Beruflich Dokumente
Kultur Dokumente
1
2
Acupuncture against depression
3
CONTENTS
FOREWARD ...................................................................................................................................5
INTRODUCTION............................................................................................................................5
RESEARCH QUESTION..............................................................................................................6
ABSTRACT ....................................................................................................................................6
BACKGROUND..............................................................................................................................6
Hypothesis ...................................................................................................................................7
CLINICAL RELEVANCE............................................................................................................7
PT relevance................................................................................................................................8
Massage therapy .....................................................................................................................8
Exercise therapy .....................................................................................................................8
Quality of life ..............................................................................................................................9
MATERIAL Y METHODS...........................................................................................................9
RESULTS......................................................................................................................................10
DISCUSSION ...............................................................................................................................13
What can we improve? ............................................................................................................15
CONCLUSION.............................................................................................................................15
AKNOWLEGMENTS .................................................................................................................15
APPENDIX A ...............................................................................................................................16
APPENDIX B……………………………………………………………………..……………..16
REFERENCES.............................................................................................................................20
4
FOREWARD
Throughout the study of physiotherapy the western medical methods have been applied over and
over again, with little regard for Chinease medicine. This can be seen as an error of judgment, with
an idea that these methods are of little value. We have chosen to research one area of traditional
medicine to show its value is sientficaly recorded.
INTRODUCTION
First of all, the topic was chosen between both of us, because there was an interesting opportunity
to search about depression and acupuncture due to the increase of the number of the patients with
that dissease worldwide and because of the significant number of them who arrive to the
physiotherapy clinics to be treated.
Its known, that depression is a common disease. Lot of times, there is not proper diagnosis proceed
and even the diagnosis is well done, the established treatment is not correct. The acupuncture is
widely thought to be an effective treatment..
5
RESEARCH QUESTION
Background: Depression is recognized as a major public health problem, which has a substantial
impact on individuals and to society. Acupuncture has become a popular complementary and
alternative treatment approach for depression treatment.
Research question: What are the effects of acupuncture treatment for depression? _
Physiotherapy relevance: Nowadays the increase of depressive patients in the physiotherapy
clinics and the more competitive requirements makes the physiotherapy to look for new therapies
that may have good results combined with traditional therapy
.
Method: This document is a systematic review; it is descriptive, observational, longitudinal and
retrospective.
Results: Acupuncture has positive effects in depressive patients but still there is not enough
evidence. Only in one study there was full remission of the symptoms.
BACKGROUND
society. Depressive disorders are common in
Clinical depression is defined a syndrome the general population. The rate of depression
with symptoms of low mood, loss of pleasure among women is two to three times that of
and interest, sleep disturbances, weight and men The World Health Organization has
appetite changes, fatigue, feelings of described depression as an “unseen burdenii.”
worthlessness or guilt, poor concentration The Global Burden of Disease study reported
and (when severe) suicidal thoughts and that when measured by Disability Adjusted
gestures, that persist for at least two Life Years (DALY), unipolar major
weeks.11i. depression ranked fourth in 1990, and would
Depression is recognized as a major public rise to second by 2020, in terms of the overall
health problem, which has a substantial burden of all diseases.
impact on individuals and to Recent studies on depression in primary care
have demonstrated that it is necessary to
6
improve the identification of this clinical Chinese philosophical ideas of Yin and Yang
condition. Approximately 50% to 60% of the and the Five Elements which form the basis
cases are not detected, and even the patients of Chinese medical theory. These theories
who receive correct diagnosis often are not form the basis for explaining disease and
given an appropriate and specific treatmentiii. physiological function. A westernized
Depression in a primary care clinic: the medical application of acupuncture involves
prevalence and impact of an unrecognized the use of acupuncture administered in
disorder. It has been estimated that the relation to mainstream, and using trigger
average time interval between symptom onset, points, segmental points and commonly used
identification and treatment of the disorder is formula points. Medical acupuncture may
4 to 6 yearsiv. involve the application of acupuncture based
If a proper treatment was delivered, the on the principles of
prevention of morbid-mortality caused by Neurophysiology and anatomy, and the
depression could be as high as 70% v . exclusion of TCM principles and
Consequently, although the patients of philosophyvii.
primary care units present mild depressive
symptoms if compared to cases of major Hypothesis
depression, the under diagnosis of such
symptoms has an impact on the individuals' Our hypothesis in fact is acupuncture has
life, not only regarding the presence of positive effect for depression treatment.
symptoms, but also causing impairment of The nul hypothesis is that there is no
quality of life and social functioning, and significant impact of acupuncture upon
increasing the use of health resourcesvi. ;. depression.
7
10. Objective evidence of agitation or may have good results combined with
retardation traditional therapy. Acupuncture and its
effectiveness of it will be discussed
Major Depression Coding
Classical treatment
Major depression can be code according to
severity, psychotic features, and somatic For all the classical therapy for depression
(melancholic) features. treatment we found two therapies:
The severity of depression can be classified
as mild, moderate, or severe. 1. Massage therapy:
8
interaction. Exercise may increase levels of depressive symptoms looked for health
monoamine neurotransmitters that mediate assistance at primary care clinics more
stress and depressive reactions. Strenuous Often, had longer hospital stays and missed
exercise may release endorphins, which have more workdays than the less depressed
morphine like qualities. Fitness levels are patients x.
lower in depressed individuals. Therefore, it
has been argued that increased aerobic fitness
MATERIAL Y METHODS
may directly lift mood ix.
