Electroacupuncture Points to Improvements in Depression-Related Insomnia

Electroacupuncture added to standard care improved sleep quality in people with depression-related insomnia, a randomized clinical trial showed.

At 8 weeks, a -6.2 point change (95% CI -6.9 to -5.6) from baseline in Pittsburgh Sleep Quality Index (PSQI) scores was seen in people with depression and insomnia who received electroacupuncture, reported Shifen Xu, PhD, of the Shanghai Municipal Hospital of Traditional Chinese Medicine in China, and co-authors.

Participants who had electroacupuncture had a -3.6 point change (95% CI -4.4 to -2.8, P<0.001) in PSQI scores at 8 weeks compared with those who received sham acupuncture, and a -5.1 point change (95% CI -6.0 to -4.2, P<0.001) compared with standard care, the researchers wrote in JAMA Network Open.

Improvement in sleep quality was sustained at week 32. Patients in the electroacupuncture group had a greater reduction of severity of insomnia, depressive mood, and anxiety symptoms at the end of the 8-week intervention. No severe adverse events were recorded.

The findings are exciting "because depression is a common illness, and sleep disturbance is a frequent comorbidity with depression," noted Albert Yeung, MD, ScD, and David Mischoulon, MD, PhD, both of Massachusetts General Hospital in Boston, in an invited commentary.

"The study also has public health importance, given that many patients with depression do not seek help from mental health professionals owing to stigma associated with mental illness and many commonly used antidepressants and sedative-hypnotics have adverse effects, the latter of which may produce habituation and dependence," the editorialists observed.

The trial included adults who had baseline PSQI scores greater than 7 (range 0-21, with higher scores indicating worse quality of sleep and more sleep disorders), met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for depression, had Hamilton Depression Rating Scale (HDRS-17) scores of 20 to 35 (range 0-52, with higher scores indicating higher depression levels), and were consistently with or without regular use of antidepressants for 4 weeks before the study began.

The trial ran from September 2016 to July 2019. Participants were randomized to receive electroacupuncture and standard care, sham acupuncture and standard care, or standard care only.

Participants in the electroacupuncture and sham acupuncture groups received real or sham acupuncture treatment three times a week for 8 weeks and wore eye masks during treatment. All acupuncturists met standardized training practices for electroacupuncture or sham acupuncture sessions.

A total of 270 people enrolled in the study; 23 dropped out for various reasons. Mean age of participants was about 50 and 71.9% were women.

During the 8-week intervention period, participants who had electroacupuncture had an improvement of 29.1 minutes (95% CI 21.5-36.7) of total sleep time as recorded by actigraphy.

Those who had electroacupuncture also saw improvements in Insomnia Severity Index scores (-7.6 points, 95% CI -8.5 to -6.7), HDRS-17 scores (-10.7, 95% CI -11.8 to -9.7), and Self-Rating Anxiety Scale scores (-2.9 points, 95% CI -4.1 to -1.7).

"Previous studies have shown that acupuncture has little effect on treating depression combined with insomnia," Xu and co-authors wrote. "However, such findings were hampered by flaws in study design, including short treatment duration and different acupoint prescriptions, as well as variable acupuncturists' skills."

A limitation was that the study's primary outcome was subjective and vulnerable to reporting bias, the researchers noted. In addition, acupuncturists were not blinded to group assignment.

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