Electro-acupuncture & Depression
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)
On pages 64-65 of issue #1, 2008 of Xin Zhong Yi (New Chinese Medicine), Bai Shu-jie et al. published an article titled “ Clinical Observations on the Treatment of Psychiatric Depression with Electro-acupuncture & Temporal Three Needles.” A summary of this article is presented below.
This study was a randomized, two-wing comparison study. Altogether, there were 60 cases enrolled which were then randomly and equally divided into a treatment group and a comparison group. All 60 patients had a confirmed diagnosis of depression based on the diagnostic criteria for depression found in the CCMD (the Chinese equivalent of the DSM-IV). In addition, all cases scored a Hamilton Depression Rating Scale (HAMD) of 20 points or more. Patients’ ages ranged from 18-80 years. Patients with organic diseases resulting in depression, suicidal ideation, impairment in liver and/or kidney function, pregnant and breast-feeding women, and those not able to complete at least one course of treatment were excluded from this study.
In the treatment group of 30 cases, there were 18 males and 12 females with a mean age of 45.8 ± 13.2 years and a mean disease duration of 2.5 ± 1.65 months. In the comparison group of 30, there were 17 males and 13 females with a median age of 46.6 ± 14.6 years and a median disease duration of 2.8 ± 1.70 months. Hence, in terms of sex, age, and disease duration, these two groups were considered statistically comparable for the purposes of this study.
All members of the comparison group were solely administered 20mg of sai le te pian (an unidentifiable Western medical antidepressant, presumably and serotonin-selective re-uptake inhibitor or SSRI). In addition, all members of the treatment group also received electro-acupuncture at the main points of Nie San Zhen (Temporal Three Needles). This is a group of three points located two inches directly above the apex of the ear and one inch anterior and posterior to that first point. Auxiliary (body) points following the symptoms were also added as follows:
If there was liver qi depression and binding, Tai Chong (Liv 3), Shen Men (Ht 7), Xing Jian (Liv 2), San Yin Jiao (Sp 6), and Ge Shu (Bl 17) were added.
If there was qi stagnation with phlegm depression, Tai Chong (Liv 3), Dan Zhong (CV 17), Feng Long (St 40), Zhong Wan (CV 12), Shen Men (Ht 7), and San Yin Jiao (Sp 6) were added.
If worry had damaged the spleen, Ge Shu (Bl 17), Xin Shu (Bl 15), Nei Guan (Per 6), San Yin Jiao (Sp 6), Feng Chi (GB 20), and Ren Zhong (GV 26) were added.
If there was a heart-spleen dual vacuity, Zu San Li (St 36), Nei Guan (Per 6), He Gu (LI 4), Xue Hai (Sp 10), and Bai Hui (GV 20) were added.
If there was yin vacuity with fire effulgence, Tai Xi (Ki 3), Shen Men (Ht 7), San Yin Jiao (Sp 6), Bai Hui (GV 20), and Nei Guan (Per 6) were added.
After the skin in the local areas was disinfected, 28-30 gauge 1.5 inch Hua-tuo Brand “fine” needles manufactured in Suzhou were used. The points on the scalp were needled transversely at an 15 degree angle to a depth of 0.8-1 inch. Needling parameters were not given for the body points. The points on the scalp were stimulated with twisting and turning hand technique to the limits of the patient’s endurance until a numb, distended, heavy feeling was produced locally. Then these needles were attached to a G-6805 electro-acupuncture machine and the points were stimulated with dense dispersing wave as strong as the patient could bear for 30 minutes each treatment. It is assumed that treatment was given either once or every other per day (since this is the norm in China), although this was not specifically stated. However, it was stated that four weeks of treatment equaled one course of therapy. After four and then again eight weeks of treatment, patients’ response to treatment was evaluated using the HAMD and Zung’s Self-rating Depression Scale (SDS).
