Is auricular acupuncture safe and effective for treating depression? Study sheds light

The randomized clinical trial (RCT) of 74 patients with depression undergoing auricular acupuncture for six weeks found no significant differences in the adverse events between the intervention (specific auricular acupuncture) and control (nonspecific auricular acupuncture) groups, implying the safety of the intervention. Also, no significant differences were found in depression recovery (50% reduction from baseline in Patient Health Questionnaire–9 score).

"Specific auricular acupuncture over 6 weeks was safe but not more effective for depression recovery than nonspecific auricular acupuncture after 3 months," the study stated.

Depression is one of the foremost causes of disability worldwide, affecting more than 300 million people (4.4% of the global population). Nonadherence to antidepressant treatment is a concern for healthcare professionals and, therefore, there is an increasing interest in nonpharmacological treatments.

Auricular acupuncture is a type of acupuncture that involves the insertion of thin semipermanent needles into specific points on the auricular pavilion. It is a low-cost, simple, and well-tolerated option but requires further studies to establish its safety and efficacy. Therefore, Daniel Maurício de Oliveira Rodrigues, Department of Health Sciences, Cruzeiro do Sul University, São Paulo, Brazil, and colleagues aimed to estimate the safety and efficacy of auricular acupuncture as a treatment for depression.

The RCT was conducted at four university research centres in Brazil. It recruited adults aged 18 to 50 years whose score on PHQ-9 implied moderately severe depression (score 15-19) or moderate depression (score 10-14). Those with previous application of AA, severe depression (PHQ-9 score >20), and risk of suicidal ideation were excluded.

Seventy-four participants (84% women, median age, 29 years) were randomized into two treatment groups, which included specific AA (SA; n=37) and nonspecific AA (NSA; n=37). Both groups received 12 sessions of AA with daily stimulation twice a week over 6 weeks and were followed for 3 months. All participants continued with their usual care.

The treatment protocol of the SA group consisted of six acupuncture points on the auricular pavilion chosen according to the depression diagnosis by traditional Chinese medicine (subcortex, Shenmen, lung, heart, liver, and kidney). Acupuncture points of the NSA group were the cheek and face area, the external ear, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm the areas having neuroreactive points.

The study's primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months.

The researchers reported the following findings:

• There was no statistically significant difference in depressive recovery between the groups at 3 months (58% participants in the SA group versus 43% in the NSA group; risk ratio [RR], 1.34).
• The proportions of depression recovery and remission at 4 and 6 weeks based on the PHQ-9 were higher in the SA group (except for depression recovery at six weeks) with no statistically significant differences.
• A statistically significant difference was observed in symptom remission at three months (46% in the SA group versus 13% in the NSA group; RR, 1.99) in favour of SA.
• There were no significant differences in adverse event rates between the groups, evidencing the intervention’s safety.
• Most participants reported mild pain at the needle application site (94% of patients in the SA group versus 91% of patients in the NSA group).
• Five participants dropped out of the study due to adverse events.

"The results of this RCT suggest that specific auricular acupuncture over 6 weeks is safe and feasible," the researchers wrote. "Although the differences between SA and NSA groups failed to reach statistical significance for the primary outcome, SA did produce greater symptom remission at 3 months."

"There is a need for a more protracted intervention, a more extensive sample size study, and an objective evaluation of the results to further investigate the efficacy of SA for depression," they concluded.

Reference:

de Oliveira Rodrigues DM, Menezes PR, Machado Ribeiro Silotto AE, et al. Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(11):e2345138. doi:10.1001/jamanetworkopen.2023.45138