Acupuncture and Pregnancy

Study on Acupuncture for depression in pregnancy shows 63% response rate

Here is another article regarding exciting research about the effectiveness of acupuncture for treating depression in pregnancy. It is noteworthy that individualized treatment ( a treatment protocol chosen to address the specific needs of an individual) is even more effective than standardized treatments (the type of treatments necessary in studies and reported on below). In other words, it is likely that individualized treatment can promise even better results than can be shown in stardardized studies. It all adds up to acupuncture offering a safe and effective treatment for depression.

March 3, 2010 — Targeted acupuncture may offer women with major depression a safe and effective alternative to antidepressant medication, new research suggests.

Investigators at Stanford University School of Medicine in California found that women with major depressive disorder treated with depression-specific acupuncture had a 63% response rate after 12 sessions compared with a 44.3% response rate in 2 combined control groups who were treated with either acupuncture not known to help alleviate depressive symptoms or Swedish massage.

“Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues … but treatment of depression during pregnancy is critically important so that a woman can maintain her sense of well being and take good care of herself, her fetus and, someday, her child,” study coauthor Deirdre Lyell, MD, Stanford University School of Medicine, said in a statement.

Led by Rachel Manber, PhD, the study was published in the March issue of Obstetrics & Gynecology.

Response Rates Significantly Higher

For the study, investigators randomized 150 women whose pregnancies were between 12 and 30 weeks of gestation and who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depressive disorder and who scored at least 14 on the 17-item Hamilton Rating Scale for Depression.

Of the 141 women who eventually entered the study, 52 received depression-specific acupuncture, 49 received control acupuncture, and 49 others received Swedish massage.

Treatments were provided twice a week for the first 4 weeks and then weekly thereafter for 4 additional weeks, with each session lasting about 25 minutes.

The investigators found that response rates were significantly higher in women who received depression-specific acupuncture than for either control group. Response rates in women randomized to the 2 control interventions did not differ significantly from each other at 37.5% for the control acupuncture group vs 50% for the massage group.

On the other hand, remission rates did not differ significantly between women who received depression-specific acupuncture at 34.8% and the combined control groups at 29.5%. They also did not differ between those assigned to the control acupuncture group at 27.5% or the massage group at 31.2%.

Thirty-three of the study participants discontinued treatment before the study endpoint, 30% of them for reasons related to the pregnancy. Some women in both acupuncture groups reported transient discomfort at the point of needle insertion, and 1 woman experienced bleeding at the needle site.

Significantly fewer women who received massage reported any adverse effects compared with the 2 acupuncture groups.

Clinically Meaningful

The study authors point out that the benefits observed with depression-specific acupuncture can be considered “clinically meaningful” when assessed in a broader context of depression studies.

Although there are no randomized controlled trials of antidepressants being used during pregnancy, 1 randomized controlled trial found that interpersonal psychotherapy produced a 52% reduction in Hamilton Rating Scale for Depression scores and a 19% remission rate after 16 weeks of therapy, to which the currently study compares very favorably.

According to the study, antidepressant use during pregnancy doubled between 1999 and 2003, but many women are reluctant to take these medications because of safety concerns. In fact, in this particular study, 94% of the women involved expressed reluctance to take an antidepressant because of their pregnancy.

“Because there’s this concern about medication among pregnant women and their physicians, it’s important to find an alternative,” said Dr. Manber.

Results from this study therefore suggest that this standardized acupuncture protocol could be considered a “viable treatment option” for depression during pregnancy, the investigators conclude.

Michael Thase, MD, University of Pennsylvania School of Medicine, cautions that findings from this study are preliminary, although they suggest that depression-specific acupuncture may have value in major depressive disorder in this patient population.

On the other hand, another study assessing depression-specific acupuncture in a broader population of men and women with major depressive disorder failed to find a significant effect from the modality, so evidence supporting acupuncture for the treatment of major depressive disorder is not consistent.

“Still there is reason to be cautious when prescribing antidepressants in pregnancy, and one has to weigh the pros and cons of using an antidepressant on an individual basis,” he told Medscape Psychiatry.

“If these promising findings are confirmed, it would be good to have another option to complement the focused forms of psychotherapy which are currently used for antenatal depression,” he added.

The study was funded by the Agency for Healthcare Research and Quality. The study authors and Dr. Thase have disclosed no relevant financial relationships.

Obstet Gynecol. 2010;115:511-520.
Clinical Context

Major depressive disorder may occur in up to 14% of pregnant women, possibly in response to hormonal fluctuations or anticipated lifestyle changes. Depression during pregnancy has been associated with poor birth outcomes and postpartum depression. Untreated depression during pregnancy may harm the mother as well as the baby, particularly if the mother neglects prenatal care or engages in self-destructive behavior.

