Depression

Depression is a common psychiatric disorder that affects an estimated 10-15% of the world population at some point in their lives (Muthmainah & Nurwati 2016). Depression is not merely referring to acute emotional responses to everyday challenges and mood swings. It can be long-lasting and vary from being mild to severe in intensity, affecting one’s ability to function in their daily life, and at its worst, can be life-threatening as it can lead to suicide.

There are many known and effective treatments available for depression, such as antidepressants and psychotherapy. Although these treatments are effective for most patients, they are not without their setbacks. Antidepressants are known to have a wide array of negative side effects, including nausea, insomnia and weight gain (Iliades 2015). Furthermore, approximately 10-20% of depressed patients are treatment-resistant even with aggressive treatments (Holtzhemier & Mayberg 2011). Whilst less than 50% of those with depression receive adequate therapeutic response even after a treatment switch (Sharp & Cowen 2011). Hence, alternative treatments such as acupuncture and Chinese Medicine are being sought after.

From a Chinese Medicine perspective, depression is due to the disharmony caused by stagnation or deficiency of Qi and/or Blood or a disturbance of one or more of the organ systems (The Advocate 2012). When there is a lack of Qi or Blood, this results in undernourishment of the body and Shen, our mental consciousness, manifesting symptoms such as exhaustion, feeling flat and a lack of concentration. If Qi or Blood flow is hindered or blocked, this results in stagnation, manifesting as irritability, headaches and agitation.

Based on the theory, acupuncture treatments aiming to strengthen Qi and/or Blood and dissolve stagnation, is known to treat psychological disorders such as depression and has proven to do so with rare adverse events (Witt et al. 2009). It is speculated that the mechanism of acupuncture is similar to that of antidepressants, increasing serotonin levels in the brain and thus, is able to provide symptomatic relief (Ma 2004).

1. Monoamine/Serotonin

Monoamines are a family of neurotransmitters including serotonin, norepinephrine and dopamine. They play a big role in mood and cognitive regulation so when they are low, particularly serotonin, depression can occur.

Serotonin is known as the happiness chemical. It has other functions too like regulating blood pressure, smooth muscle, sleep, mood, appetite, pain control and more. In particular, scientists found that low levels of serotonin receptors is associated with depression. This is why Selective Serotonin Reuptake Inhibitors (SSRIs) are the first prescribed medication. Furthermore, acupuncture has a similar mechanism of increasing serotonin levels in the brain.

A study in Korea was done to see the efficacy of acupuncture in alleviating depression by looking at the serotonin signalling regulation in the prefrontal cortex of maternally-separated rat pups (Park et al. 2012). The two active groups received acupuncture on point of HT7 or ST36. They found the HT7 group had improved behaviours, normalised serotonin metabolite vs receptor ratios and a similar effect to SSRIs. They also found it corrected the lower levels of brain derived neurotrophic factor (BDNF), which served as a neurotransmitter modulator and is essential for leaning and memory.

2 The Hypothalamic Pituitary Adrenal axis (HPA axis)

The HPA axis is the stimulation and inhibition loop between the hypothalamus, pituitary gland and adrenal gland. Depressed patients may have a dysregulated HPA axis (Menke 2019). The hypothalamus releases cortisol-releasing hormone (CRH) which binds to CRH1 and CRH2 receptors in the pituitary which then releases adrenocorticotropic hormone (ACTH). This tells the adrenal glands to release cortisol which binds to receptors that tell the hypothalamus to stop releasing CRH. When the involved hormones, especially cortisol, are at abnormal levels, this process goes wrong. Cortisol is released to cope with stress and scientists found that depressed people show higher levels of cortisol. A rat study compared acupuncture on point of PC6 and TE5 on rats with high cortisol levels, and found PC6 significantly improved depressive behaviour by modulating the HPA axis (Lee et al. 2009).

To conclude, acupuncture on points of HT7 and PC6 shown significant therapeutic effect in depression in the studies. Both of the points have the function of nourishing Heart Blood and the Shen in Chinese Medicine perspective, therefore, they are effective for depressive disorders.

Reference

• Muthmainah. & Nurwati, Ida. 2016, ‘Acupuncture for Depression: The Mechanism Underlying Its Therapeutic Effect’, Medical Acupuncture, vol. 28, no. 6, pp. 31-307.

• Iliades, C. 2015, 7 Antidepressant Side Effects, Everyday Health, viewed 7 October 2019, <https://www.everydayhealth.com/depression/drug-side-effects.aspx>.

• Holtzheimer, P. & Mayberg, H. 2011. ‘Stuck in a rut: rethinking depression and its treatment’, Trends in Neurosciences, vol. 34, no.1, pp. 1-9.

• Sharp, T. & Cowen, P.J. 2011, ‘5-HT and depression: is the glass half-full?’, Current Opinion in Pharmacology, vol. 11, no. 1, pp- 45-51.

• The Advocate 2012, Looking at depression through Chinese Medicine, viewed 9 October 2019, <https://www.theadvocate.com.au/story/80427/looking-at-depression-through-chinese-medicine/>.

• Witt, C.M., Pach, D., Brinkaus, B., Wruck, K., Tag, B., Mank, S. & Willich, S.N. 2009, ‘Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form’, Forschende Komplementarmedizin, vol. 16, no. 2, pp. 91-97.

• Ma, S. 2004, ‘Neurobiology of Acupuncture: Toward CAM’, Evidence-based complementary and alternative medicine, vol. 1, no.1, pp.41-47.

• Park, H., Yoo, D., Kwon, S., Yoo, T.W., P, H.J., H, D.H., Lee, H. & K, S.T. 2012, ‘Acupuncture stimulation at hT7 alleviates depression-induced behavioural changes via regulation of the serotonin system in the prefrontal cortex of maternally-separated rat pups’, The Journal of Physiological Sciences, vol. 62, no. 4, pp. 351-357.

• Lee, B. Shim, I. Lee, H. Yang, Y & Hahm, D. 2009, ‘Effects of acupuncture on chronic corticosterone-induced depression behavior and expression of neuropeptide Y in the rats’, Neuroscience Letters, vol. 453, pp.151-156.