Depression and its Treatment by Acupuncture and Chinese Medicine

This afternoon I was treating a new patient whose chief compliant was depression, which is something that we work with quite frequently at the Northside Holistic Center. In speaking with him, he commented that he had read my blog and had only seen postings about pregnancy-related depression as well as articles which I had written related to anxiety and Post Traumatic Stress Disorder (PTSD).

It struck me that I hadn't devoted an entire post to the subject of treating depression with Chinese medicine and acupuncture yet, and that it was important to address this, since many clients come to us with either depression as their main concern, or as a secondary issue that we can work on with them.

Treating depression is enormously satisfying to me because of the very high success rates and enormous improvements that the patients see in their lives. Moreover, depression frequently underlies other health issues and resolving it will often aid in the recovery from these other health complaints. People will seek out acupuncturists to work on their depression for one of three reasons: they either want to avoid medications altogether; the medications are not controlling the depression adequately, or they would like to reduce their dose of medication (in which case we strongly recommend that they let their MD know their plans).

Chinese medicine, of which acupuncture is a part, takes any condition and examines it through the prism of the whole body. That is, in coming up with a treatment plan, we take into consideration the person's current and past health history, as well as constitutional tendencies - those things which aren't a problem but define the person's experience of their body. These may include tendencies to run hot or cold, reactions to stress, bowel habits, complexion issues, etc. Thus, two people who have the same western medical diagnosis of depression may each receive a different acupuncture protocol and herbal formula. In this way we are able to taylor our treatment to the individual, which yields superior results.

Research/Other Articles:

An overview of acupuncture and depression along with a few research citations can be found here.

• Time Magazine covered some interesting research looking into the mechanism by which acupuncture treats anxiety, stress and depression. The scientists noted that,

  Rats who got acupuncture showed fewer symptoms of anxiety and depression than stressed-out rats who didn't get treatment. [and that] Acupuncture may work by targeting the same pathways that stress travels along, according to a new study in rats from Georgetown University Medical Center and published in the journal Endocrinology.

  “There was nothing in the literature about acupuncture for PTSD and chronic stress,” [the researcher said] says, so she decided to study it. To find out if acupuncture was affecting chronic stress, Eshkevari and a team of researchers looked at what happened in a key pathway in dealing with stress for both humans and rats: the hypothalamus-pituitary-adrenal axis (HPA). It’s the same pathway targeted by some anti-anxiety drugs and antidepressants, Eshkevari says, and the HPA is involved in the production of the stress hormone cortisol.

• A fascinating study from Britain suggests that when acupuncture is used to treat patients with depression, gene expression governing mood is also corrected. A synopsis of the study can be read here.

The research shows that depression causes “abnormal gene expression” in “a large number of genes” and this affects “multiple brain functions” and nerve cells. Depression causes pathological biochemical changes and these changes cause more depression. The researchers note, this “vicious circle makes it difficult to cure conditions such as depression.” The researchers note that this educational investigation indicates “that electroacupuncture at Baihui and Yintang modulates depression by regulating the expression of particular genes.”

• The Depression Clinical and Research Program at Massachusetts General Hospital in Boston has demonstrated that acupuncture is effective in the treatment of clinical depression for patients who are non-responsive to conventional pharmaceutical antidepressant therapies. The abstract can be seen here:

The Massachusetts General Hospital study documents that existing clinical evidence supports acupuncture as a stand-alone therapy for depression. This study researched the ability of acupuncture to augment conventional antidepressant therapy when patients did not respond to their medications. The study concluded that acupuncture is effective as an adjunct therapy to antidepressants for both partial and non-responders. Acupuncture was administered one to two times per week during the study and the researchers concluded that acupuncture was “safe, well-tolerated and effective” for patients suffering from depression.

Reference:

Albert S. Yeunga, Victoria E. Amerala, Sarah E. Chuzia, Maurizio Favaa and David Mischoulon. A pilot study of acupuncture augmentation therapy in antidepressant partial and non-responders with major depressive disorder. Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.

• A research study in the journal, Complementary Therapies in Medicine, (an abstract of which can be found here) found that a group of women with major depression treated with acupuncture had the same relapse rate as another group treated only with conventional prescriptions. This study suggests that acupuncture may be as successful as drug therapy in helping control major depression.

