Effect of acupuncture treatment on depression: Correlation between psychological outcomes and salivary cortisol levels - Efecto del tratamiento de acupuntura sobre la depresión: un estudio de correlación sobre variables psicológicas y niveles de cortisol salivar

Effect of acupuncture treatment on depressionVol. 34, No. 1, enero-febrero 2011 21Salud Mental 2011;34:21-26SUMMARYIntroductionThere are growing scientific data that show the potential therapeuticbenefit of treating depression with acupuncture. The most studiedmechanisms of action of antidepressants, such as the monoamineoxidase inhibitors, tricyclic antidepressants or serotonine reuptakeinhibitors, are their ability to enhance the synaptic availability orthe binding of these monoamines to their respective receptors andtheir effect on adaptations within signal transduction pathwaysdownstream from monoamine receptors. Life stressors or psycho-social events play a significant role in precipitating a first or secondepisode of major depression. Physiologically, stress activates theHypothalamic-Pituitary-Adrenal (HPA) axis. Activation of the axisbegins with the release of a corticotrophin-releasing factor (CRF),which stimulates the remainder of the cascade, successivelyprompting the release of adrenocorticotrophic hormone (ACTH) andcortisol. Multiple reports have related HPA axis hyperactivity,including CNS (i.e., corticotrophin-releasing factor), pituitary (i.e.,adrenocorticotrophic hormone), and adrenal (i.e., cortisol) to majordepression, and suicide behaviour. One of the resources of TCM forthe treatment of depression is acupuncture, and it has been suggestedas an alternative to antidepressants for its action on the brainmonoaminergic systems. Up to now, there are a few examples ofrandomized and controlled clinical trials of the effect of acupunctureand electroacupuncture on major depression and we have obtainedsimilar results when using acupuncture and electroacupuncture orconventional antidepressant drugs. Since the 1970’s many reportshave been done to explain the mechanism of action of acupuncture.Some studies performed in humans and animals studies had foundan increment in the levels of β-endorphin, ACTH and cortisol followinglow frequency electroacupuncture. The release of ACTH and cortisolsuggests that electroacupuncture is acting on the HPA axis and throughthis mechanism could have a modulatory effect on the stress systemand depression. The influence of acupuncture on differentneurotransmitter systems like β-endorphin itself or monoamines, likenoradrenaline and serotonine, can also mediate effects of acupunctureon mood and behavior.The aim of this study was to establish the effect of a low frequencyelectroacupuncture point formula on the clinical improvement ofdepressed patients and its relation with changes on salivary cortisol.Material and methodsSubjects: 42 patients, recruitment and Study Population, at aUniversitary Primary Care clinic and randomly divided into control(sham acupuncture) or case group (real acupuncture). Intervention: Low frequency electroacupuncture point formulaMain Outcome Measures: Clinical score in the Carroll Scalefor Depression and psychiatric Symptoms Check List (SCL-90). SalivarycortisolResultsThe formula used in this study showed a major effect on the reductionof the depressive symptomatology of patients studied compared tothe control group.ConclusionsTo our knowledge, this is the very first report on acupuncture treatmentthat evaluates depression symptoms and its evolution using the Carrollrating scale. Effect over depressive symptomatology was higher inthe real acupuncture group than in the sham acupuncture group.Taking all data together, the formula used in this study showed amajor effect on the reduction of the depressive symptomatology andCortisol levels of patients studied compared to the sham control group.Key words: Acupuncture, depression and salivary cortisol.RESUMENAntecedentesLa medicina moderna describe la depresion como una enfermedadmental, que se caracteriza por al menos dos semanas continuas depresentar alguno de estos sintomas: labilidad emocional, perdidadel interes en actividades que resultaban placenteras, sentimientosde culpa y aburrimiento, nivel de energia notablemente disminuido,