Tag Archives: mental health

Question Marks

Will acupuncture help me?

Many people ask us as acupuncturists: “What is acupuncture for?  Will it help me?”

There is not a specific list of conditions acupuncture can “treat”, but it can be used safely by the vast majority of patient groups, including during pregnancy, as there are very few contraindications. 

Our Condition Resources Pages provide links to evidence-based factsheets, based on the most commonly requested reasons for attending acupuncture.

A huge number of clinical guidelines now recommend/suggest acupuncture as an approach; most commonly for musculoskeletal, connective tissue, neurological, obstetrics & gynaecology, women’s health, oncology and gastrointestinal issues. (Zhang & al 2022a)

Acupuncture needles in a patient’s back

It is good to read around the research into the symptom or condition you’re looking to address, the factsheets, links and references here on our condition pages are a good place to start, enabling you to find and appraise the original research papers.

Pain

Acupuncture is well-known for use in pain, and is recommended in many countries’ national health services. The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain:  The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”. In America, per the US government’s National Institutes of Health: “Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).”

Popularity with the public, and uptake by insurers

Acupuncture is popular and well established. Per the WHO (2019) global report, acupuncture is widely used across the world, and in the UK, clinicians administer over 4 million acupuncture treatments each year (Zhang et al, 2022b).

Per He et al (2022) in the BMJ “Acupuncture has been incorporated into the health insurance policies of several countries. Studies have indicated that there have been many recommendations for the use of acupuncture in many clinical practice guidelines published worldwide. Both the number of guidelines recommending acupuncture and the number of acupuncture randomised controlled trials (RCTs) are increasing”

Find Out More

Shaftesbury Clinic provides a free 15 minute consultation (in person, videocall or phone call – all need to be pre-booked). This will enable you to weigh up the research, and aid in your decision about acupuncture as a possible complement to medical treatment

The British Acupuncture Council also has a number of resources for you to take a look at, including a 30-minute documentary about acupuncture

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct complement to usual care – it’s advisable to let your doctor know when you use this approach.

References:

He, Y., Li, J., Li, Y., Jin, R., Wen, Q., Li, N. and Zhang, Y., 2022. Strengthening the quality of clinical trials of acupuncture: a guideline protocol. BMJ open, 12(1), p.e053312. LINK: https://bmjopen.bmj.com/content/12/1/e053312 )

NICE (2021) Chronic pain: Scenario: Management Last revised in April 2021

NIH (2022) https://www.nccih.nih.gov/health/acupuncture-in-depth.

Zhang, Y.Q., Lu, L., Xu, N., Tang, X., Shi, X., Carrasco-Labra, A., Schünemann, H., Chen, Y., Xia, J., Chen, G. and Liu, J., 2022a. Increasing the usefulness of acupuncture guideline recommendations. bmj376. https://bmj.com/content/376/bmj-2022-070533.full

Zhang, Y.Q., Jing, X. and Guyatt, G., 2022b. Improving acupuncture research: progress, guidance, and future directions. BMJ, 376. https://www.bmj.com/content/376/bmj.o487

Helen
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New Research : Acupuncture Tapping in Psychotherapy

A new research article looks at acupuncture points and psychotherapy in practise. The interesting new article in the Journal of Psychotherapy Integration, discusses the use of acupuncture points within psychotherapy (the reference, and links to original article are below).

A holistic approach is increasingly being understood to include more that one modality to increase how effective an approach can be. This is well known for crossing the borders between, say mainstream medicine in areas like pain, but possible less so in the sphere of mental health, despite the fat that acupuncture and TCM (Traditional Chinese Medicine) have long included protocols for health on all levels of mind and body.

Traditional acupuncture uses needle stimulation on a network of specific points, tailored to the patient and presenting condition. In addition to, or instead of needles, acupuncturists can also use heat or acupressure (needle-less stimulation of points).

