Last week, I had an interesting discussion with several friends. The topic was "depression." The questions asked were do antidepressants really work, what are the alternatives to prescription medications and do they work as well as medications. Depression has become so widespread that antidepressants are now the most commonly prescribed class of medication in the U.S. Over the past 20 years, the percent of Americans taking antidepressants doubled. Currently, 1 in 10 Americans is taking one or more antidepressants.
Depression is believed to be the result of chemical imbalances in the brain, especially low levels of the neurotransmitter serotonin. Depression is commonly divided into three subdivisions: mild, moderate and severe. Recent published medical research has demonstrated that prescription antidepressants work best for those who have severe depression but for mild to moderate depression, antidepressants do not seem to be any more effective than a "sugar pill" or placebo. That does not mean that antidepressants are not effective, but it does suggest that there are many factors that contribute to depression, not just changes in brain neurotransmitters. For many, antidepressant medications may not be the best option.
A recent study in the Canadian Journal of Psychiatry suggests that acupuncture, as a stand-alone therapy, may be quite effective for mild to moderate depression. This particular study was a compilation of several different studies looking at the effectiveness of acupuncture at relieving the symptoms of mild to moderate depression. These studies looked at many different kinds of acupuncture including traditional acupuncture with needles, electro-acupuncture as well as laser acupuncture.
It also included a wide segment of the population from very young to very old. Putting all these studies together they found that acupuncture is at least as effective as antidepressant medications and when used in conjunction with antidepressants, acupuncture may also reduce many of the medication side effects.
How acupuncture works is a topic of much conjecture. From a Western medicine perspective, acupuncture can increase the levels of a number of different neurotransmitters and, theoretically, changes in neurotransmitter levels influence the length and duration of a depressive episode.
According to traditional Chinese medicine however, depression may be the result of a "dysregulation" of the seven emotions -- joy, anger, worry, contemplation, grief, fear and shock. If acupuncture is able to reestablish a balance among these emotions, the symptoms of depression are relieved. Either way, the current medical literature suggests that acupuncture is an effective therapy for mild to moderate depression.
Although the medical research is compelling, the weight of medical research on acupuncture and depression is not conclusive. However, medical research has also demonstrated that other simple approaches such as relaxing exercise, stress reduction, meditation and yoga can be beneficial in mild to moderate depression.
An ancient Chinese curse is "May you live in interesting times." These certainly are interesting times and it is not surprising that mild to moderate depression is increasingly seen in many medical practices (including mine). It is good to have effective alternatives to more medication.
• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Health System. His website is www.alt-med.org.