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Acupuncture for anxiety

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Translation- Evidence Based Acupuncture Evidence Summary – Acupuncture for the treatment of anxiety

Research shows that 1-30% of the world's population suffers from some form of anxiety [1]. There are 13 different subclassifications of anxiety disorders included in the most recent Diagnostic and Statistical Manual (DSM-5), with symptoms and physical manifestations varying significantly [2]. From shortness of breath and fluctuations in heart rate to direct panic attacks, headaches, pain, and insomnia [3]. Anxiety is a complex, pervasive condition that is generally treated with medication.

Acupuncture for anxiety

According to the most recent scientific research, acupuncture is an effective treatment for anxiety. In 2017, The Acupuncture Evidence Project was published by Dr. John McDonald PhD and Dr. Stephen Janz [4], providing a comparative overview of the clinical and scientific evidence for acupuncture. This comprehensive document, revised after two earlier reviews, concluded that there is sufficient evidence to suggest that acupuncture is moderately effective in treating anxiety [5].

The evidence included a 2016 systematic review with over 400 randomized patients that showed the effects of acupuncture for treating anxiety have been significant compared to conventional treatments [6]. The largest of these studies, which included 120 randomized patients, demonstrated that acupuncture had a significant effect on reducing anxiety and depression compared to conventional treatments such as pharmacological approaches and psychotherapy, with more than a two-fold reduction in symptoms [7].

A more recent systematic review published in 2018 showed that all 13 included studies reported a decrease in anxiety for their treatment group compared to the control groups. Three of these studies used pharmaceuticals as a control study [8].

Biochemical Mechanisms of Acupuncture

The autonomic nervous system (ANS), consisting of the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS), regulates the internal conditions necessary for existence (homeostasis) [8]. Information is received from the body and the external environment, and then either the SNS, which emits stimulating signals, or the PNS, which emits signals for relaxation, responds. These signals direct the body to react in various ways, such as increasing heart rate and contractile force, or by lowering blood pressure and slowing heart rate [9]. It is interesting to note that studies show that acupuncture has an effect on both the SNS and the PNS, as some other examples below demonstrate.

One of the most sensitive measures of the body's ability to cope with stress is the so-called Heart Rate Variability (HRV). Instead of beating consistently at the same pace like a metronome, the heart changes its speed based on its finely tuned response to the environment. Higher HRV is associated with better health in all areas, including mental health and low levels of anxiety. Acupuncture has been shown to improve the body's ability to cope with stress by enhancing HRV [10].

When the body experiences a lot of stress, a part of the brain, the hypothalamus, releases neurochemical substances [9]. Research shows that acupuncture can inhibit this response [10]. It has also been demonstrated that acupuncture increases the release of endorphins [11], the body's own feel-good chemicals. These chemicals play a crucial role in regulating stress responses such as the level of pain, heart rate, blood pressure, and our digestion [12,13,14,15].

All these acupuncture mechanisms have a direct effect on reducing anxiety.

The conventional treatment of anxiety mainly consists of a combination of pharmacological and psychological interventions.

Acupuncture for anxiety

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Conventional Treatment of Anxiety

Pharmacological Approach
There are various medications prescribed for anxiety, including benzodiazepines (alprazolam), selective serotonin reuptake inhibitors (SSRIs) like paroxetine, and tricyclic antidepressants (imipramine), either individually or in combination [16]. According to recent research, about 50% of patients pharmacologically treated for anxiety have an inadequate response [17], meaning their symptoms are not relieved to clinically significant levels or the patient experiences adverse effects. Some researchers even go as far as to suggest that pharmacological treatments are "less than ideal" in terms of efficacy when applied for both short- and long-term treatment [18].

Systematic reviews show that benzodiazepines can lead to sedation and drowsiness, mental slowing, and anterograde amnesia (difficulty forming new memories) [19].

