DEPRESSION - more about the Black Dog

Depression - acupuncture care in Warragul

Depression is a serious health disorder, ranked by the World Health Organization (WHO) in 2015 as the largest single contributor to global disability, with an estimated 4.4% of the population affected[1]. The incidence of this disorder is rising at an alarming rate (18.4% increase between 2005 and 2015[2]), with one in 15 adults (6.7%) experiencing depression in any given year, and one in six people (16.6%) at some stage in their life[3].

Symptoms can include feelings of guilt, worthlessness, sadness and depressed mood, changes in appetite, disturbed sleep patterns, weight changes and thoughts of suicide or death, persisting for longer than two weeks[3]. There are many sub-classifications of depression listed in the DSM-V (Diagnostic and Statistical Manual 5[4]) and the ICD-10 (International Statistical Classification of Diseases and Related Health Problems[5]), both of which are used by medical professionals to diagnose psychological and patho-psychological conditions. 

CLINICAL RESEARCH – ACUPUNCTURE

Acupuncture is considered to be a safe treatment for some forms of depressive disorders[6] and recent research suggests there is moderate evidence supporting the effectiveness of acupuncture for its treatment[7]. A systematic review conducted in 2015 reports that acupuncture, when used in conjunction with a standard pharmacological intervention was superior to the use of medication alone[8].

Whilst the mechanism of action (MOA) for acupuncture treatment of depression is not yet fully understood, there are recent novel research approaches that may provide insight into how acupuncture alleviates depressive behaviour. It is suggested that inflammation may play a role in the pathophysiology of depression[9,10], and research has shown that a combined treatment of acupuncture and fluoxetine significantly decreased the expression of pro-inflammatory cytokines[11] (regulators of the body’s response to infection, inflammation, trauma and assaults on the immune system[12]). Further research reveals that acupuncture (as a stand-alone treatment) alone may also have an antidepressant-like effect due to inhibition of inflammatory mediators released in the brain[13].

USUAL TREATMENT OF DEPRESSION

Mainstream medicine does not yet completely understand how depression develops, but recognizes that current treatments are ineffective for a large portion of sufferers[14]. The usual care of this disorder primarily involves some form of pharmacotherapy which is recommended as the first-line treatment option for a major depressive episode1[5]. There are many types of medications to choose from, including selective serotonin reuptake inhibitors (SSRI’s); serotonin-norepinephrine reuptake inhibitors (SNRI’s); tricyclic antidepressants (TCA’s); monoamine oxidase inhibitors (MAOIs); atypical antidepressants and others, which, when combined with antidepressant medication, may enhance their effects1[6]. Adverse effects of antidepressant medication are common1[7], with more than 60% of patients experiencing at least one[18]. These can range from emotional and interpersonal effects1[9] and weight gain (when coupled with an unhealthy lifestyle)[20] through to increased risk of suicide (in adolescents)[21].

There are multiple non-pharmacologic treatment options for depression, but consensus is yet to be reached regarding the strength of the evidence. Some research suggests counselling, education, exercise, problem solving, behavioural activation and guided self help programs are evidence-based options [22], while another suggests that the majority of non-pharmacological interventions are not evidence-based[23]. 

Research suggests that between 49%-84% sufferers of depression recognise the need for some form of treatment and prefer a non-pharmacologic approach[24]. Therefore, as acupuncture is both effective and safe, it well-placed to rise to the top of the list of treatment options for this insidious disorder.

REFERENCES

  1. World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates [internet].; [cited 14th July 2017]. Available from http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf

  2. GBD 2015 Disease and Injury Incidence Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388(10053):1545-1602

  3. American Psychiatric Association. What Is Depression? [internet].; [cited 14th July 2017]. Available from https://www.psychiatry.org/patients-families/depression/what-is-depression

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013

  5. World Health Organization. ICD-10 Version:2016 [internet].; [cited 14th July 2017]. Available from http://apps.who.int/classifications/icd10/browse/2016/en

  6. Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis. J Affect Disord. 2010;1:9-21

  7. McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review. Australian Acupuncture and Chinese Medicine Association Ltd. 2017.

  8. Chan YY, Lo WY, Yang SN, Chen YH, Lin JG. The benefit of combined acupuncture and antidepressant medication for depression: A systematic review and meta-analysis. J Affect Disord. 2015 May 1;176:106-17

  9. Miller AH, Raison CL. The role of inflammation indepression: from evolutionary imperative to modern treatment target. Nature Reviews Immunology. 2016;16:22-34

  10. Köhler O, Benros ME, Nordentoft M. Effect of Anti-inflammatory Treatment on Depression, Depressive Symptoms, and Adverse Effects. Psychiatry. 2014;71(12):1381-1391

  11. Lu J, Shao RH, Hu L, Tu Y, JY Guo. Potential anti-inflammatory effects of acupuncture in a chronic stress model of depression in rats. Neuroscience Letters. 2016;618:31-38

  12. Dinarello CA. Proinflammatory cytokines. Chest. 2000; 118(2):503-8

  13. Lu J, Shao RH, Hu L, Tu Y, JY Guo. Acupuncture ameliorates inflammatory response in a chronic unpredictable stress rat model of depression. Brain Research Bulletin. 2016;128:106-122

  14. Ménard C, Hodes GE, Russo SJ. Pathogenesis of depression: Insights from human and rodent studies. Neuroscience. 2015;321:138-162

  15. Bauer M, Pfennig A, Severus E, Whybrow PC, Angst J, Möller HJ. World Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders. 2013;14:334-385 

  16. Mayo Clinic. Depression (major depressive disorder) [internet].; [cited 18th July]. Available from http://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/treatment/txc-20321538

  17. Crawford AA, Lewis S, Nutt D, Peters TJ, Cowen P, O’Donovan MC, Wiles N, Lewis. Adverse effects from antidepressant treatment: randomised controlled trial of 601 depressed individuals. Psychopharmacology. 2014;231(15);2921-2931

  18. Amick HR, Gartlehner G, Gaynes BN, Forneris C, Asher GN, Morgan LC, et al. Comparative benefits and harms of second generation antidepressands and cognitive behavioural therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ. 2015; 351:h6019

  19. Read J, Cartwright C, Gibson K. Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. Psychiatry Research. 2014;216(1):67-73

  20. Shi Z, Atlantis E, Taylor AW, Gill TK, Price K, Appelton S, Wong ML, Licinio J. SSRI antidepressant use potentiates weight gain in the context of unhealthy lifestyles: results from a 4-year Australian follow-up study. BMJ Open. 2017;7:e016224 

  21. Bottelier MA, Schrantee A, van Wingen G, Ruhé HG, de Ruiter MB, Reneman L. A power analysis for future clinical trials on the potential effects of SSRIs on amygdala reactivity. Frontiers in Biology. 2016;11(3):256-259

  22. Farah WH, Alsawas M, Mainou M, et al. Non-pharmacological treatment of depression: a systematic review and evidence map. Evidence-Based Medicine. 2016; 21(6):214-221

  23. Gartlehner G, Wagner G, Matyas N, et al. Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews. BMJ Open. 2017;7:e014912

  24. Prins MA, Verhaak PFM, Bensing JM, van der Meer K. Health beliefs and perceived need for mental health care of anxiety and depression-The patient’s perspective explored. Clinical Psychology Review. 2008;28(6):1038-1058

ANXIETY