A recent review in Scientific American looked at whether acupuncture can treat depression. Like many acupuncture research studies, the answer is unclear and I am not sure that it can ever be resolved.
There are certain inherent difficulties in acupuncture research that I have written about before. The main obstacle is the question of whether or not there is really a “sham” treatment that “real” treatment can be compared to – because without it, double-blinded studies are impossible to do.
There have been well-intended attempts to create a “sham” needle that doesn’t penetrate the skin, and we can use colored light instead of laser light, but studies show that even these interventions stimulate and change the electrical characteristics of the acupoint and the skin around it. In fact, the amount of energy needed to have an effect on an acupoint is so tiny that even touching it or thinking about it can activate it in some people! This makes it difficult if not impossible to not stimulate a point when you address it in almost any way.
Whether the patient knows if they are getting real or sham treatment alters the results, of course, and if the practitioner is not blinded, that has an effect as well – thus the need for the “double-blind” in the most definitive studies.
If we can’t do double-blinded, placebo controlled studies then we tend to say there’s “no evidence” that a treatment works – but that’s not really true. There are other types of evidence that have value, even if the value is quantitatively different. Not every therapy can be studied in a double-blinded way, but that doesn’t mean they aren’t valuable. Observational studies, expert opinion, and clinical evaluation are all meaningful.
What any doctor learns pretty quickly after they leave their academic training is that no treatment works all the time or for everyone, and that therapeutic trials are the rule, not the exception, whether for eastern or western medicine. In depression, patients often need to try 3-4 anti-depressant medications before finding one that works with tolerable side effects. Or they may need to explore different approaches to psychotherapy, or some combination of the two, to find the best treatment for them. This need to thoughtfully experiment is true in most other medical conditions as well, whether it is high blood pressure, heart disease, diabetes, asthma, autoimmune diseases or cancer.
Acupuncture is remarkably safe, and thousands of years of recorded experience, including over 100 years in Europe and 40 in the U.S. show us that it works well for many people and conditions, but not for everyone and everything. A trial of 4-6 treatments will tell generally you whether it will help an individual with a particular problem, whether it’s pain, insomnia, stress, fatigue, immune dysfunction or allergy.
People don’t get worse from acupuncture, and there are usually positive side effects like improvement in mood, sleep, stress tolerance, and digestion that often accompany treatment. You risk some time and money to see if it will help you, but not your health.
