Acupuncture for mental health
The Acupuncture for Mental Health (AMH) group is a team of Wellington based acupuncturists with a special clinical interest in mental health. AMH team members have completed the Blueprint MH101® training and have access to professional peer supervision and support to ensure safe practice within their scope of practice. They use verified measures to assess the severity of distress of people who come to their clinics seeking treatment for mental health conditions and understand the clear pathways to refer onwards if required.
Overview of evidence and safety for acupuncture
Evidence
Mental health remains a considerable public health concern in New Zealand with 46.6% of the total population predicted to be affected by a mental health disorder at some point in their life and 20.7% having been affected in the last 12 months (1). This is consistent with worldwide findings with the WHO study of global burden of disease finding depression to be the third leading cause of disability (2). Mental health continues to be identified as an area where an effectiveness gap in treatment exists, with up to 60% of patients prescribed pharmacological agents for depression experiencing a lack of efficacy. General practitioners (GPs) state that mental health is an area of clinical practice in which available treatments are not fully effective (3,4).
Recently, research has demonstrated that there is a growing interest in non-mainstream treatments of mental health conditions, with various studies reporting between 6.8-10% of mental health consumers selecting complementary therapies as either their first choice or as an adjunct to standard care. In Wang’s survey on alternative medicine use for major depression, acupuncturists reported that up to 10% of clients presented with mental health concerns as their primary complaint (5).
The evidence for using acupuncture in the adjunctive management of mental health conditions is promising, yet it is a rarely considered option (6). A 2019 systematic review that incorporated 29 studies including 2268 participants found that acupuncture showed clinically relevant benefits in reducing the severity of depression compared to sham acupuncture, usual care and as an adjunct treatment to medication. It additionally found that acupuncture, when compared to counseling, was of equivalent effect. The authors of this review also noted that many patients suffering depressive symptoms may also be experiencing a range of other symptoms such as pain, insomnia, digestive complaints and low energy. Typically, a traditional acupuncturist will consider these symptoms when constructing a treatment plan (7). Also reported here, and elsewhere, are the minimal side effects, and high patient tolerance of acupuncture as a treatment modality (8–10).
It has been suggested that where there are effectiveness gaps in a specific area of clinical practice, such as mental health, and where effective CAM interventions such as acupuncture exist but are not being applied, practice guidelines should incorporate these interventions where there is evidence (3,11–13).
Safety
The consensus within the literature is that the rate of adverse events (AEs) related to acupuncture as a percentage of total number of treatments is very small, therefore it is a safe therapy when applied in clinical practice by trained professionals. However, whilst serious events are rare, minor AEs are relatively common and include pain, bleeding and bruising, fatigue, and fainting.
References
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Oakly Browne MA, Wells JE SK (eds)., Oakly Browne M, Wells J, Scott K. Te rau hinengaro: The New Zealand mental health survey [Internet]. Wellington; 2006 [cited 2013 Jun 27]. Available from:
https://www.health.govt.nz/system/files/documents/publications/mental-health-survey.pdf
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World Health Organization (WHO). The global burden of disease: 2004 update [Internet]. Geneva; 2008 [cited 2018 May 11]. Available from:
https://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/
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Fisher P, van Haselen R, Hardy K, Berkovitz S, McCarney R. Effectiveness gaps: a new concept for evaluating health service and research needs applied to complementary and alternative medicine. J Altern Complement Med. 2004;10(4):627–32. Available from:
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Fava M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry. 2003;53(8):649–59.
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Wang J, Patten SB, Russell ML. Alternative medicine use by individuals with major depression. Can J Psychiatry. 2001;46(6):528–33. Available from:
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MacPherson H, Vickers A, Bland M, Torgerson D, Corbett M, Spackman E, et al. Acupuncture for chronic pain and depression in primary care: a programme of research. In: Programme Grants for Applied Research, No 53. Southampton (UK): NIHR Journals Library; Available from:
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Armour M, Smith CA, Wang L-Q, Naidoo D, Yang G-Y, MacPherson H, et al. Acupuncture for depression: A systematic review and meta-analysis. J Clin Med. 2019;8(8):1140. Available from:
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Hollifield M, Sinclair-Lian N, Warner TD, Hammerschlag R. Acupuncture for posttraumatic stress disorder. J Nerv Ment Dis. 2007;195(6):504–13. Available from:
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MacPherson H. Acupuncture for depression: State of the evidence. Acupunct Med. 2014;32(4):304–5. Available from:
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Ravindran A V, da Silva TL. Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: A systematic review. J Affect Disord. 2013;150(3):707–19. Available from:
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Lian WL, Pan MQ, Zhou DH, Zhang ZJ. Effectiveness of acupuncture for palliative care in cancer patients: A systematic review. Chin J Integr Med. 2014;20(2):136–47. Available from:
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Jou J, Johnson PJ, Clark TC, Ben-Arye E, Jong MC, Shelley BM, et al. Nondisclosure of complementary and alternative medicine use to primary care physicians. JAMA Intern Med. 2016;176(4):545. Available from:
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Roberts K, Nie J-B, Dowell T. From knowing silence to curious engagement: The role of general practitioners to discuss and refer to complementary and alternative medicine. J Interprof Educ Pr. 2017;9:104–7. Available from:
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Solomon D, Adams J. The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review. J Affect Disord. 2015;179:101–13. Available from: