Acupuncture May Help Depression



A new study finds acupuncture to be highly effective in treating depression.


 

ACUPUNCTURE MAY HELP DEPRESSION

At least 1 in 10 Americans have been afflicted with major depression at some point in their lives, and some studies suggest that as many as 1 in 5 Americans have experienced significant depression before.  At any given time, an estimated 7 percent of adults in the United States are suffering from major depression.  (For reasons that are not entirely clear, women are twice as likely as men to be diagnosed with major depression.)  In view its very high incidence, it is not surprising that major depression is the leading cause of disability in the U.S. for people between the ages of 15 and 44.

There are a variety of potentially effective therapies available for depression including, primarily, cognitive therapy (i.e., meeting with a therapist for counseling) and antidepressant medications.  However, in view of the limited coverage made available for cognitive therapy by health insurers, there has been an increasing reliance upon antidepressant medications in the U.S. for many years.  While many of these medications can significantly reduce the signs and symptoms of major depression, they are often associated with significant side effects, and as many as half of all patients with severe chronic depression will fail to respond to most such medications.

A newly published prospective randomized controlled study from England suggests that acupuncture may be as effective as cognitive therapy and antidepressant medications as a treatment for depression.  This study appears in the online journal PLOS Medicine.

In this study, 755 patients with documented chronic major depression were randomized to one of three different treatment groups: acupuncture, cognitive therapy (counseling), and “usual care alone.”  (The latter group, which also included the use of antidepressant medications, served as the “control group” for this clinical study.)  All patient volunteers were subsequently reassessed with validated diagnostic tests throughout the 12-month course of this clinical study.

On average, the patient volunteers who participated in this clinical trial underwent 10 acupuncture sessions and 9 counseling sessions.  Compared to “usual care,” there was a statistically significant decrease in depression-associated symptoms in both the acupuncture and the counseling groups at 3 months and at 6 months after the start of this clinical study (by 12 months, however, the patients in the “usual care” group had improved to a level comparable to the acupuncture and counseling groups).  To summarize, acupuncture and counseling were each found to be highly effective in reducing the severity of depression-associated symptoms in patients with moderate-to-severe depression, and both were actually found to be more effective than the “usual care” (including antidepressant medications) received by the control group of patient volunteers at 3 months and at 6 months. 

This small study suggests a potential role for acupuncture in the treatment of major depression, and should stimulate additional research in this, and other, non-pharmacologic therapies for depression, particularly given the minimal risks associated with acupuncture in otherwise healthy patients.  However, if you are already taking antidepressant medications, and you are interested in trying acupuncture as a treatment for depression, please do not stop taking your medications without your doctor’s approval, as doing so could result in a worsening of your depression!

 

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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

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Clonidine and the Antidepressant Effexor Both Reduce Hot Flashes

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The blood pressure medication clonidine and the antidepressant venlafaxine (Effexor) both reduce hot flashes caused by breast cancer treatment and by menopause.




CLONIDINE AND THE ANTIDEPRESSANT EFFEXOR BOTH REDUCE HOT FLASHES

 

The modern management of breast cancer often includes “hormonal therapy,” in which medications that block the effects of estrogen, or decrease the amount of estrogen manufactured by the body, are used to reduce the risk of breast cancer recurrence.  Despite significantly lowering the risk of breast cancer recurrence in patients with estrogen-sensitive breast tumors, recent clinical research studies have shown that fewer than one-half of all breast cancer patients actually go on to complete the recommended 5-year course of hormonal therapy.  (This very poor level of compliance with a medical therapy proven to lower recurrence and death rates associated with breast cancer is particularly an issue among younger women.)

While there are several reasons why more than half of all breast cancer patients do not complete their recommended course of hormonal therapy, one of the major causes, and especially among younger patients, is that these medications are commonly associated with significant side effects, including the same hot flashes that frequently accompany menopause.

Numerous treatment interventions have been tried in an effort prevent hot flashes associated with breast cancer therapy (as well as hot flashes in postmenopausal women without breast cancer), but very few of these therapies have been shown to have any clinically significant benefit. However, several previous clinical studies have suggested that certain types of antidepressant medications, as well as the blood pressure medication clonidine, may reduce the severity and frequency of hot flashes. Unfortunately, much of the research in this area has been of rather low quality, and so the findings of these lower level studies have not radically changed the way that most physicians have managed their patients’ hot flashes. Now, a newly published prospective, randomized, placebo-controlled, blinded clinical research study, which appears in the current issue of the Journal of Clinical Oncology, strongly suggests that venlafaxine (also known by its trade name, Effexor®), a medication that is part of the new “serotonin–norepinephrine reuptake inhibitors” (SNRIs) class of antidepressants, and clonidine may both be effective in decreasing the severity and frequency of hot flashes in women with a history of breast cancer.

In this study, 102 women with a history of both breast cancer and severe hot flashes were secretly and randomly assigned to take either venlafaxine (75 mg per day), clonidine (0.1 mg per day), or an identical-appearing placebo (sugar) pill. Following 12 weeks of observation, 80 patients remained in this clinical study. At the end of this 12-week clinical study, both clonidine and venlafaxine were found to significantly decrease the severity and frequency of hot flashes, when compared to placebo pills. Although both medications were clinically effective in reducing hot flashes, and although venlafaxine resulted in a more rapid reduction in hot flashes than clonidine, clonidine was associated with a greater overall improvement in hot flashes, when compared to venlafaxine, after 12 weeks of treatment. (Venlafaxine was also associated with a greater incidence of nausea, constipation, and appetite loss, compared to clonidine.)

The findings of this study add to those of prior studies that have shown a 15 to 25% reduction in the severity and frequency of hot flashes with antidepressants such as venlafaxine, and with clonidine. Moreover, prior studies have shown that these two medications reduce the severity and frequency of hot flashes in women with a history of breast cancer as well as in postmenopausal women without a prior history of breast cancer.

One important limitation of this study is its small size, and its high patient drop-out rate, which resulted in small numbers of patient volunteers in each of the three “arms” of this prospective, randomized, blinded, placebo-controlled study.  However, the findings of this small clinical research study, nonetheless, are still consistent with those of previously published studies; and taken together, these studies suggest that venlafaxine (and other modern antidepressant medications) and clonidine may be effective in reducing the severity and frequency of hot flashes in both breast cancer patients who are undergoing hormonal therapy for their cancer and in postmenopausal women with menopause-associated hot flashes.


 

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Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


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I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 



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