A CASE OF SEVERE CHRONIC DEPRESSION TREATED WITH ACUPUNCTURE

W. LINDSAY JACOB, M.D.

ABSTRACT--The following is a case of severe manic depressive illness characterized primarily by depression, which had not responded to psychotherapy nor to psychotropic drugs, yet had an excellent response to acupuncture. Depression and mania have traditionally been treated with acupuncture by Chinese physicians.

      The patient is a 30 year old, single, white female who first consulted with me in 1987. She was referred by her psychologist after having been treated unsuccessfully in one of the local psychiatric hospitals. For the next two years the patient was treated twice a week with psychological counseling by her psychologist and came to this practice for medication (1200 mg of lithium carbonate per day, 50-150 mg of amitriptyline at night, and occasionally hypnotics such as lorazepam when necessesary)(1,2). Although the patient managed to work through much of this time, the treatment was, however, largely unsuccessful and usually resulted in significant side effects from the medications. During this time she was hospitalized twice at a major psychiatric facility, receiving on one occasion a series of electro-shock treatments (3). She was also given an endo-crinological work-up to rule out any hormonal causes contributing to her depression (4).
     On August 22, 1989 she was started on a series of acupuncture treatments consisting of electrical stimulation between points Baihui (GV-20) and Yintang, at a frequency of 1.5 hertz, as described by Dr. J.S. Han, professor and leading researcher at the University of Beijing, China (5). Treatment sessions were given twice a week, for approximately one hour. By October 13,1989, a gradual reduction of her lithium and amitriptyline was started. Acupuncture treatments continued on a weekly basis. On December 29, 1989, the patient discontinued all of her medications, her mood was normal and she noticed great improvement in her sleeping habits. In addition to being treated with electrical stimulation at points Baihui (GV-20) and Yintang, points GB-38, LR-3 and LR-5 were used in conjuction with the auricular points Sympathetic and Liver. During the course of her acupuncture treatment, the patient would occasionally shift to symptoms of mild mania, which were well controlled by using GB-38, SP-6 and KI-6, in addition to the auricular point Shen Men and, on occasions, HT-7. At present the patient is back to work full time. Her elevated mood has allowed her to respond better to psychotherapy and her overall improvement has been remarkable.

DISCUSSION
     The rationale for the primary use of points Baihui (GV-20) and Yintang is unclear. Animal studies have shown, however, that midbrain monoamines such as serotonin and norepinephrine have been implicated in acupuncture analgesia (6). It is possible that this same mechanism could be in part responsible for the favorable effect of using acupuncture in psychiatric illnesses. Classical Chinese acupuncture texts report scalp points being used to treat depression.
     The points utilized along the lower extremity meridians were aimed at regulating the Liver energy and at times calming the Heart energy, when the "Liver Fire" affected it, with resultant manic symptoms. The frequency of 1.5 hertz was used as a conservative level of electrical stimulation to obtain intended results and still minimize the possibility of driving the cortex to a convulsion through electrical stimulation. A number of other uses of low frequency stimulation( 1-4 herz) of the head with TENS have been reported to be somewhat successful in treating depression (5). In my experience, however, acupuncture seems to work far better than the simple application of small currents at low frequencies to the skin across the head.
     In the treatment described above, the patient underwent a total of 40 acupuncture treatments. It is believed that faster results could have been obtained had the patient been treated more than twice a week, although this frequency allowed for gradual and well tolerated reduction of the patient's medications. Less severe cases of chronic depression showed equally favorable results after approximately ten treatments.
     Much work needs to be done to increase our understanding of the efficacy of acupuncture in the treatment of depression. It is important that physicians treating depression with acupuncture, design well controlled studies with rigorous patient selection and reliable long-term follow-up. Acupuncture has been used for millennia in the treatment of depression and mania, even though psychiatry has not been a separate branch of Chinese medicine, which is traditionally an inductive science connecting all human functions together rather than analyzing its parts.

REFERENCES
1. Kupfer, F. D. Maintenance Treatment of Recurrent Unipolar Depression Pharmacology & Psychotherapy, in Kenoii, D.; Racogni, G., editors. Chronic Treatments in Neuropsychiatry. Raven Press. New York, 1985.

2. Werenberg, A.A. and Amsterdam, J.D. Treatment of Resistant Depression: Definition and Treatment Approaches. Journal of Clin. Psychiatry. June, 1990; 39-49.

3. Abrams, R. ECT and Tricyclic Antidepressants in the Treatment of Endogenous Depression. Psychophamacologic Bulletin. 1982; 18:73-75.

4. Hale, R.C. Psychiatric Effects of Thyroid Hormone Disturbances. Psychosomatics, 1983; 24 (1): 7-17.

5. Han, J.S. Electroacupuncture: An Alternative to Antidepressants for Treating Affective Diseases? Internt. J. Neurosci., March 1986; 29(1-2): 79-92

6. Han, C. S.; Chou, P.H.; Lu, C.C. et al. The Role of Central 5-HT in Acupuncture Analgesia. Sci. Sin.. 1979; 22:193-220.

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