Acupuncture: a promising treatment for depression during pregnancy

Abstract

Background

Few medically acceptable treatments for depression during pregnancy are available. The aim of this randomized controlled pilot study was to determine whether acupuncture holds promise as a treatment for depression during pregnancy.

Methods

Sixty-one pregnant women with major depressive disorder and a 17-item Hamilton Rating Scale for Depression (HRSD₁₇) score ≥14 were randomly assigned to one of three treatments, delivered over 8 weeks: an active acupuncture (SPEC, N=20), an active control acupuncture (NSPEC, N=21), and massage (MSSG, N=20). Acupuncture treatments were standardized, but individually tailored, and were provided in a double-blind fashion. Responders to acute phase treatment (HRSD₁₇ score<14 and ≥50% reduction from baseline) continued the treatment they were initially randomized to until 10 weeks postpartum.

Results

Response rates at the end of the acute phase were statistically significantly higher for SPEC (69%) than for MSSG (32%), with an intermediate NSPEC response rate (47%). The SPEC group also exhibited a significantly higher average rate of reduction in BDI scores from baseline to the end of the first month of treatment than the MSSG group. Responders to the acute phase of all treatments combined had significantly lower depression scores at 10 weeks postpartum than nonresponders.

Limitations

Generalizability is limited by the small sample and its relative homogeneity.

Conclusion

Acupuncture holds promise for the treatment of depression during pregnancy.

Introduction

Major depression during pregnancy is common, with an estimated prevalence of 3.5% (Cutrona, 1983) to 11% (Gotlib et al., 1991, Holcomb et al., 1996, O'Hara et al., 1984, Pajulo et al., 2001). Three recent longitudinal studies documented equivalent or slightly higher depressive scores during the last 2 months of pregnancy than at 6–8 weeks postpartum (Evans et al., 2001, Hayes et al., 2001, Josefsson et al., 2001).

Despite the substantial prevalence, many cases are undetected and thus untreated, resulting in deleterious consequences to the mother and infant (such as, increased risk for postpartum depression (Beck, 2001, Chaudron et al., 2001, Cutrona, 1984, Lum, 1990, O'Hara et al., 1984, Pfost et al., 1990) and negative pregnancy outcome (Chung et al., 2001, Hedegaard et al., 1993, Lindgren, 2001, Steer et al., 1992)). The treatment of major depression during pregnancy has therefore been identified as a priority area for improvement in the clinical management of depression by both the Committee on Research on Psychiatric Treatments of the American Psychiatric Association and, independently, by the Summit on Women and Depression, organized by the American Psychological Association and the National Institute of Mental Health.

Current clinical guidelines for the pharmacological treatment of depression during pregnancy recommend carefully weighing the risks to the woman and the fetus associated with no treatment relative to the risks of treatment (American Psychiatric Association, 1993, Robert, 1996). Manufacturers of antidepressant medications advise that they be avoided during pregnancy, and many pregnant women are reluctant to undergo pharmacological treatment for their depression. Psychotherapy is a safe treatment option during pregnancy, but only interpersonal psychotherapy (IPT) has been evaluated in pregnant women (Spinelli and Endicott, 2003). Most empirically supported psychotherapies are not readily available or affordable. Consequently, there is a need for safe, effective, and affordable alternative treatments for depression during pregnancy. The little available empirical research suggests that acupuncture may hold promise for the treatment of depression (Allen et al., 1998, Roschke et al., 2000). The present randomized controlled pilot study evaluated the efficacy and safety of acupuncture as a treatment for depression during pregnancy. We hypothesized that acupuncture treatment tailored for depression symptoms would be more efficacious than either of two comparison treatments, control acupuncture and massage.