1. Acupuncture for depression treatment Professional assignment of Project (PAP) Contractors: Xiaolu Hou & Juncal Román Client:Contra-expertise en Inspanningsonderzoek naar Arbeids belastbaarheid Coach:Cia Kesselaar Hogeschool van Amsterdam European School of Physiotherapy 26-Jan-07 2007 Amsterdam The Netherlands

2. Contents IntroductionIntroduction Clinical relevanceClinical relevance DefinitionsDefinitions PT relevancePT relevance MethodsMethods ResultsResults DiscussionDiscussion ConclusionConclusion QuestionsQuestions

3. Introduction Research question:Research question: “What are the effects of Acupuncture treatment for depression?” Hypothesis: Acupuncture has positive effect for depression treatment.

4. Clinical relevance In 2000 depression was named the 4th leading contributor to the global burden of disease.In 2000 depression was named the 4th leading contributor to the global burden of disease. Depression has no prejudice, affecting all genders, races and age groups.Depression has no prejudice, affecting all genders, races and age groups. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 thousand lives every year.At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 thousand lives every year. Chinese medical treatment of depression has obtained gratifying therapeutic effects, yet it still lacks satisfactory evaluation methods for the differentiation and therapeutic effects.Chinese medical treatment of depression has obtained gratifying therapeutic effects, yet it still lacks satisfactory evaluation methods for the differentiation and therapeutic effects.

5. Depression Definition of depression:Definition of depression: A common mental disorder – Depressed mood –loss of interest or pleasure –feelings of guilt or low self- worth –disturbed sleep or appetite –low energy –poor concentration.

6. PT relevance Classical treatmentClassical treatment -massage (low evidence) -massage (low evidence) -exercise -exercise Nowadays the increase of depressive patients and the more competitive requirements makes the physiotherapy to look for new therapies that may have good results combined with traditional therapyNowadays the increase of depressive patients and the more competitive requirements makes the physiotherapy to look for new therapies that may have good results combined with traditional therapy

7. Acuputure Definition of acupuncture: –Therapy method from traditional Chinese medicine (TCM) –Insertion of fine needles into different parts of the body –Correcting the imbalance of energy in the body. –There are a range of styles eg: Traditional Classical Auricular Trigger point Single point

8. Little details about TCM The brain  material basis for all mental and emotional activities.The brain  material basis for all mental and emotional activities. 7 emotions: 7 emotions: 1.Joy, 2.anger, 3.melancholy, 4.anxiety, 5.grief, 6.fear 7.terror The brain is the confluent location of all the yang channels.(12 channels)The brain is the confluent location of all the yang channels.(12 channels) Converge in the head and the lucid Yang from all the 5 Zang 6 Fu organs also converges in the head.Converge in the head and the lucid Yang from all the 5 Zang 6 Fu organs also converges in the head. 5 Zang :liver, heart,spleen, lung, kidney5 Zang :liver, heart,spleen, lung, kidney 6 Fu: gallbladder, small intestine, stomach, large intestine, bladder. SanJiao 6 Fu: gallbladder, small intestine, stomach, large intestine, bladder. SanJiao

9. TCM and Depression There are five TCM syndromes of depressionThere are five TCM syndromes of depression 1. stagnation of the liver-qi syndrome. 2. stagnation of the liver-qi and deficiency of the spleen. 3. stagnation of the liver-qi and phlegm. 4. deficiency of both the heart and spleen. 5. Yin-deficiency of both the liver and kidney.

10. Trigger points for depression BaihuiBaihui -making free flow of qi in the brain. -making free flow of qi in the brain. ShentingShenting -sedation and tranquilization NeiguanNeiguan -connects with both the triple energizer dominating qi and regulating channel of yin functioning to reliever stuffiness in the chest and regulate flow of qi. ZusanliZusanli -is the point for stomach and spleen. To transport the qi and blood. ShenmenShenmen -to relieve mental stress SanyinjiaoSanyinjiao -for supplementing qi and blood and nourishing the liver and kidney.

11. Methods Systematic reviewSystematic review Construction of a criteria list:Construction of a criteria list: –Using information from PEDRO –Using information from module EBP 2.3 articles Articles found using key words:Articles found using key words: depression, depressive disorders, acupuncture, physiotherapy, major depression. Reviewed by both members of group twice.Reviewed by both members of group twice.

12. Preliminary inclusion criteria 41 abstracts 9 articles excluded as full article not available 15 articles excluded as over 10 years old 6 articles excluded as not in English 4 articles excluded as systematic reviews 7 articles included

13. Results Max score available in 40Max score available in 40 Mean score is 29Mean score is 29 –Small sample sizes –Randomization –No follow up –No inclusion criteria With a standard deviation of 4.5 (24.5 – 33.5)With a standard deviation of 4.5 (24.5 – 33.5) 1 of the 7 articles found there to be no significance in the use of acupuncture against depression.1 of the 7 articles found there to be no significance in the use of acupuncture against depression. Of the 5 articles considered of high validity, 4 showed a high p value (p<0.05)Of the 5 articles considered of high validity, 4 showed a high p value (p<0.05)

14. Conclusion Most of the articles shows that there is positive effect of acupuncture for depression treatment.Most of the articles shows that there is positive effect of acupuncture for depression treatment. But the validity of the study is still questionable.But the validity of the study is still questionable. Further studies may need to consider that the use of acupuncture as a solution for depression.Further studies may need to consider that the use of acupuncture as a solution for depression.

15. Acknowledgement Special thanks to Cia Kesslaar (our coach) and also as our client for her valuable input. Thanks to Miranda Asher and Tonje Thingvoll our classmates who were helping a lot.