Behavioral Approach
Cognitive behavioral therapy (CBT) and mindfulness-based CBT are two other popular and effective forms of conventional anxiety treatment and can be prescribed as standalone therapies, or in combination with medications [20]. CBT is a talk therapy aimed at overcoming incorrect or negative thought patterns [21]. It has the advantage of flexibility, tailoring the therapy to each individual and their relevant anxiety disorder. A meta-analysis found that CBT, compared to a placebo therapy, had a moderate to large effect in reducing anxiety stemming from a variety of causes [22].

Conclusion
While there are ethical and methodological challenges in setting up studies comparing the effectiveness of acupuncture with conventional treatment for anxiety [23,24], the best available evidence shows that acupuncture has moderate benefits in treating anxiety. Studies indicate that acupuncture is more effective than pharmacotherapy and comparable to talk therapy, making it a useful referral choice. Furthermore, research has revealed various known biochemical and biophysical mechanisms that may provide an explanation for the workings of this ancient modality.

References:

  • 4. McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review. Australian Acupuncture and Chinese Medicine Association Ltd. 2017.
    The Acupuncture Evidence Project [←]

  • 6. Goyata SL, Avelino CC, Santos SV, Souza Junior DI, Gurgel MD, Terra FS. Effects from acupuncture in treating anxiety: integrative review. Rev Bras Enferm. 2016 Jun;69(3):602-9  https://pubmed.ncbi.nlm.nih.gov/27355312/  [←]

  • 7. Arvidsdotter, T., Marklund, B., & Taft, C. (2013). Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients–a pragmatic randomized controlled trial. BMC Complementary and Alternative Medicine, 13(1), 308. http://doi.org/10.1186/1472-6882-13-308 [←]

  • 8. Amorim, D., Amado, J., Brito, I., Fiuza, S. M., Clinical, N. A. T. I., 2018. (n.d.). Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Elsevier. http://doi.org/10.1016/j.ctcp.2018.01.008  [←]

  • 11. Ribeiro SC, Kennedy SE, Smith YR, Stohler CS, Zubieta JK. Interface of physical and emotional stress regulation through the endogenous opioid system and m-opioid receptors. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2005;1264-1280.  https://doi.org/10.1016/j.pnpbp.2005.08.011 [←]

  • 12. Harbach H, Moll B, Boedeker RH, et al. Minimal immunoreactive plasma b-endorphin and decrease of cortisol at standard analgesia or different acupuncture techniques. European Journal of Anaesthesiology. 2007; 24:370-6  http://doi.org/10.1017/S0265021506001906  [←]

  • 14. Yin J, Chen J, Chen JDZ. Ameliorating effects and mechanism of electro acupuncture on gastric dysrhythmia, delayed emptying and impaired accommodation in diabetic rats. The American Journal of Physiology. 2010; 298:G563-G570 
    https://doi.org/10.1152/ajpgi.00252.2009 [←]

  • 15. Agelink MW, Sanner D, Eich H, Pach J, Bertling R, Lemmer W, Klieser E, Lehmann E. Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders? Fortschritte der Neurologie-Psychiatrie. 2003;71:141-9   https://pubmed.ncbi.nlm.nih.gov/12624851/ [←]

  • 17. Generoso MB, Trevizol AP, Kasper S, Cho HJ, Cordeiro Q Shiozawa P. Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis. 2017;32:49-55  http://doi.org/10.1097/YIC.0000000000000147 [←]

  • 18. Baldwin D, Hou R, Gordon R, Huneke N, Garner M. GAD: experimental medicine models, emerging targets: Pharmacotherapy in generalized anxiety disorder: novel experimental medicine models and emerging drug targets CNS-drugs .; .Available from                                                                   https://eprints.soton.ac.uk/406180/ [←]

  • 20. Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G. Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review. 2014; 34:130-140  http://doi.org/10.1016/j.cpr.2014.01.002 [←]

  • 22. Hofmann, S.G., psychiatry, J.S.T.J.O.C., 2008. (n.d.). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Ncbi.Nlm.Nih.Gov  https://pubmed.ncbi.nlm.nih.gov/18363421/ [←]