Although the use of antidepressants during pregnancy doubled between 1999 and 2003, many depressed women are unwilling to take these medications while pregnant because of safety issues. It is therefore important to find a nonpharmacologic, safe yet effective treatment option for depression during pregnancy. Previous studies have shown that acupuncture is an effective treatment of depression in the general population.
Study Highlights

* The goal of this randomized controlled trial was to estimate the efficacy of acupuncture for depression during pregnancy.
* The study sample consisted of 150 pregnant women between 12 and 30 weeks of gestation who metDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depressive disorder.
* Participants were randomly assigned to receive either depression-specific acupuncture (n = 52) or 1 of 2 active controls: control acupuncture (n = 49) or Swedish massage (n = 49).
* All treatments were standardized and lasted 8 weeks (12 sessions).
* Junior acupuncturists blinded to treatment assignment needled participants at points prescribed by senior acupuncturists.
* The main study endpoint was the Hamilton Rating Scale for Depression, performed by blinded raters at baseline and after 4 and 8 weeks of treatment.
* Response rate was defined as having at least a 50% reduction in symptoms.
* Analysis of continuous data was by intent-to-treat, with use of mixed-effects models.
* Rate of decrease in symptom severity was greater in women who received depression-specific acupuncture vs the combined controls (d = 0.39; 95% confidence interval [CI], −1.31 to 1.65; P < .05) or control acupuncture group alone (P < .05; Cohen's-d = 0.46; 95% CI, −1.24 to 2.31).
* In women who received depression-specific acupuncture, response rate (63.0%) was also significantly greater vs the combined controls (44.3%; P < .05; number needed to treat, 5.3; 95% CI, 2.8 - 75.0) and control acupuncture group (37.5%; P < .05; number needed to treat, 3.9; 95% CI, 2.2 - 19.8).
* The control groups were not significantly different in symptom reduction and response rates (control acupuncture, 37.5% vs massage, 50.0%).
* Rates of adverse events were not significantly different for the 3 treatment groups
* Acupuncture-related adverse effects included transient discomfort at the point of needle insertion (7 participants in the control acupuncture group and 14 in the depression-specific acupuncture group) and bleeding at the needling site (1 in the depression-specific acupuncture group).
* Massage-related adverse effects included transient discomfort in 5 participants.
* None of these adverse effects resulted in study discontinuation.
* The investigators concluded that the short acupuncture protocol tested in this study yielded symptom reduction and a response rate similar to those seen with standard depression treatments of similar length.
* Study limitations include limited generalizability of the results because of the high education and socioeconomic status, predominance of Caucasians (67%), and exclusion of comorbid mental and medical disorders.
* In addition, the massage therapy provided in this study was shorter vs standard practice.

Clinical Implications

* Depression during pregnancy is responsive to treatment with a short acupuncture protocol, which could be a viable treatment option for depressed pregnant women. Rate of decrease in symptom severity was greater in women who received depression-specific acupuncture vs the combined controls or control acupuncture group alone.
* Response rate (≥ 50% reduction in symptoms) was 63.0% in women who received depression-specific acupuncture, which was significantly greater vs the combined controls (44.3%) and control acupuncture alone (37.5%). Response rate with depression-specific acupuncture was similar to those seen with standard depression treatments of similar length.

CME Test

According to the randomized controlled trial by Manber and colleagues, which of the following statements about reduction in depressive symptom severity in pregnant women who received depression-specific acupuncture, control acupuncture, or Swedish massage is correct?

( )Rate of decrease in symptom severity was greater in women who received depression-specific acupuncture vs the combined controls

( )Rate of decrease in symptom severity was not greater in women who received depression-specific acupuncture vs the control acupuncture group alone

( )Acupuncture-related adverse effects led to study discontinuation in 3 patients in the depression-specific acupuncture group

( )Results are easily generalizable to women with comorbid posttraumatic stress disorder

According to the randomized controlled trial by Manber and colleagues, which of the following statements about response rate in depressed pregnant women who received depression-specific acupuncture, control acupuncture, or Swedish massage is not correct?

