Findings from Quantitative Studies
There is a limited amount of research currently available on acupuncture for depression and/or anxiety during pregnancy. One 2013 Cochrane Systematic Review (1) looked at 2 Randomized Controlled Trials (RCT’s) on acupuncture by the same lead author. The first was a small pilot RCT (2), the second was the full RCT by the same authors (3). Smith 2019 (4) performed a similar Systematic Review (SR) which again included the same two studies (2, 3).
Manber 2004 (2) was a small pilot RCT with 54 participants and found a 69% response rate (defined as a reduction in symptoms of at least 50% from baseline) for the intervention group, who received 8 weekly treatments of depression-specific acupuncture. In comparison, the massage control group resulted in a 32% response rate, a statistically significant difference. The second intervention group, acupuncture which was not depression-specific, resulted in a 47% response rate, which was not a statistically significant difference. The authors point out that the 69% response rate for depression-specific acupuncture is similar to response rates for conventional treatments for depression, which range between 50-70%. Keeping in mind this was a single, small study with some design flaws, the results show promise and the need for further research.
Manber 2010 (3) was the full RCT of the 2004 pilot study. This was a larger study with 150 participants and compared women having depression-specific acupuncture with two control groups: non-specific acupuncture and massage (to control for time spent and personal attention). Like Manber 2004, it was an 8 week trial and participants underwent two sessions per week for the first 4 weeks followed by once weekly sessions for the next 4 weeks. The researchers found that acupuncture treatments specifically for depression led to a significantly higher response rate (63%) compared with both acupuncture treatments not specifically for depression (38%) as well as combined controls of 44% (non-specific acupuncture and massage). The depression-specific acupuncture treatments also resulted in a statistically significant rate of decrease in symptoms severity compared with combined controls or non-specific acupuncture. Any side-effects were mild and short-lived, and any adverse events were deemed unrelated to acupuncture. Again, the researchers noted that the response rate and symptom reduction achieved through depression-specific acupuncture treatments was comparable to standard depression treatment (either medication or psychotherapy).
A small trial in 2007 (5) compared women who had acupuncture 8-12 times over 8 weeks with those who did not. Both groups had “usual care” which included individual or group counseling sessions and/or homeopathic remedies. These women reported both anxiety, depression and irritability. After the 8 weeks, the acupuncture group showed a statistically significant reduction in the intensity of emotional distress including mood, sleep and relationships. Although this was a very small, quasi-randomized controlled study and larger, randomized controlled trials are needed, it is important to note its contribution to the limited body of research currently available and to note that no serious adverse events were reported and there were no differences in birth or newborn outcomes between groups.
A pragmatic RCT out of Australia (6) in 2020 compared 3 groups: women having acupuncture treatment once weekly for 8 weeks, women having weekly Progressive Muscle Relaxation (PMR) sessions, and those receiving only treatment as usual (TAU). All study participants received TAU. TAU included regular visits with a midwife or OB and access to psychotherapy and medication which was prescribed and utilized as needed. All participants were between 24-31 weeks pregnant. The researchers had participants complete the Edinburgh Postnatal Depression Scale (EDPS) self-assessment at the start of the study, midway though and at the end. Another assessment was completed at 6 weeks postnatally. Although this was a small study of 57 women and it relied on self-reported outcome measures, it was well-designed and showed promising results. EDPS depression scores were significantly lower in the acupuncture + TAU group; additionally, stress and psychological distress (also measured via self-assessment measures) were significantly lower in this group compared with the other two at the 8 week mark (completion of the study). No difference was found between groups 6 weeks postnatally, but this could be expected since generally acupuncture treatment is recommended to continue every 2 to 3 weeks to maintain treatment gains. No adverse effects were reported during this study.
This study is important because from an acupuncturist’s perspective, the acupuncture treatments given were generally clinically realistic and they were performed by a well-qualified, experienced acupuncturist. In addition, since statistically significant results were obtained, the adequate dose of acupuncture treatment was able to be determined (once weekly for 8 weeks).
Findings from Qualitative Studies
Two qualitative studies were conducted based on a study protocol by the authors of the pragmatic RCT (6) out of Australia described in the previous section.
The first study (7) looked at healthcare providers’ attitudes towards acupuncture for depression during pregnancy. Midwives, OB’s, psychiatrists and GP’s in Australia were interviewed. The overarching theme to emerge was that there was a general openness to using acupuncture for depression during pregnancy provided there was evidence for safety and effectiveness. The healthcare providers spoke about the need for alternatives to medication due to safety concerns and reluctance of pregnant people to take medication, and voiced that whenever possible their preference was for non-pharmaceutical therapies.
The second qualitative study (8) was conducted to interview the women who participated in the Australian study described above (6). 8 out of the 17 women who completed the 8 weeks of acupuncture treatments during the study were able to be interviewed. Common themes emerged from their interviews- each of them had a long history of mental illnesses and knew that times of change (such as pregnancy) were a trigger for increasing their symptoms. They described “feeling stuck” in that they wanted to feel better yet knew from past experience that conventional treatments could be “hit or miss”. One participant mentioned that as far as psychotherapy, “some counselors are good, others are not so good” and as far as medication, they either couldn’t tolerate side effects in themselves or worried about medication harming their baby. They heard about the acupuncture trial and decided to try it. Most had heard about acupuncture but never tried it previously, and felt some uncertainty. Some were interested and open-minded to acupuncture treatments, others were skeptical and not optimistic it would help. However they reported when they gained relief with acupuncture it was a pleasant surprise. Women reported “cumulative and ongoing relief from symptoms”, and “in addition to relaxation, all participants described other beneficial effects such as refreshment, calmness, an enhanced ability to cope and increased positivity and motivation”.