Acupuncture and Counselling Similarly Effective in Alleviating Depression

by | Oct 21, 2019 | 2013, Alternative Therapies, Depression

Written by Angeline A. De Leon, Staff Writer. In this randomized controlled trial of acupuncture and counselling for patients presenting with depression, both interventions were associated with significantly reduced depression at 3 months when compared to usual care alone.

acupunctureAccording to the Global Burden of Disease Study, depression is projected to be the second leading cause of disease burden in the world by 2020 1. Not only is depression one of the most common reasons for primary care consultations 2, the cost of care associated with the mental illness also poses a tremendous burden at the economic level 3. Treatment for depression has typically relied heavily on pharmaceutical drugs 4, however, more than half of patients receiving anti-depressant treatment show inadequate response to medication 5. Furthermore, adherence to medication is relatively low, with about 30% of patients reporting inconsistent compliance 2. Acupuncture is a needle-based form of alternative medicine that has been used to treat a variety of different conditions, including depression 6. Empirical evidence for its efficacy in the treatment of depression, however, is still limited 7, particularly in comparison to other interventions like structured psychotherapy and pharmaceutical drugs. In a 2011 Cochrane review, it was reported that one form of psychotherapy, counselling, offers short-term, but not long-term benefits for depression 8, indicating a need to examine and compare different treatment interventions for depression, including traditional and non-traditional approaches. Thus, in a 2013 study published in PLOS Medicine, researchers sought to evaluate the efficacy of acupuncture and counselling, in comparison to standard care, in the treatment of depression.

Using a parallel-arm, randomized controlled trial design, researchers recruited a total of 755 patients (mean age = 43.5 years) suffering from moderate to severe depression within the past five years. Participants were randomly allocated to one of three treatment arms: acupuncture (based on customized treatment protocol within standardized framework) plus usual care (n = 302); counselling (based on a manualized protocol and using a humanistic approach) plus usual care (n = 302); or usual care alone (n = 151). Both acupuncture and counselling groups received up to 12 sessions on a weekly basis for 12 months. At baseline, Month 3, and at 12-month follow-up, the Patient Health Questionnaire (PHQ-9) was administered. The Beck Depression Inventory (BDI-II) was also administered, at baseline and at 12-month follow-up.

At 3 months, the acupuncture group, compared to usual care alone, demonstrated an average additional reduction of 2.46 points on the depression score of the PHQ-9 (p < 0.001, 95% Confidence Interval: -3.72 to –1.21), with an effect size of d = -0.39 (95% CI: -0.58 to –0.19). In the counselling group, relative to usual care alone, subjects showed an average additional reduction of 1.73 points on PHQ-9 depression score (p = 0.008, 95% CI: -3.00 to –0.45), with an effect size of d = -0.27 (95% CI: -0.47 to –0.07). Over the course of 12 months, treatment benefits of acupuncture and counselling over usual care alone which were observed at Month 3 were still evident: PHQ-9 was reduced by 1.55 points (95% CI: -2.41 to –0.70) with acupuncture and by 1.50 points (95% CI: -2.43 to –0.58) with counselling. No significant between-group differences were reported for acupuncture and counselling on PHQ-9. Analyses also revealed greater relative reduction in depression score on the BDI-II with acupuncture (-2.88 points, 95% CI: -5.68 to –0.08) and with counselling (-2.74 points, 95% CI: -5.50 to 0.02) than with usual care alone at 12 months. No significant between-group differences, however, were evident for acupuncture and counselling on BDI-II scores.

Overall, findings suggest that both acupuncture and counselling, when provided in conjunction with standard care, are associated with valuable benefits for depression. Therapeutic effects are apparent as early as around three months and appear to be sustained over the course of a 12-month period. Evidence from the study contributes to increasing patient choice, in terms of understanding all available and effective treatment approaches for depression. Strengths of the study include a relatively large sample size, the employment of more than one measure of outcome (BDI-II and PHQ-9), and the use of individualized treatment programs (both for acupuncture and counselling) which were delivered to patients by qualified and highly experienced practitioners. Potential limitations of the study are its inability to determine the utility of acupuncture and counselling for more mild forms of depression and its limited capacity to speak to the efficacy of each treatment program for patients not receiving anti-depressant medication. Additional studies accounting for these limitations are merited, and it would also be valuable to further compare the cost-effectiveness of each treatment program in future trials.

Source: MacPherson H, Richmond S, Bland M, et al. Acupuncture and counselling for depression in primary care: a randomized controlled trial. PLoS Med. 2013; 10(9): e1001518. DOI: 10.1371/journal.pmed.1001518.

© 2013 MacPherson et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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October 21, 2019.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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