02 June 2011

Acupuncture no better than placebo for major depression

Both real and sham electro-acupuncture may significantly reduce depressive symptoms, hints a new study that underscores the benefits of both acupuncture and the placebo effect.


Both real and sham electro-acupuncture may significantly reduce depressive symptoms, hints a new study that underscores the continuing controversy over benefits of both acupuncture and the placebo effect.

In the two groups of participants, all with major depressive disorder (MDD), researchers found a similar average drop of around 40% in depressive scores.

In other words, it appeared that electro-acupuncture provided no more help than a placebo.

"A growing number of Americans are using approaches from complementary and alternative medicine (including acupuncture) to treat their depression and other mental disorders," senior author Benoit Mulsant of the Centre for Addiction and Mental Health in Toronto, Canada, told Reuters Health in an email.

They're doing so, however, without much evidence to support these approaches, he added.

The study

In the new study, published in the Journal of Clinical Psychiatry, Mulsant and his colleagues randomised 28 subjects to receive 12 30-minute active electro-acupuncture sessions over a period of six to eight weeks. Another 25 patients were randomised to receive the same number of control acupuncture sessions.

Each active session consisted of the placement of two sterile stainless steel needles at two acupuncture points on the scalp. Control sessions were done in a similar manner, but with placement into non-acupuncture points.

Prior to randomisation, all patients had mild to moderate MDD, a score of 14 or higher on the Hamilton Depression Rating Scale (HDRS), and had tapered off all antidepressants and other psychotropic medications.

No significant difference in results

At the end of the study, the researchers found no significant differences between the two groups. Average absolute HDRS scores dropped by 37.5% and 41.3% in the electro-acupuncture and control acupuncture groups, respectively.

Adverse effects were similar for the two interventions, with no serious events reported.

Like most studies involving acupuncture, the researchers faced several limitations, including the difficulty in choosing an appropriate sham intervention.

"A placebo control intervention has to be both inert and believable," explained Mulsant. "However, a believable placebo control intervention improves the associated clinical outcome to a greater extent than no treatment, wait-list, or other non-needle controls."

He suggested that by having all the patients come to a clinic and interact with an acupuncturist twice a week, they were able to take some "non-specific" factors out of the equation.

Still, the most likely interpretation of the results, said Mulsant, is that electro-acupuncture had "no specific effect beyond a placebo effect".

"At this point psychiatrists who would consider recommending acupuncture as a potential treatment for their depressed patients should realise that this approach is not supported by evidence," he added. - (Lynne Peeples/Reuters Health, June 2011)

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Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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