoms based on their Patient Health Questionnaire-9 scores reduced from 76.7%.[7] In month 3, the majority of the patients had mild or no depressive symptoms. In addition, all of the patients in this study experienced anacute stage of depression, and further studies are still needed to provethe effectiveness of antidepressants for treating patients with chronic or treatment-resistant depression.

In Japan, there is a pilot study conducted by Shinba in 2017, 15 drug-resistant patients with depression underwent a standard treatment regimen of Transcranial Magnetic Stimulation (TMS) to the left dorsolateral prefrontal cortex. The result suggests that the maintenance of frontal activation during stimulation in the course of TMS series is related to the effectiveness in treatment of depression. This study, offers one new way to treat depression, even though it reveals that TMS is a better reaction in mild conditionof depression rather than the severe one. The number of the sample has also to be a consideration too, because this study has a small number of patients. Future study with a larger sample size and necessary to expand the assessment to depression in general because the results are valid for the patients who do not show sufficient improvements with antidepressant medication.

In terms of Western medicine, depression is still a challenging issue. Certainly, antidepressants may help the ego to function better in short term, but in doing so, some ways of treatments are helping the antidepressants to support the adequate treatment for the mental state which itself is the root of depression.

Treatment of depression using acupuncture

Before going into the explanation of treatment of depression using acupuncture, some journals about acupuncture are listed below for reference [Table 1].
Table 1: Systematic Table of the Result of Acupuncture

Click here to view

Acupuncture is an important part of Chinese medicine. However, until now, the most known part of the acupuncture practiced in the West originates from a part of Chinese medicine. A lot of research was conducted on treating depression by using acupuncture, and they have varieties in result. Researchers conduct the research of acupuncture in different ways. Several clinical trials have been carried out with manual, electric, and laser acupuncture for different kinds of depression, including MDD, MinD, antenatal, postpartum depression, menopause, geriatric, and poststroke depression.

The overall clinical results on using acupuncture to treat depression are promising. Acupuncture improves the quality of life, particularly that of sleep, in psychiatric patients.[2] Wu in 2012 stated a comparison of combination of manual and Electro Acupuncture (EA) with the tetracylic AD mianserin in 29 patients and found a significant reduction in Hamilton Depression Rating Scale scores in both groups, but no difference between groups. A study (n = 66) compared EA with the tetracylic AD maprotiline in patientswith depression syndrome.[8] Han et al. (2002) found that patients receiving EA scored lower in self-report measures of depression and anxiety, and the efficacy index was significantly higher for EA, compared with maprotiline. In a more recent study of 60 patients, the same group found EA to be comparable to maprotiline, with fewer side effects.

Acupuncture has been used to manage various physical symptoms that can often be side effects from ADs including nausea, weight gain, and sexual dysfunction. de Lorent et al.conducted a study of auricular acupuncture versus progressive muscle relaxation in patients with depressive disorder. This study was using point 51 (sympathetic point), point 55 (shen men), point 95 (kidney point), point 97 (liver point), and point 101 (lung point) in both ears of the patient. The other group reveived a PMR treatment which asked the patient to close their eyes while sitting comfortably. The result shows that treatment with AA significantly decreased tension, anxiety, and anger/aggression throughout the 4 weeks, compared with PMR treatment.[9]

Women during pregnancy also have a big chance to suffer a depression syndrome. Manufactures of antidepressants medication advise that they are avoided during pregnancy, and many pregnant women are reluctant to undergo pharmacological treatment for their depression. Manberet et al. conducted a study by treating a woman with depressionusing acupuncture and massage. The results have shown that responses rates at the end of acute phase were statistically higher for acupuncture than massage. Even thoughthis study shows that acupuncture can treat depression in pregnant women, we have to consider about the safety of the treatment.[10] We already admit that some acupoints are contraindicated for pregnant women, so we have to be careful when handling these cases.

  Discussion and Conclusion Top

The aim of using Western medicine and acupuncture intreating depression is to reduce thedepressed feeling of the patient itself. Using antidepressant insome cases was stated to be successful in treating the depression. The problem is coming up when the patient has to take two or even threedifferent brands of drugs simultaneously. The patient has to rely on the medicine in their life. Antidepressant works by giving an elusive goal of happiness. This feeling is really comforting for patients with depression to the patients; this situation some how leads them into addictive side of antidepressant. Some of the research stated that antidepressant works mostlyin acute stage of depression. There are still pros and cons on whether antidepressant will work in treating patients with chronic and treatment-resistant depression.

Acupuncture is one of complementary therapies to treat depression. This seems promising because some studies show that some treatment successfully works for depression. Wide variety of combining acupuncture point sometimes become a problem or bias to the result of the therapy. Acupuncture wins over an antidepressant on the side of side effect. Acupuncture therapies almost give noneof side effect compared to antidepressant. Some research inacupuncture really needs to examine the clinical efficiency and acceptability of acupuncture as well as its effectiveness, compared with antidepressant or other depression treatment. Acupuncture will be a priority of treatment for depression if the technique and evidence based on clinical experience are improved by practitioners. Since all of the people with depression can try acupuncture, the pregnant women should not be excluded.

Both antidepressant (Western medicine) and acupuncture need further research in case of their effectiveness in treating depression. We also encourage the scientific community to adopt an overarching strategy that includes clinical practice-informed approaches on the one hand and basic science approaches on the other hand, both of which should be aimed at better informing the design of the acupuncture treatment and sham controls in clinical trials. As for the examples, “whole systems research,” pragmatic trials, and surveys of real-world clinical practice can help to provide a more comprehensive understanding of the multiple components that potentially underlie the therapeutic effects of acupuncture treatment.

Studies are also needed to identify the physiological effects associated with individual components of acupuncture. These include more in-depth and systematic investigations regarding the importance of such parameters as needle placement and depth, stimulation type and intensity, and needle number as well as the mechanism by which these parameters influence physiological responses (immediate and longer-term) and modify biomarkers. Also needed are assessments of putative physiological effects of nonspecific needling components integral to acupuncture treatment components, for example, patient expectation. To better understand why sham needling (superficial at nonacupuncture point sites) has relatively similar clinical effects as true needling at acupuncture points, experiments in humans and animals should simultaneously examine the effects of verum and sham needling (using one or multiple needles) on the local tissues and nervous system.

In the future, we need some ways to combine both therapies to treat people with depression, especially those in chronic and treatment-resistant depression. Further studies and more samples are needed to see clear research and reducebias in studies. Few studies included follow-up periods orassessed important outcomes such as the quality of life. These outcomes are very important for patients with depression because we know that people with depression really needed a better quality of life during or after depression phase. This literature review has a limitation in resources of journals so a further discussion is necessary to explain more abouttreating depression using antidepressant (Western medicine) versus acupuncture.

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Conflicts of interest

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