Electroacupuncture relieves insomnia in patients with depression: JAMA

China: Electroacupuncture (EA) is an effective and safe alternative therapy for treating insomnia in patients with depression, reports an article published in JAMA Network Open.

The study showed that patients in the EA group experienced improved quality of sleep compared with the sham acupuncture (SA) or control group at week 7 and was sustained at week 32. 

Globally, approximately 4.4% of the population suffer from depressive disorder, a mental health problem characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life. Depression and sleep problems have a bidirectional relationship. Their co-occurrence makes them very difficult to treat and confer a greater risk of relapse and recurrence of depression.

Acupuncture has been regarded as a potentially effective drug-free approach for helping to treat mental illness and sleep disorders in clinical practice. Electroacupuncture is a modern variation of acupuncture where a small electric current is passed between pairs of acupuncture needles. Previous studies have demonstrated the efficiency of EA in improving sleep patterns in patients with primary insomnia, but its efficacy in the treatment of comorbid insomnia and depression remains uncertain.

Xuan Yin, Shanghai University of Traditional Chinese Medicine, China, and colleagues conducted a clinical trial to assess the efficacy and safety of EA as an alternative therapy for improving sleep quality and mental state for patients with insomnia and depression.

Investigators enrolled 270 patients (age 18 to 70 years) with insomnia and depression for a 32-week clinical trial (8-week intervention plus 24-week observational follow-up) conducted at 3 tertiary hospitals. Patients were randomized to receive EA treatment and standard care, sham acupuncture (SA) treatment and standard care, or standard care only as control. The primary outcome was set as the change in Pittsburgh Sleep Quality Index (PSQI) from baseline to week 8.

Key findings of the trial data: 

• The mean difference in PSQI from baseline to week 8 within the EA group was −6.2.

• At week 8, the difference in PSQI score was −3.6 between the EA and SA groups and −5.1 between the EA and control groups.

• The efficacy of EA in treating insomnia was sustained during the 24-week post-intervention follow-up.

• During the 8-week intervention period, the EA group showed marked improvement in the HDRS-17 score (−10.7), Insomnia Severity Index (−7.6), and Self-rating Anxiety Scale (−2.9 ) scores, and the total sleep time recorded in the actigraphy (29.1 minutes).

• There were no differences in the frequency of sleep awakenings between the groups.

• There were no reports of any serious adverse events.

The authors conclude that the quality of sleep improved significantly in the EA group compared with the SA or control group at week 8 and was sustained at week 32. EA with standard care significantly alleviated insomnia among patients with depression.

Further studies should focus on a longer treatment period with precise objective outcome assessment, the authors wrote.

Reference:

Yin X, Li W, Liang T, et al. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(7):e2220563. doi:10.1001/jamanetworkopen.2022.20563