Acupuncture appears to be an effective way to reduce depression symptoms during pregnancy, according to a first-of-its-kind study from Stanford University School of Medicine researchers.

The study authors, led by Rachel Manber, PhD, professor of psychiatry and behavioral sciences, said they hope the results will raise awareness of the problem of depression during pregnancy and provide patients and physicians an alternative to antidepressants. "This standardized acupuncture protocol could be a viable treatment option for depression during pregnancy," they wrote in a paper that will appear in the March issue of Obstetrics & Gynecology.

Up to 14 percent of pregnant women may have major depressive disorder, a condition characterized by feelings of dread, gloom and hopelessness, and a loss of interest in normally pleasurable activities. Some women suffer from depression before becoming pregnant, stop taking their medication and then experience a relapse; in other women, pregnancy itself may cause depression.

Clinicians aren't exactly sure how pregnancy leads to the disorder, but an influx of hormones could be the culprit. Some women might also feel overwhelmed by the major changes in their life, which could trigger depression. "Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues," said co-author Deirdre Lyell, MD, assistant professor of obstetrics and gynecology.

Depression, if left untreated, can pose risks to both mother and baby. The mom-to-be could stop taking care of herself or her fetus, and might even engage in self-destructive behavior. Studies have also linked depression during pregnancy to poor birth outcomes and postpartum depression. "Treatment of depression during pregnancy is critically important so that a woman can maintain her sense of well-being and take good care of herself, her fetus and, someday, her child," said Lyell.

The use of antidepressants during pregnancy doubled between 1999 and 2003, according to a 2007 American Journal of Obstetrics and Gynecology study, but many women avoid taking medication because of safety concerns. In fact, Manber said, 94 percent of the depressed women involved in her study expressed reluctance to take antidepressants.

"Because there's this concern about medication among pregnant women and their physicians, it's important to find an alternative," said Manber.

For this study, the researchers recruited 150 women whose pregnancies were between 12 and 30 weeks gestation and who met the criteria for major depressive disorder. The women were randomized to receive one of three treatments: acupuncture specific for depression; control acupuncture, during which needles were inserted in points not known to help alleviate depressive symptoms; or massage. All of the women received eight weeks of therapy and were assessed for depression at the four- and eight-week marks by an interviewer who was unaware of the treatment each woman received.

The researchers found that women who received the depression-specific acupuncture experienced a bigger reduction in depression symptoms than the women in the other groups. The response rate - defined as having a 50 percent or greater reduction in symptoms - was 63 percent for the women receiving depression-specific acupuncture, compared with 44 percent for the women in the other two treatment groups combined.

The researchers weren't surprised by what they found - a pilot study yielded similar results, and other studies have shown acupuncture is an effective treatment for depression in the general public - but they were pleased with the results.

"I don't think that one-size-fits-all treatments are appropriate for everyone, but acupuncture should be considered as an option," said Lyell. "I hope that people will respect the rigorous methodology used in this blinded, randomized, controlled trial and accept the result: Traditional acupuncture was associated with a significant improvement in depression."

Both Manber and Lyell said they plan to continue their research on women's health during pregnancy and postpartum. Lyell recently presented work showing that practitioners under-identify and under-acknowledge depression during pregnancy, and she's now analyzing birth-outcome data to look for correlations between depression, treatment and obstetric outcomes.

This study was funded by the Agency for Healthcare Research & Quality. Other Stanford authors on the study include Rosa Schnyer, DAOM; Andrea Chambers, PhD; Maurice Druzin, MD; Erin Carlyle; Christine Celio; Jenna Gress; Mary Huang; Tasha Kalista and Robin Martin-Okada.

Source:
Michelle Brandt
Stanford University Medical Center