Depression and anxiety are common mental health issues, occurring in approximately 1 in 10 and 1 in 9 people respectively, in Ireland. Drugs are routinely prescribed for such illnesses so it’s reasonable to wonder how the ancient Chinese medical practice of acupuncture – the insertion of needles into specific places on the body – can bring about positive changes in the these difficult emotional states.
Before addressing that question, I’d like to start with some definitions: According to the HSE, depression is “feelings of extreme sadness that can last for a long time. These feelings are severe enough to interfere with your daily life, and can last for weeks or months, rather than days”.
According to the HSE, anxiety is “a feeling of unease, such as worry or fear, that can be mild or severe…………. people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life”. For a fuller discussion and lists of the many associated feelings, thoughts, behaviours, physical signs and symptoms, see here. These lists make clear that the signs and symptoms of depression and anxiety are actually very variable, meaning that different people will have their own experience of depression and anxiety.
Chinese Medicine, Mind and Body
The relationship between signs and symptoms in the mind and body is something Chinese medicine has recognised for over two thousand years, and treatment addresses both. Specifically, treatment is aimed at whatever signs and symptoms present in any given individual, rather than treating ‘depression’ or ‘anxiety’ with a one-size-fits-all protocol.
This highly individualised approach is based on the Chinese concept of ‘constitutional tendency’ which recognises that we are all born with our own unique physiology and temperament which is further shaped by our environments, experiences, lifestyles and life stages. This determines our mental health tendencies, and how we react to particular circumstances. For example, if two different people are subjected to the same stress, say, a high pressure work environment, one may become insecure, withdrawn and anxious, while the other may be irritable, confrontational and low or negative.
Western Medical Treatment
Western medicine discriminates between degrees of severity in depression and anxiety, and provides treatment accordingly. On offer are talking therapies (e.g. counselling), lifestyle advice, anti-depressants and ECT or lithium in severe cases. Commonly, patients are offered anti-depressant drugs such as Prozac, Lexapro or Citalopram, which increase the amount of serotonin in the brain and are said to lift the mood (although research now casts some doubt on their effectiveness for mild to moderate depression). It is estimated that up to 500,000 people in Ireland are taking antidepressants or anti-anxiety medication.
Diagnosis and Treatment with Acupuncture
As a practitioner of Chinese Medicine I spend about 1.5 hours with a patient at a first consultation trying to capture as much information as I can about their main complaint, lifestyle and constitutional tendencies. Besides questioning, I use Chinese medicine diagnostic techniques including: feeling the pulse, observing the tongue and examining the Channels (or Meridians) to discover which ‘systems’ in the patient’s mind and body are giving rise to their particular symptoms.
Depending on what is discovered, different combinations of acupuncture points will be used to target particular symptoms. For example, a patient who has been diagnosed with depression might complain of symptoms including insomnia, irritability, chest tightness or pain, and palpitations. Examination might reveal that their pulse varies in strength and regularity; their tongue has a purplish tinge; and, the Channels on their forearms and inner shins are tender and have a ‘lumpy’ texture. These signs and symptoms are associated with the Pericardium and Liver. Using as little as four needles over 6-8 treatment sessions will significantly improve symptoms of poor sleep, irritability and low mood.
The Patient’s Responsibilities
Of course, there is more to recovery than treatment with needles. Acupuncture is not a miracle cure that can fix anything; the patient must take responsibility for changing their mind-set and lifestyle. So, for example, if external stress is a major factor the patient must be offered advice on ways to ‘de-stress’ e.g. seeking counselling, learning to meditate, practising yoga or tai chi, or taking up any activity that helps the mind and body to switch off. Similarly, if a person’s lifestyle is contributing to their mood (e.g. lack of physical exercise, excessive alcohol intake, poor diet) they will be offered advice on making changes that will help.
The Scientific Research
Supporting the case for using acupuncture to treat depression and anxiety is a rapidly growing body of scientific evidence including over 8000 clinical trials looking at the mechanisms and treatment of various conditions. These are published in medical-scientific research journals such as NCBI, PubMed and the Cochrane Library.
The body of evidence for treatment of depression is still relatively small but recent research suggests that “acupuncture is a potential effective monotherapy for depression, and a safe, well tolerated augmentation in AD (anti-depressant) partial responders and non-responders”. Similarly, research has concluded that “Acupuncture is a promising intervention for patients with chronic anxiety symptoms that have proven resistant to other forms of treatment.”
Mechanisms and Actions
The actions of acupuncture have been shown by functional Magnetic Resonance Imaging (fMRI). This demonstrates that the insertion of needles at specific points triggers a cascade of chemicals which relay messages to the brain and thereby regulate the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is responsible for our reaction to stressful events. When activated by stress the HPA releases hormones called adrenaline and cortisol which help us to cope with short and long term stress. This is a necessary part of a healthy nervous system. However, when the HPA is over-stimulated, or repeatedly stimulated, by a series of stressful events or an ongoing situation the sympathetic nervous system (also known as the flight or fight mechanism) becomes chronically stressed and over-active, giving rise to symptoms like depression, anxiety, high blood pressure, headaches, insomnia, sweating, and a host of other symptoms.
By regulating the HPA axis acupuncture is re-balancing the sympathetic nervous system with the para-sympathetic nervous system (responsible for rest and relaxation) and hence returning the body from a state of hyper-arousal to one of relaxation. Obviously, though, regulation of the HPA is not the whole story in treating depression and anxiety because not all cases arise from stressful events. The scientific knowledge of these different states and how acupuncture works is still evolving but in the meantime, regardless of the gaps in scientific understanding, patients continue to find acupuncture helpful because of its unique approach to treating each individual’s presentation.