Cure was defined as complete disappearance of the psychiatric symptoms and an increase in HAMD score of 75% or more. Marked progress was defined as a decrease in psychiatric symptoms and a decrease in HAMD score of 50-74%. Some progress was defined as a decrease in psychiatric symptoms as well as a decrease in HAMD score of 25-49%. No effect meant that there was no obvious improvement in the psychiatric symptoms and a decrease in HAMD score of less than 25%. The following table shows the outcomes of the two groups based on these criteria.
Group Treatment Cured 10 Marked progress 16 Some progress 1 No effect 3 Total effectiveness 90%
Group Comparison Cured 7 Marked progress 8 Some progress 9 No effect 6 Total effectiveness 80%
The next table shows mean HAMD scores between the two groups before and after four and eight weeks of treatment.
Group Treatment Before tx 28.67 ± 6.53 4 weeks 14.38 ± 5.46 8 weeks 9.67 ± 4.69
Group Comparison Before tx 28.28 ± 6.85 4 weeks 22.38 ± 5.42 8 weeks 18.67 ± 4.53
The last table shows mean SDS scores between the two groups before and after four and eight weeks of treatment.
Group Treatment Before tx30.85 ± 7.08 4 weeks 18.68 ± 6.35 8 weeks 10.15 ± 5.84 Group Comparison Before 30.45 ± 6.93 4 weeks 24.25 ± 6.65 8 weeks 17.75 ± 6.98
Thus it is clear that the combination of Western drug therapy with electro-acupuncture at the Temple Three Needles points as well as other body acupuncture selected on the basis of pattern discrimination was more effective than the Western antidepressants alone. Further, in terms of adverse reactions, there were less of these in the treatment group. In the treatment group, there were two cases of dry mouth and nausea and another two cases of dizziness and lack of strength. However, in the comparison group, there were three cases of nausea and four cases of dizziness.
Based on their 20 years clinical experience, the authors state that the treatment of depression over that time (with Western drug therapy) has become increasingly successful. However, these drugs still cause a number of adverse reactions or side effects, such as dizziness, dry mouth, and constipation.
In terms of the electro-acupuncture protocol, the authors believe that depression is mostly due to liver qi depression and binding. The temple is traversed by the foot shao yang gallbladder channel, and the liver and gallbladder have an exterior-interior relationship. Therefore, they believe that the Temple Three Needles points can course and free the flow of the liver-gallbladder channel and network vessel qi (shu tong gan dan jing luo zhi qi), clear the liver and drain the gallbladder (qing gan xie dan), regulate and ease the flow of the qi mechanism (tiao zhang qi ji), and resolve depression and regulate the spirit (jie yi tiao shen). They also favor these points because they are located on the head and “the brain is the mansion of the original spirit.” These points were first discussed by Zhang Rui in his Song dynasty Pu Ji Fang (Universal Aid Formulary) were they are recommended for stroke, aphasia, and hemiplegia and are described as being magically effective (shen xiao).
In terms of neuropsychiatry and brain chemistry, the authors say that serotonin (5-HT) function is insufficient in patients who are depressed. Serotonin stimulates thyrotropin-releasing-hormone (TRH)-induced prolactin (PRL) release by acting directly at the pituitary gland level, and a decrease in PRL release has also been shown to be related to major depression. Acupuncture is known to stimulate this releasing factor. Similarly, acupuncture can also intensify norepinephrine (NE) function, and depletion of NE has been shown to be linked to depression. (Serotonergic pathways are believed to function largely in mood, while NE is likely involved with drive and energy state. Both systems function in appetite, sleep regulation, and anxiety.) Further, the authors state that acupuncture promotes the decrease in cortisol. (In depressed people, cortisol peaks earlier in the morning and does not level off or decrease in the afternoon or evening. Although the exact mechanism that causes depression is uncertain, clinical studies suggest that chronically elevated cortisol may induce clinical depression by somehow affecting central serotonergic neurotransmission.) Hence, acupuncture affects four suspected neurochemical pathways associated with depression: 5-HT, PRL, NE, and cortisol.
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