Tapping of a specific set of points in a protocol, is a fairly ew approach to self-care when experiencing anxiety or pain symptoms, for example. This can be done when the patient has been trained on how to do this, and increasingly this has been adopted in other settings. Today, other techniques incorporate some of the benefits of acupuncture alongside talking therapies, and there is a decent and growing research body here.

Per this research article Feinstein (2022 – ref and link below) the research and use of this are coming to the fore; there are “28 systematic reviews and meta-analyses, 125 clinical trials, 24 case studies, 26 reports describing systematic observations, 17 mixed-method clinical trials that included a tapping component, and 88 articles addressing clinical procedures, theory, mechanisms, or related issues” (Feinstein, 2022).

Sometimes called Emotional Freedom Technique (EFT), this shows the way in which cross-modality approaches can be applicable to real life cases. The acupuncture component of this has indeed been shown to be an active part of EFT (Church et al, 2018).

The overall outcome from looking at the state of research into the integration into psychotherapy of using tapping of acupuncture points is promising, and that the growing evidence base documents the effectiveness, speed, and durability of the approach.

References:

Church, D., Stapleton, P., Yang, A. and Gallo, F., 2018. Is tapping on acupuncture points an active ingredient in Emotional Freedom Techniques? A systematic review and meta-analysis of comparative studies. The Journal of nervous and mental disease206(10), pp.783-793.

Feinstein, D., 2022. Integrating the manual stimulation of acupuncture points into psychotherapy: A systematic review with clinical recommendations. Journal of Psychotherapy Integration. https://psycnet.apa.org/record/2022-61876-001

Helen
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Shaftesbury Clinic Star of Conditions

Post Traumatic Stress Disorder (PTSD) – Condition information

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

The British Acupuncture Council (BAcC) has a research digest of recent articles, with a small section on recent studies in this area (toward the base of the document – see Resources below).

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

In the UK, a trial was done by the British Acupuncture Council with HealthWatch Norfolk (2018) to evaluate the usefulness and acceptability of acupuncture for PTSD in veterans in Norfolk, UK. This small trial gave very encouraging results for the veterans who took part in it (link below) and further larger trials involving a greater number of patients and practitioners would be useful to corroborate this.

There have been a number of research trials in the United States of America in particular working with veterans groups, where acupuncture and a particular protocol of ear acupuncture are often used in this area.

Elsewhere, a systematic review and meta-analysis of 7 trials was not able to draw strong conclusions (Grant et al, 2018 n=709 overall), of note many trials had a lower quality of evidence, meaning further high quality RCT trials and large reviews are warranted in this growing area.

References:

BAcC and Healthwatch Norfolk (2018) Stand Easy: An Evaluation of the effectiveness and acceptability of acupuncture as a treatment for PTSD for veterans in Norfolk

Grant, S., Colaiaco, B., Motala, A., Shanman, R., Sorbero, M. and Hempel, S., 2018. Acupuncture for the treatment of adults with posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Trauma & Dissociation19(1), pp.39-58.

Resources:

British Acupuncture Council PTSD factsheet including specific research, trials and mechanisms of action for acupuncture in this condition,

British Acupuncture Council Research Digest

Helen
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Shaftesbury Clinic Star of Conditions

Mental Health – Condition Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

The British Acupuncture Council Research Digest (see link below) looks at some of the more recent studies and trials to have been done into Depression, Anxiety, PTSD and Insomnia

See our own Blog on the research for Acupuncture and depression, anxiety, stress and mental health issues.

Resources:

British Acupuncture Council evidence based factsheets exist for the following conditions, including specific research, trials and mechanisms of action for acupuncture in this condition: Anxiety; Depression; Insomnia; PTSD, Stress

British Acupuncture Council Research Digest – Mental Heath (toward the bottom of the document)

Helen
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Acupuncture and depression, mental health

by Helen Smallwood, Shaftesbury Clinic

This blog post will concentrate on the use and research regarding acupuncture and mental health, and with a particular focus on depression.