( )Response rate was 63.0% in women who received depression-specific acupuncture

( )Response rate was 44.3% in the combined controls

( )The control groups were not significantly different in response rates

( )Response rate was defined as having at least a 75% reduction in symptoms

For more information, or to set up an appointment for treatments in Toronto, call Dawn at 647-209-8259 or visit www.dawnaarons.com

Acupressure for Labour

Debra Betts, an acupuncturist from New Zealand, has produced an excellent booklet titled, “Acupressure for Labour- promoting natural labour and partner involvement”. She has made this document available free of charge and you can download it here. Acupressure Booklet D.Betts

I recommend that couples (or women and their labour partners) print out the booklet and practice point locations and positions in advance of the labour so that you feel comfortable with the information when you need it. Debra’s suggestions are helpful and effective.

Most partners want to be actively involved in labour and are often at a loss of how to help and stay connected. Suggestions in this booklet will benefit both the labouring woman and her partner.

Thank you for Debra Betts for her clear presentation, useful information and great generosity.

Feel free to contact me at www.dawnaarons.com if you have any questions about the handout or would like more information about other labour options.

The Varieties of Toronto Acupuncture

I find it intellectually stimulating to practice acupuncture in Toronto, Canada.

Toronto is a hub for acupuncture styles that range from classic Traditional Chinese Medicine (TCM), Japanese Acupuncture, and western based acupuncture. If you just do a web search for “acupuncture in toronto” you will immediately see the wide world of teaching styles and types of therapists that are engaged in one of the acupuncture forms available in Toronto, Ontario.

Types of therapists include: acupuncturists who have studied at one of the TCM schools, Naturopaths, Chiropractors, Medical Doctors, Massage Therapists, Shiatsu Therapists, and other health professionals.

Any of them could be helpful. My suggestion, since it is how I was trained, is to find a good TCM acupuncturist in Toronto. My expertise is primarily with pregnancy and pregnant women, so I tend to prefer acupuncturists that have a focus or are a veteran in a particular classic style of acupuncture.

Women’s Health Issues: Pregnancy and Menopause

Early on in my acupuncture career, I found an affinity with treating women’s health issues including menopause and right now my practice is almost exclusively focused on pregnant women.

I find that pregnancy is a wonderful and exciting time! It is a magical time. Alas, it can also be a difficult time. Women are often discouraged when the challenges of pregnancy feel overwhelming. And although it may be reassuring to be told that one’s aches and pains (for example, morning sickness, or sciatica, carpel tunnel syndrome, pelvic pain, back pain, insomnia, exhaustion or anxiety) is “normal”, that doesn’t bring relief.

Many women are told that there is nothing they can do to help themselves feel better. Their experience is often ignored or at best, belittled.

There are “new” options that are actually thousands of years old. Traditional acupuncture offers safe and effective relief. Thousands of women are enjoying relief they didn’t realize was possible. When performed by a knowledgeable professional, acupuncture really works!

Please contact Dawn Aarons by email at dawn@dawnaarons.com or visit her website at www.dawnaarons.com

Acupuncture during Pregnancy

People often are surprised that I use acupuncture to assist pregnant women. They ask me, “What can acupuncture do?”
Acupuncture gives information to the body that helps the body to balance itself. In Chinese Medicine theory, symptoms are a sign of imbalance. When the imbalance is addressed, the symptoms disappear.
The childbearing year is an exciting time full of changes. “Balance” during pregnancy and post-partum is always relative, adaptive and constantly shifting. Acupuncture successfully relieves discomforts and stress.
In pregnancy, the most common reasons that women come for a treatment include nausea and vomiting (NVP) commonly referred to as morning sickness, aches and pains – especially repetitive strain disorders such as carpel tunnel and tennis elbow, and pains related to weight bearing adjustments, such as back, hip and pelvic pains. Sciatica is a common concern. Women also come with digestive concerns, heartburn and constipation. Often women feel exhausted and are looking for energy and a place to discuss their fears, anxieties and insecurities. Many women find that they sleep better after acupuncture. In some cases, women are referred for acupuncture to lower high blood pressure and avoid pre-eclampsia. I have also successfully treated women with pregnancy related skin conditions. In late pregnancy, acupuncture and moxibustion can help encourage the fetus turn from a breech position, and is also used to encourage labour to start post dates.
Research supports the use of acupuncture for labour preparation (also called “cervical ripening”). This is usually performed as a series of 4 weekly treatments beginning at 37 weeks gestation.
Most women find acupuncture in pregnancy to be a very positive experience. Once the needles are in place, many women experience a deep sense of relaxation and often nap.
The uses of acupuncture in pregnancy are varied, just as women’s experience of pregnancy often is.

Morning Sickness, II – Does acupuncture help?

Does acupuncture really help women with Morning Sickness?

