Anxiety and depression are widespread issues affecting millions across the world. While there are various medications available to help with the sympoms of depression and anxiety, people are increasing looking for more natural alternatives; either instead of, or to help alongside medication.
I worked on a clinical trial in 2012 in York that was funded by the NHS that looked at how anxiety and depression responded to acupuncture, counselling and 'usual care'; which was usually either medication or nothing at all. The results for both acupuncture and counselling were much more positive and more longer lasting than the usual care group. This trail measured the outcomes of the patients involved using a number of different ways of measuring depression and anxiety, so it more tackled the question of 'does acupuncture work?' and not so much the 'why does acupuncture work?' question. Thankfully, more recent research looks at how acupuncture affects the hypothalamic-pituitary-adrenal (HPA) axis, a vital component in managing stress responses. The article from the Journal of Integrative Medicine explores the HPA axis, how acupuncture interacts with it, and what this means for easing anxiety and depression.
Understanding the HPA Axis
The HPA axis consists of three critical components: the hypothalamus, pituitary gland, and adrenal glands. This complex network plays a crucial role in regulating stress, mood, and essential bodily functions. Whenever a person faces stress, the hypothalamus releases corticotropin-releasing hormone (CRH). This signals the pituitary gland to produce adrenocorticotropic hormone (ACTH), which prompts the adrenal glands to release cortisol, often referred to as the body's primary stress hormone.
Cortisol enables the body to manage stress by increasing metabolism and mobilizing energy reserves. However, prolonged stress can disrupt the HPA axis, resulting in heightened cortisol levels which in turn disrupts the body's processes and create the symptoms anxiety and depression.
The Connection Between Acupuncture and the HPA Axis
Research has shown that acupuncture can positively affect the HPA axis, which may enhance stress management and emotional stability. Evidence indicates that acupuncture can reduce elevated cortisol levels. This decrease creates relaxation and helps restore the HPA axis's balance, alleviating anxiety and depression.
Mechanisms of Action: How Acupuncture Works
Neurotransmitter Regulation
Acupuncture impacts the release of various neurotransmitters, such as endorphins and serotonin. For example, studies showed that individuals receiving acupuncture showed a significant increase in endorphin levels. Endorphins act as natural pain relievers and can provide feelings of happiness. On the other hand, serotonin, known as the "feel-good" neurotransmitter, plays a significant role in maintaining mood balance. By boosting these neurotransmitters, acupuncture can significantly reduce symptoms associated with anxiety and depression.
Reduction of Inflammation
Increased inflammation is linked to anxiety and depression. Research indicates that acupuncture can reduce systemic inflammation by regulating inflammatory cytokines. This reduction can lead to improved mental health and better HPA axis regulation.
Acupuncture Points and Techniques for Anxiety and Depression
My role working on the AcuDep clinical trial at York University was to analyse the data provided by the acupuncturists administering the treatments. My observations were that although there was a significant trend in acupuncture points used, the most commonly used points weren't necessarily the most important. Chinese Medicine theory looks holistacally at the patient and takes into account the patient's individual set of symptoms, circumstances and needs when forming a diagnosis. Therefore, no two patient's acupuncture point prescription was the same, or stayed the same throughout their treatment. There are however, a number of acupuncture points which have multiple uses and generalise benefits. These points were the most commonly used acupuncture points on the trial, and while it is important to recognise that general support to the body is the basis to any good treatment, the points less commonly used are likely to have been the key to unlocking the benefits for each individual. Below is the table of acupuncture points used in the trial, taken from my publication in Evidence Based Complementary and Alternative Medicine Journal, called Acupuncture for Depression: Patterns of Diagnosis and Treatment within a Randomised Controlled Trial.
Rank | Acupuncture point name | No. of patients used on | No. of times point used over trial | Mean no. of times used within each course of treatment | % No. of patients used on (n = 266) | |
1 | Spleen 6 | 241 | 1867 | 7.7 | 91% | 8.87% |
2 | Liver 3 | 237 | 1708 | 7.2 | 89% | 8.11% |
3 | Stomach 36 | 221 | 1519 | 6.9 | 83% | 7.21% |
4 | Large Intestine 4 | 197 | 1205 | 6.1 | 74% | 5.72% |
5 | Pericardium 6 | 184 | 1075 | 5.8 | 69% | 5.11% |
6 | Yintang | 151 | 1072 | 7.1 | 57% | 5.09% |
7 | Kidney 3 | 174 | 828 | 4.8 | 65% | 3.93% |
8 | Heart 7 | 174 | 826 | 4.7 | 65% | 3.92% |
9 | Du 20 | 113 | 654 | 5.8 | 42% | 3.11% |
10 | Lung 7 | 129 | 586 | 4.5 | 49% | 2.78% |
11 | Kidney 6 | 121 | 554 | 4.6 | 45% | 2.63% |
12 | Gallbladder 34 | 112 | 490 | 4.4 | 42% | 2.33% |
13 | Liver 8 | 100 | 450 | 4.5 | 38% | 2.14% |
14 | Large Intestine 11 | 98 | 438 | 4.5 | 37% | 2.08% |
15 | Spleen 9 | 79 | 369 | 4.7 | 30% | 1.75% |
16 | Ren 12 | 60 | 339 | 5.7 | 23% | 1.61% |
17 | Ear Shenmen/Auricular Shenmen | 55 | 335 | 6.1 | 21% | 1.59% |
18 | Pericardium 7 | 59 | 291 | 4.9 | 22% | 1.38% |
19 | Kidney 7 | 54 | 241 | 4.5 | 20% | 1.14% |
20 | Stomach 40 | 59 | 237 | 4.0 | 22% | 1.13% |
Evidence Supporting the Efficacy of Acupuncture
Several other studies provide equally as strong evidence for the effectiveness of acupuncture in reducing anxiety and depression. For instance, a systematic review of randomized controlled trials found that individuals receiving acupuncture reported anxiety reduction rates of up to 60%. However, acupuncture can be a tricky thing to measure as by it's holistic nature, providing a different treatment to each patient does not give the consistent data that fits neatly into the research boxes. Conversely, using a standardised acupuncture point prescription will not give patient's those custom benefits to treatment. I've written more about the difficulties of research into acupucture in another blog post here: https://www.benelliot.co.uk/post/research-into-acupuncture
Integrating Acupuncture into a wider approach
Its worth mentioning that while the benefits of acupuncture for anxiety and depression are clear, these benefits are maximised when incorporated into a comprehensive plan. Combining acupuncture with other therapies, such as cognitive-behavioral therapy (CBT), regular exercise, and mindfulness practices, can produce enhanced effects and give the patient a better understanding of the mechanisms of their anxiety and depression, meaning it will be easier to prevent a reoccurrance. Engaging in a well-rounded treatment plan allows individuals to develop practical coping strategies, providing tools for better mental health management.
For appointments at my York based clinic, please visit benelliot.co.uk