• The Journal of Alternative and Complementary Therapies published a study in which patients were either given the drug, fluoxetine, at the standard dosage or a low dose of the drug with acupuncture therapy.  The study found that both groups did as well as the other. This suggests that patients may be able to use lower doses of their pharmaceuticals when using acupuncture. This would minimize side effects and drug interactions in those patients. An abstract of the study can be read here.

• Fox News has an article, accompanied by a video which can be seen here. In the article, the experts cited say,

"The functional MRI studies are showing that acupuncture has an influence over brain chemicals, such as dopamine and serotonin"  as well as "And so, what we’re finding is that for these patients that are suffering from mild to moderate depression, acupuncture is just as effective as these antidepressants,” and "Acupuncture is also a good alternative for women who are pregnant and for people who no longer want to rely on antidepressants."

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Menstrual Pain Responds Well to Acupuncture

Many women in the western world experience pain directly before and/or during their period. From a Chinese medical perspective this is not healthy and reflects an imbalance in the way that the body is functioning. Happily, acupuncture and Chinese medicine are extremely useful in treating PMS, period pain, and the other attendant issues which can accompany the menstrual cycle. 

Perhaps just as important is the that once a course of treatment has been completed, most women find that their period related discomfort is indefinitely improved and that other bodily functions are concurrently improved.

Research and Articles

• A pilot study, published in the European Journal of Obstetrics, Gynecology and Reproductive Biology, which can be read about here, compared the use of pain killing medication to acupuncture and found that,

After one month's treatment, pain scores were significantly lower in both groups (p<0.05). Mean pain scores decreased by 52.2% and 69.5% in the NSAID and acupuncture groups, respectively.

Concluding that,

Acupuncture was as [at least, if not more] effective as NSAID therapy for patients with primary dysmenorrhea.

• The Institute for Social Medicine, Epidemiology, and Health Economics published a study of more than 600 women, in which it was determined that:

...acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual care alone and was cost-effective within usual thresholds.

 An Italian study showed that 87% of the women who received acupuncture for painful periods had significant pain reduction with their period and concluded that,

Our findings suggest that acupuncture may be indicated to treat dysmenorrhea related pain, in particular in those subjects in whom NSAID or oral contraceptives are contraindicated or refused.

-Acupuncture Treatment of Dysmenorrhea Resistant to Conventional Medical Treatment

V. Iorno1, et al. Centro di Medicina del Dolore ‘Mario Tiengo’ Osp Maggiore Policlinico Mangiagalli Regina Elena, Milano

An article in the March 2011 issue of The Clinical Journal of Pain found that treating patients with acupuncture had a clear pain reducing effect, which was independent of circulating prostaglandin levels in the blood. A summary of the study can be read here. 

Crohn's Disease Treatable by Acupuncture, Study Says

A recent study in the Journal of Acupuncture demonstrates, yet again, the utility of Chinese medicine in treating Crohn's disease. The article, cited here, describes the study which looked at the treatment of several acupoints in managing the disease, which is characterized by chronic inflammation of the intestinal tract. This inflammation often leads to diarrhea, abdominal bloating and pain, vomiting, weight loss, eye disorders, arthritis, dermatological disorders, and fatigue.

Image courtesy of http://www.radpod.org/2006/12/02/crohns-disease-2/

There are many other studies, from around the world which demonstrate the utility of Chinese medicine in treating this digestive problem. Among them is a German study published in Digestion [abstract readable here], which concluded that, "...traditional acupuncture offers an additional therapeutic benefit in patients with mild to moderately active CD."

Acupuncture and Chinese herbal therapy have a long history of treating this disorder, often very successfully. At the Northside Holistic Center we frequently treat Crohn's, ulcerative colitis, and other chronic digestive issues.

Psoriasis and Chinese Medicine

<the beginning of a rough draft on the treatment of various forms of psoriasis with Chinese medicine. Please check back often as this article will be enlarged regularly>

 Image courtesy of flickr from: http://farm2.static.flickr.com/1016/1133597255_bd427077b5.jpg 

Psoriasis is a chronic dermatological issue which presents as a thick white, silver or red patches of skin, often with dramatic flaking. It is the result of inappropriately rapidly growing skin cells which form plaques. These plaques may occur anywhere on the body, but tend to congregate on the knees, elbows, scalp, hands, feet or lower back. The disorder usually spares the face itself, though we do occasionally see facial psoriasis in the clinic.