I have worked with dozens of women with Morning Sickness over the past 13 years. Some women have immediate dramatic improvements, while others do not. Most women find that acupuncture, in combination with lifestyle and dietary modifications, improves their quality of life and is a welcome support.

Here are two very different stories of women that I have worked with:

Rosa- “Rosa” was a social worker pregnant with her second child. She was working full time and had a two year old son. Rosa was 10 weeks pregnant and had been constantly nauseated from the beginning of the pregnancy. She continued to force herself to work, with regular visits to the washroom to vomit. She was able to eat small meals, though often had to throw up soon after eating. She had never tried acupuncture before and had been encouraged to come by her sister-in-law. During the treatment, Rosa allowed herself to relax and to cry. She was exhausted and scared. When she stood up from the treatment, Rosa’s nausea was gone. She was thrilled. She began a pre-planned holiday the following day. I spoke with Rosa after her holiday to learn that the nausea did not return. She was doing well and had cut down on her work schedule. I did not see Rosa again, but was told that her pregnancy and birth were healthy and happy.

Dana – “Dana” saw me weekly throughout her pregnancy starting at 28 weeks. This was here third pregnancy in which she suffered from hyperemesis. It was difficult for Dana to get out of bed without being overwhelmed with nausea and vomiting. A care worker was called in to help her with her children. She was taking a large dose of Diclectin which did take the edge off somewhat but did not stop the symptoms. After we began regular acupuncture treatments, Dana rarely vomited. Her nausea subsided for a day or two after treatment, but regularly returned. Acupuncture was a welcome short term relief and helped her to feel well enough to eat more and enjoy her children. Dana was still nauseated throughout labour. She told me that she felt the nausea lift at the moment that her placenta separated (and was then born). She remembered feeling the same way at her previous birth.

Research

Dawn Aarons, Acupuncture Therapist in Toronto, Canada was interested in the following acupuncture research which she wishes to share:
Research conducted in Australia in 2002 concludes that “acupuncture is a safe and effective treatment for women who experience nausea and dry retching in early pregnancy”. Here are more details about these studies:

Smith et al. in 2002 published two articles from their research on nausea and vomiting in pregnancy. The first looked at the effectiveness of acupuncture and the second at the safety of acupuncture treatment in early pregnancy.

Summary

The objective was to compare i. traditional acupuncture treatment, ii. acupuncture at Neiguan P-6 only, iii. sham acupuncture and iv. no acupuncture treatment for nausea and vomiting.

593 women who were less than 14 weeks pregnant and were suffering nausea and vomiting of pregnancy were randomised into 4 groups and received treatment weekly.
The acupuncture group, in which points were chosen according to a traditional acupuncture diagnosis, received two 20 minute acupuncture treatments in the first week followed by one weekly treatment for the next four weeks.

The sham acupuncture group were needled at points close to but not on acupuncture points and both the sham and Neiguan P-6 acupuncture groups were treated with the same frequency as the traditional acupuncture group.

All group received their treatment from the same acupuncturist.

The outcomes of treatment were measured in terms of nausea, dry retching, vomiting and health status.
When compared to the women who received no treatment, the traditional acupuncture group reported less nausea throughout the study and less dry retching from the second week. The Neiguan P-6 acupuncture group reported less nausea from the second week and less dry retching from the third week. The sham acupuncture group reported less nausea and dry retching from the third week.

So while all three acupuncture groups reported improvement with nausea and dry retching, it was the traditional acupuncture group that had the fastest response.
Patients receiving traditional acupuncture also reported improvement in five aspects of general health status (vitality, social function, physical function, mental health and emotional role function) compared to improvement in two aspects with both the Neiguan P-6 and sham acupuncture groups. In the no treatment group there was improvement in only one aspect.

Although there were no differences in vomiting found in any of the treatment groups the authors speculated that more frequent treatments might have produced greater benefits.

In assessing the safety of acupuncture in early pregnancy data was collected on perinatal outcome, congenital abnormalities, pregnancy complications and problems of the newborn.

No differences were found between study groups in the incidence of these outcomes suggesting that there are no serious adverse effects from the use of acupuncture treatment in early pregnancy.

Conclusion

Acupuncture is a safe and effective treatment for women who experience nausea and dry retching in early pregnancy.

Both my personal experience and research support the assertion that acupuncture is helpful for women suffering from nausea and vomiting in pregnancy. While there are no guarantees, acupuncture brings relief and improves the quality of life of most pregnant women that try it. It does not have side effects and is safe to use in pregnancy. Acpuncture offers new options to women.

Stay tuned for Morning Sickness III – self help suggestions and recommendations