Research confirms effectiveness of ear acupuncture in treating depression

Auricular acupuncture, recommended by the World Health Organization (WHO) and offered as an integrative treatment since 2006 by Brazil’s National Health Service (SUS) (Sistema Única de Saúde), is safe for people with depression and effectively reduces the symptoms of this mental illness, according to a study conducted by researchers from the University of São Paulo (USP) and the University of Santa Catarina del Sur (UNISUL).

The findings of the study are reported in a paper published in the journal Neurology. JAMA Network OpenJudging from the data provided by the Ministry of Health, Labor and Welfare, auricular acupuncture has been shown to be effective as an alternative treatment for depression, a mood disorder for which an increasing number of people are seeking treatment from the SUS.

According to the WHO, depression is one of the leading causes of disability worldwide. In Brazil, the lifetime prevalence of depression is 15.5%, one of the highest in the world. Additionally, depressive disorders account for 10.3% of life years lost (YLL), a measure of premature mortality calculated by subtracting the maximum life expectancy of a person of that age from the age at death.

However, globally, fewer than half of people with depression receive appropriate treatment, such as psychotherapy or medication. In some countries, the figure is less than 10 percent. This is due to the high cost of antidepressants and their side effects, such as stomach upset and reduced libido. As a result, there is growing interest in non-pharmacological and more affordable options. In the United States, for example, one-third of the population prefers alternative treatments for depression.

One such alternative therapy is auricular acupuncture, an ancient Chinese technique that involves inserting thin needles into acupressure points in the outer ear to stimulate various organs, including the brain and vagus nerve. Needles are inexpensive, with a pack of 50 (for 10 treatments) costing less than 10 reais (about $2 at current exchange rates).

The technique is simple and quick (each session takes 5 to 15 minutes), does not require extensive training, and can be administered by nurses or physiotherapists, whereas full-body acupuncture can only be performed by qualified practitioners. A drawback is that its efficacy and safety in treating depression have not yet been fully established.

The researchers looked for this kind of evidence in a study conducted between March and July 2023. The study included 74 patients with mild or moderate depression scores on the Patient Health Questionnaire-9 (PHQ9). Potential participants were not included if they had previously received auricular acupuncture or if they were severely depressed and threatening suicide. Participants received 12 15-minute sessions over a six-week period.

The average age of participants was 29 years old, and most (84%) were women. Participants were split into two groups of 37 each. One group received specific auricular acupuncture (SA) to treat depression according to traditional Chinese medicine, stimulating six points in the outer ear corresponding to the Shenmen (spirit), subcortical, heart, lungs, liver, and kidneys.

The other received non-specific treatment (NSA) using non-points or auricular points (four points on the auricular, cheek, face and auricular) not associated with psychiatric symptoms. For ethical reasons, all participants continued their usual treatment. The efficacy and safety of acupuncture treatment were assessed after 4 weeks, 6 weeks and 3 months.

At the end of the follow-up period, 58% of patients in the SA group had improved their PHQ9 scores by at least 50%, compared with 43% in the NSA group. This difference was not considered statistically significant.

Nevertheless, the authors note that some results are promising: for example, the proportion of patients who experienced recovery and remission of depression was higher in the SA group after 4 weeks, and a statistically significant difference in remission in favor of the SA group was observed after 3 months.

“Our results show that a specific auricular acupuncture treatment can help around 60% of people recover from depression, which is roughly the same recovery rate as pharmacological treatment, according to other published studies on the topic,” said Daniel Mauricio de Oliveira Rodrigues, lead author of the study and professor of neurology at UNISUL.

“Furthermore, 46% of these participants reported disappearance of symptoms, compared with 13% in the NSA group. By comparison, this rate is approximately 35% in patients treated with medication.”

Another promising result was the lack of serious side effects, with no significant differences between the groups. The majority of participants (94% in the SA group and 91% in the NSA group) reported feeling only mild pain at the needle site. “This proves the safety of the intervention over six weeks,” Rodriguez said.

Safer

“We are truly witnessing an epidemic of mood disorders. I don’t think we’ve ever seen such an epidemic of anxiety and depression since the COVID-19 pandemic. Accepting the gold standard of treatment is far from ideal,” said Alexandre Faisal Curie, a researcher in the Department of Preventive Medicine at the University of São Paulo School of Medicine (FM-USP).

“In clinical practice, we see patients with chronic depression who take medication for long periods of time and experience side effects and relapse, so there is a need for complementary options with proven effectiveness.”

Faisal added that there are three key lessons to be learned from the study: for the SUS, it validates a technique that is already widely used and is in fact the most frequently implemented integrative treatment in the public system; for patients, it confirms that auricular acupuncture is a safe option for treating mental illness; and for health professionals, it removes the stigma against non-allopathic therapies.

Despite the promising results, the researchers noted that the study had notable limitations and that longer studies with more participants are needed to more deeply explore the effectiveness of this treatment. “We believe that the inclusion of a larger population would yield even more favorable results for this intervention,” Faisal said.