Acupuncture in the management of perimenopausal depression comorbid with insomnia: systematic reviews and a randomized controlled clinical trial
Creators: name: Zhao, Feiyi
Publisher: name: RMIT University
Year: 2024
Subjects: classificationCode: 320221
subject: Psychiatry (incl. psychotherapy)
classificationCode: 420803
subject: Traditional Chinese medicine and treatments

description: Perimenopause is a window of vulnerability of women to develop depressive episodes. Perimenopausal depression (PMD) often overlaps with perimenopausal insomnia (PMI). Whilst pharmacologic treatment (antidepressive agents and/or sedative-hypnotics) or cognitive behavioral therapy (CBT) alleviate comorbid PMD and PMI, pharmacotherapies are usually associated with potential dependence and adverse effects and CBT has limited availability due to shortage of qualified practitioners. Some women are reluctant to use hormone replacement therapy, a routine and effective strategy, because of such potential risks as cardiovascular diseases, and gynecological and breast cancers.

Women looking for more natural or safer approaches to manage PMD, PMI, and/or other menopausal symptoms often turn to complementary medicine therapy (CAM), such as mindfulness, yoga, herbal products, vitamins, and supplements, reflexology, acupuncture, etc. There is, however, no reliable evidence available supporting any CAM modality for PMD and its comorbid symptoms.

The knowledge gap is whether acupuncture is a viable alternative option for women who are subject to PMD comorbid with PMI? No relevant RCTs were available at the time of the project. This PhD project aimed to bridge the knowledge gap via investigating three aspects of acupuncture: (1) effectiveness; (2) safety; and (3) possible mechanisms of action. One narrative review, four systematic reviews and meta-analyses (SR/MAs), and one randomized sham-acupuncture controlled trial (RCT) were conducted for investigation.

Overall, there is low quality of evidence supporting the effectiveness and safety of acupuncture for PMI, PMD, and depression-related insomnia. Evidence derived from literature also suggests that acupuncture changes objective sleep indices, such as increasing the total sleep time and sleep efficiency, and decreasing the wake after sleep onset and number of awakening times. Its effect on PMD, PMI and other climacteric symptoms are believed most likely to be mediated via upregulation of E2 and/or downregulation of FSH and LH levels. The subsequent world first sham-acupuncture controlled RCT involving 70 participants (average age: 48.9 ± 2.1; coffee user: 17.1%; tea user: 92.9%) ruled out such a hypothesis. Sham-acupuncture was achieved by shallowly inserting needles at acupoints unrelated to PMD/PMI and avoiding the De-qi sensation. Major outcomes for mood, sleep and perimenopausal symptoms were measured at the end of the last treatment session, 8-weeks and 16-weeks follow-up, respectively, to reflect acupuncture’s short-, medium-, and long-term efficacy. The RCT demonstrated that 17-week acupuncture treatment was well-tolerated by perimenopausal women and contributed to clinically meaningful improvements in comorbid PMD and PMI, with satisfactory short- and medium-term effects. The long-term effect of acupuncture was however suboptimal. Given both acupuncture and sham-acupuncture improved PMD with no significant between-group difference, whether the antidepressive effect of acupuncture was specific or non-specific could not be determined.

Taken together, these findings extend the results in previous studies, and provide compelling evidence supporting that acupuncture can be considered for women who are suffering from comorbid PMD and PMI but do not want to or cannot tolerate orthodox pharmacotherapies.