Home Therapeutic relationship Electroacupuncture shows promise for depression-related insomnia

Electroacupuncture shows promise for depression-related insomnia

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Electroacupuncture (EA) can significantly improve sleep quality in patients with depression who also suffer from insomnia, according to new research.

In a study of more than 200 adults with depression and comorbid insomnia, the change from baseline to week 8 on the Pittsburgh Sleep Quality Index (PSQI) was 3 points higher in the group receiving l EA compared to a group receiving sham acupuncture (SA) plus standard care, and 5 points higher compared to a control group receiving only standard care. The improvements were maintained for a 24-week post-intervention follow-up.

The EA group also showed significant improvement in depression, insomnia, self-rated anxiety and total sleep time – which were not found in the SA or control groups.

“Based on the results of our trial, we recommend that patients with depression and insomnia seek EA treatment as an alternative and complementary therapy for best results,” said Shifen Xu, PhD, researcher at the Municipal Hospital of Traditional Chinese Medicine, Shanghai University. Traditional Chinese Medicine, China, told Medscape Medical News.

The results were published online July 7 in Open JAMA Network.

Two-way relationship

“Sleep disturbances are the main symptom in patients with depression,” the researchers note.

Depression and sleep problems have a two-way relationship, in that “poor sleep quality contributes to the development of depression, and depression makes a person more likely to develop sleep problems,” they write.

Patients with depression and co-occurring sleep disorders are more difficult to treat and have a greater risk of relapse and recurrence of depression, they add.

Acupuncture may be an “effective drug-free approach to help treat mental illness and sleep disorders,” the researchers note. A previous study suggested that acupuncture may improve sleep efficiency and prolong total sleep in patients with primary insomnia.

“EA is the combination of traditional Chinese acupuncture with electric pulse stimulation, and it can improve the therapeutic effect of acupuncture points throughout the needle retention time,” Xu said.

A previous pilot study of EA for depression-related insomnia showed significant improvements in sleep quality after EA treatment, but the sample size was small.

The current researchers therefore undertook the present study – with a larger sample size and a comparison with SA and standard care. They divided 270 adults (mean age, 50.3 years; 71.9% female) at three tertiary hospitals in Shanghai into three groups, each consisting of 90 participants.

The EA plus standard care group and the SA plus standard care group received 30-minute treatments three times a week for 8 weeks. The control group received only standard care.

All participants had DSM-5-diagnosed depression; baseline PSQI scores greater than 7, with higher scores indicating poorer sleep quality and more sleep disturbances; and Hamilton Depression Rating Scales (HDRS-17) scores from 20 to 35, with higher scores indicating higher levels of depression.

Patients with secondary depressive disorders due to other conditions, medications, or psychotic disorders were excluded, as were patients with a history of alcohol or drug abuse or those who had received acupuncture during course of the previous year.

Of the patients who completed the 8-week intervention, 83 were in the EA group, 81 in the SA group, and 83 in the control group. Almost all participants (91.5%) completed all outcome measures at the end of the 24-week follow-up period (also called week 32).

Calm mind, balanced mood

At the 8-week post-treatment assessment, which was the primary endpoint, the EA group had a mean reduction from baseline of 6.2 points (95% CI, -6.9 to -5 .6) of the PSQI score.

There was a significant difference in the PSQI score between the EA group and the SA group (-3.6 points; 95% CI, -4.4 to -2.8; P P

The efficacy of EA in treating insomnia was maintained during the post-intervention follow-up period when the EA group showed a significantly greater reduction in PSQI score compared to the SA group (-4.7; 95% CI, -5.4 to -3.9; P P

Patients receiving EA also experienced significant effects (all Ps

  • HDRS scores (−10.7; 95% CI, −11.8 to −9.7),

  • ISI scores, (-7.6; 95% CI, -8.5 to -6.7)

  • Scores on the self-reported anxiety scale (-2.9; 95% CI, -4.1 to -1.7),

  • Total sleep time, as recorded by sleep actigraphy (29.1 minutes; 95% CI, 21.5, 36.7)

Additionally, the EA group showed significant improvement in depression scores compared to the SA and control groups at both 8 and 32 weeks (all Ps

Results EA vs SA (95% CI) EA vs control (95% CI)
HDR 8 weeks: −5.5 (−6.8 to −4.3)

32 weeks: -5.8 (-6.8 to -4.7)

8 weeks: -8.8 (-10.1 to -7.4)

32 weeks: -5.8 (-7.1 to -4.5)

Participants in the EA group also had a 4.2% higher sleep efficiency score (95% CI, 2.6%, 5.8%) at week 8 compared to those in the SA group (P

Additionally, they had lower scores on the ISI and the Self-Rated Anxiety Scale, and longer total sleep time, compared to the control group at week 8.

None of the participants reported serious adverse events.

“Our results provide subjective and objective evidence for the efficacy and safety of EA with standard care in the treatment of comorbid depression and insomnia compared to AS with standard care or standard care alone,” the researchers write.

“The acupuncture points we used in this trial work primarily to calm the mind, relieve negative mood, and balance the yin yang“, added Xu.

Viable add-on therapy

Commenting for Medscape Medical NewsAlbert Yeung, MD, ScD, associate director of the Mass General Depression and Clinical Research Program and associate professor of psychiatry, Harvard Medical School, Boston, Massachusetts, said that with the evidence from this study, “acupuncture and/or electroacupuncture could be a viable adjunctive treatment for depressed patients who suffer from insomnia.”

Yeung, who was not involved in the study, co-authored an accompanying editorial.

“More well-designed studies are warranted to provide evidence for integrating holistic treatment into medicine,” he said.

The study was funded by grants from the National Natural Science Foundation of China and Shanghai Municipal Health. Investigators have not reported any relevant financial relationships. Although Yeung also does not report any relevant financial relationships, his co-author’s disclosures are listed in the original editorial.

JAMA Netw Open. Published online June 7, 2022. Full Text, Editorial

Batya Swift Yasgur, MA, LSW is a freelance writer with a consulting firm in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoirs of two brave Afghan sisters who told her their story).

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