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Acupuncture is known by many as being holistic, which means it looks at the workings of the body and the mind overall in an integrated way, as opposed to seeing them as separate entities. Some people are surprised to the extent to which acupuncture has been used and researched for mental health as their first impression is that acupuncture is a very physical therapy and they are mainly associating it with its uses for pain and injuries.

On a research database search, “acupuncture” + “mental health” yields over 48,000 hits of academic articles, 5,600 of which are “RCT”‘s (Randomised Controlled Trials) which are a high standard of research comparing acupuncture to another procedure, an inert control or “sham acupuncture” intervention.  Finding that of these 5,600 studies, 43% have been carried out since 2017 shows that wide and increasing scientific research is ongoing in this area. 

Read More Acupuncture and depression, mental health

Helen
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Stress – Condition Information

Page under construction

There is a great deal of information about acupuncture for Mental Health on our blog, as well as on our mental health page

About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.

Resources:

British Acupuncture Council evidence based factsheet about Stress including specific research, trials and mechanisms of action for acupuncture in this condition.

References:

Helen
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Shaftesbury Clinic Star of Conditions

Depression – Condition Resources

Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Research and Resources on Depression and Acupuncture:

A scholarly search of the available research papers on the terms “acupuncture” + “depression” yields over 107,000 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 11,600 results; of which 41% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

A large UK RCT into depression (MacPherson et al, 2013; n=755) compared patients under GP care for depression in three groups, i acupuncture, ii counselling or iii usual care alone. Compared to usual care, there was a statistically significant reduction in mean depression scores (as measured by the PHQ-9) at 3 months for both the acupuncture and the counselling groups, meaning acupuncture significantly reduced depression, this as much as did counselling. Some of the same researchers in the 2013 team (Hopton et al, 2014) also looked at the outcomes of the above study in secondary analysis of depression where there is also comorbid (concurrent) pain, published in the BMJ, where they found reductions in both pain and depression highest in the acupuncture group.

Acupuncture was also found cost effective in depression (Spackman et al, 2014; on review of MacPherson et al, 2013) as measured in QALY (an NHS measurement of quality adjusted life years gained by a treatment) in comparison to usual care alone and was also less costly per gain in QALY compared to counselling.

A systematic review and meta-analysis of 18 RCTS (Dong et al, 2017) looked at depression related insomnia, finding acupuncture was promising for this as an approach.

A Cochrane systematic review of trials regarding acupuncture in depression (Smith et al, 2018) looked at 64 studies; n=7104 in total, found tentative evidence for reduction of the severity of depression, they were reserved in their findings by the quality of some of the evidence as regards the design of some of the trials, and the researchers called for further high quality studies. Armour et al, (2019) drew similar conclusions in a systematic review of 29 studies (n=2268), noting moderate-to-large effect sizes, but noting limitation in terms of risk of bias in some studies, and some being underpowered.

A systematic review of 207 studies of acupuncture for depression of different kinds (Zhang et al, 2010) found 20 RCTs for meta-analysis, and concluded that acupuncture was able to improve post stroke depression, and had a low side-effect risk. A systematic review and meta-analysis of 13 RCTs (n=1046; Chan et al, 2015), found a “significant difference in favor of acupuncture combined with selective serotonin reuptake inhibitors (SSRIs)” [sic]. 

A new systematic review and meta-analysis by Xu et al. (2023, n=920, 32 RCT’s) in Neuropsychobiology shows clinical evidence for the association of acupuncture with improvements in the symptoms of major depressive disorder on the Hamilton rating scale for depression.  Researchers concluded “acupuncture or acupuncture plus antidepressants were significantly associated with reduced HAMD scores, with high-quality evidence.”

Other studies have looked at depression secondary to other conditions, for example stroke, where a large Cochrane systematic review of trials looked at 31 trials (n=2257 in total) (Yang et al, 2016), again, there were identified methodological issues, but the area showed promise.

Another pilot, controlled trial (n=43; Man et al, 2014) used a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression, groups compared acupuncture + SSRIs vs sham (non-invasive) acupuncture + SSRIs.  Again, positive trends were seen, but the study was small and only single-blinded, necessitating further, larger, double blinded studies.

Mechanisms of action:

More recently, studies and research have turned to measurable biomarkers as targets for looking at the effects of interventions, including acupuncture.  We know acupuncture can affect certain biomarkers in the body, including neurotransmitters, as well as having measurable effects on the brain (that can be seen in MRI’s scans, for example).  Studies such as Li et al, 2022 have looked at very specific gene expressions as biomarkers that can be targeted and measured for post stroke depression, so that for example in future studies they can be measured for their objective effects, alongside the other measures used that can be less objective (e.g. patient’s assessment of their own symptoms).

Regarding Your Individual Condition and Symptoms:

Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response.  We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation.  For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.

Resources:

British Acupuncture Council Research Digest – Mental Health Depression section (toward the base of the document)

British Acupuncture Council evidence based factsheet about Depression including specific research, trials and mechanisms of action for acupuncture in this condition.

References:

Armour, M., Smith, C.A., Wang, L.Q., Naidoo, D., Yang, G.Y., MacPherson, H., Lee, M.S. and Hay, P., 2019. Acupuncture for depression: a systematic review and meta-analysis. Journal of clinical medicine8(8), p.1140.

Chan, Y.Y., Lo, W.Y., Yang, S.N., Chen, Y.H. and Lin, J.G., 2015. The benefit of combined acupuncture and antidepressant medication for depression: a systematic review and meta-analysis. Journal of Affective Disorders176, pp.106-117.

Dong, B., Chen, Z., Yin, X., Li, D., Ma, J., Yin, P., Cao, Y., Lao, L. and Xu, S., 2017. The efficacy of acupuncture for treating depression-related insomnia compared with a control group: a systematic review and meta-analysis. BioMed research international2017.

Hopton, A., MacPherson, H., Keding, A. and Morley, S., 2014. Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial. BMJ open4(5).

Li, M., Ding, R., Yang, X. and Ran, D., 2022. Study on Biomarkers Related to the Treatment of Post-Stroke Depression and Alternative Medical Treatment Methods. Neuropsychiatric Disease and Treatment18, pp.1861-1873.

MacPherson, H., Richmond, S., Bland, M., Brealey, S., Gabe, R., Hopton, A., Keding, A., Lansdown, H., Perren, S., Sculpher, M. and Spackman, E., 2013. Acupuncture and counselling for depression in primary care: a randomised controlled trial. PLoS Med10(9), p.e1001518.

Man, S.C., Hung, B.H., Ng, R.M., Yu, X.C., Cheung, H., Fung, M.P., Li, L.S., Leung, K.P., Leung, K.P., Tsang, K.W. and Ziea, E., 2014. A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression. BMC complementary and alternative medicine14(1), pp.1-8.

Smith, C.A., Armour, M., Lee, M.S., Wang, L.Q. and Hay, P.J., 2018. Acupuncture for depression. Cochrane database of systematic reviews, (3).

Spackman, E., Richmond, S., Sculpher, M., Bland, M., Brealey, S., Gabe, R., Hopton, A., Keding, A., Lansdown, H., Perren, S. and Torgerson, D., 2014. Cost-effectiveness analysis of acupuncture, counselling and usual care in treating patients with depression: the results of the ACUDep trial. PloS one9(11), p.e113726.

Xu, G., Xiao, Q., Huang, B., Lei, H., Yin, Z., Huang, L., Zhou, Z., Tian, H., Huang, F., Liu, Y. and Sun, M., 2023. Clinical Evidence for Association of Acupuncture with Improved Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized Control Trials. Neuropsychobiology82(1), pp.1-13.

Yang, A., Wu, H.M., Tang, J.L., Xu, L., Yang, M. and Liu, G.J., 2016. Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews, (8).

Zhang, Z.J., Chen, H.Y., Yip, K.C., Ng, R. and Wong, V.T., 2010. The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis. Journal of affective disorders124(1-2), pp.9-21.

Helen
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