The intensity of psoriasis is highly variable, ranging from small, isolated patches, to dramatic full body involvement. There are forms of psoriasis, called psoriatic arthritis, which cause the joints to become involved. This may also cause finger and toenails to alter their color and texture, frequently separating from the nailbed.

While the exact cause of psoriasis is unknown, from a Western medical perspective it is thought to result from an immune system overreaction which triggers localized inflammation. Few dermatologists would hesitate to acknowledge that the state of their knowledge on psoriasis is far from complete. What is known is that the disorder can run in families, may be triggered by stress, climate, pharmaceutical use, or foods and that smoking is often an aggravating factor. 

Happily Chinese medicine can be exceptionally useful in treating this set of disorders.

Types of psoriasis commonly seen in our clinic:

• Patch/Plaque Psoriasis
• Scalp Psoriasis 
• Psoriasis of the Scalp
• Pompholyx Psoriasis
• Pustular Psoriasis
• Psoriatic Psoriasis

Results depend a great deal upon the intensity of the psoriasis, the amount of the body affected and the duration of the problem. People usually begin to see some results within 4-6 weeks of beginning therapy. This improvement will usually continue until we have achieved the return of normal skin. 

Research/Articles:

Successful Treatment of Psoriasis by Chinese Medicine, Arch Dermatol. 2008 Nov;144(11):1457-64.

Clinical assessment of patients with recalcitrant, plaque type psoriasis in a randomized trial, using a Chinese herbal formula. 

Results: Significant reductions in the sum of scaling, erythema, and induration scores (P < .001) (mean score, 6.3 after Qing Dai  treatment vs 12.8 in control subjects) and plaque area percentage (P 
< .001) (mean percentage, 38.5% after Qing Dai  treatment vs 90% in controls) were achieved with topical application of Qing Dai  ointment. Approximately 31 of 42 patients (74%) experienced clearance or near clearance of their psoriasis in the Qing Dai ointment-treated lesion.

Conclusion: The Chinese herbal formula was a safe, and effective therapy for plaque-type psoriasis.

Acupuncture Treatment for Psoriasis: a Retrospective Case Report. Acupunct Electrother Res. 1992 Jul-Sep;17(3):195-208.

We treated 61 cases of psoriasis with acupuncture, including 25 patients with complications of joint involvement and two cases with scleroderma additionally. All of the patients had failed to respond to their prior conventional western medical management. 25 patients were males and 36 were females. Their ages ranged from 22 to 84 years, with an average of about 52 years. There was no significant difference of the average ages between the sexes. Most of them (about 61%) had quite extensive involvement of the body. The average of duration of their illness was over 16 years, ranging from two to 65 years. They received an average of about nine sessions of acupuncture treatment, ranging from one to 15. Almost one third (19) of them had eleven to thirteen sessions. With the acupuncture treatment, about one-half (30) of the 61 patients had complete or almost complete clearance of the skin lesions. About a quarter (14 patients) of them had a clearance of about two thirds of the skin lesions. Eight of them had a clearance of one third of the skin lesions. Nine patients had minimal or no improvement. Our experience indicates that acupuncture is induced an effective therapeutic modality for psoriasis, particularly when the western medical management is unsuccessful. We speculated about the possible involvement of the cutaneous reticuloendothelial system in the clearance of the skin lesions.

Chinese Medicine Potentially Treatment for Liver Fibrosis

A 2009 study which assessed Chinese medical treatment for liver fibrosis concluded that, "Evidence indicates that some Chinese medicines are clinically effective in treating liver fibrosis."

Fibrosis is the replacement of healthy liver tissue with scar tissue and nodules which gradually force a decline in liver function. It is usually caused by chronic viral infections or chemical (often pharmaceutical) insult to the organ itself. 

This type of liver problem leads to a variety of frequently life threatening issues including ascites (fluid accumulation in the abdomen) and decreased immune function leading to an increased chance of infection.

Cirrhosis is very difficult to treat by standard methods and the western medical strategy usually involves trying to prevent complications and/or removing the cause of the scarring, if caused by a pharmacological agent. If the disease becomes advanced the patient may be considered for a liver transplant.

At our clinic we have had notable success, particularly with patients who, by necessity, are on medications which are creating the liver scarring; or are suffering with a chronic hepatitis C infection. This study backs up our experience quite well.