This document is a systematic review; it is
Quality of life descriptive, observational, longitudinal and
retrospective.
There are many components that affect the The key words used for finding the articles
well-being or quality of life. were: Depression, depressive disorders,
There are several studies that demonstrated acupuncture, physiotherapy, major
that the severity of the depressive disorder depression, acupuncture, TCM.
affects all dimensions of quality of life, even
when controlled with other variable, such as The database used for the database used for
age. the research Pubmed, Cocrane, Medline,
Sometimes this can cause the same or more Thelancet, Amed, PiCarta, MEDLINE,
severe impairment than other chronic PEDRO, Cochrane Central Database of
diseases. International studies have Systematic Reviews, and CINAHL,.
demonstrated that functional impairment and
use of health resources are directly All abstract that covered the required subject
proportional to the severity of the depressive were collected, most of the articles were not
symptoms, it is important to foreground that complete, and reading the abstracts and
mild depressive disorders that do not meet the finding out which were suitable for our thesis
criteria for major depressive disorder can also they were obtained from UVA.
cause significant impairment in quality of
life. The article were then excluded or included
including to the preliminary criteria:
In Brazil there was made an study for the • Articles in English
assessment of quality of life regarding the Many of the articles are in Chinese, but
severity of depressive symptoms in patients both experimenters may read all articles
of primary care clinic showed that the and give a second review.
patients those with more sever symptoms • Full articles
considers their health as being worse and less Many abstracts are available, but they do
satisfied with its health status than those not contain all the information necessary
patients with milder symptoms, even thought for our systematic review
many patients did not present major
• No systematic reviews
depressive disorders.
• Because they already included
Al so we can find an inverse correlation
references and they do not experiment
between depressive symtomatology and other
by themselves.
parameters of quality of life, such as
impairment of physical and psychological • Less than ten years old
functioning. Regarding the use of health Because because then dater is no longer
resources, the patients who presented more valid.
9
interval (100% inter-tester relaiblity). This
A criteria list was constructed, using meant no third read through was necessary.
guidelines from PEDRO and module 2.3 EBP There were only 2 articles where different
(Hva Esp course.) scores were given by the two testers and a
Each article was reviewed by both of the group third, blinded assessor gave a score that
members and given a score out of 40 correlated with the first assesors score. This,
according to the criteria list (appendix A) again, was repeated after the two week period
41 relevant abstracts were found, 7 past the with the same score given.
inclusion criteria for full investigation. A
break down is shown in figure 1. The maximal score available was 40,
minimum 0. The mean score was 29 (73%)
Articles that did not match in the inclusion with a range of 22 to 35.
criteria, we used then as supplement The standard deviation is 4.5 (24.5 – 33.5)
information for contribution of our paper (see table 1)
Articles that past the inclusion criteria will be 5 of the 7 articles gained a score above 70%
reviewed by two assessors who will follow (see figure2), which qualifies them as high
the criteria list. With a minimum interval of quality articles and their p values have been
two weeks they will then be reassessed by the noted in table 2.
same assessors. A second reading is taken to As can be seen by this table only 1 of the
test inter-tester reliability and a two week gap 7 articles found there to be no significance in
is given so scores are no given from memory. the use of acupuncture against depression.
If a deviation was found between the two Of the 5 articles considered of high validity, 4
inter-tester scores the paper will be showed a high p value (p<0.05)
reassessed by both parties.
If a discrepancy is found between the scores
of the two reviewers, a third party will be Figure 1
asked to review the article twice, again with a
two week interval. The criteria list will be
explained to the external reviewer but the 41 abstracts
scores obtained by the two reviewers will not
be disclosed.
RESULTS
7 articles included
10
Criteria list results
40
35
30
25
Score
20
15
10
0
5 1 6 4 2 3 7
Article number
11
Number Author Name of the article Score Score Score End
Xiaolu Juncal External score
Reviewer
Table 1
12
Article no Compairing P value Main conclusion
13
into fire, belonging to the excess with symptoms indicating deficiency of
syndrome. In prolonged cases, excess the heart-blood such as palpitation,
may turn into deficiency, which, forgetfulness, less and dreamy sleep but
also with symptoms indicating deficiency
according to the varying affected zang-fu of the spleen such as poor appetite and
organs and consumption of qi and blood sallow complexion; and the syndrome of
and yin and yang, may cause different yin-deficiency of both the liver and
pathologic changes of consumption of the kidney is not only complicated with
liver, spleen, heart and kidney. feverish sensation in the palms and soles,
night sweating and thready-rapid pulse
It has been shown by epidemiological characteristic of yin-deficiency in nature,
investigation that the showing rate of but also with dry eyes and soreness and
mental depression has reached over weakness in the waist and knee joints
99.6% in the four syndromes of characteristic of the symptom of the liver
stagnation of the liver-qi, stagnation of and kidney in location. The authors think
the liver-qi and deficiency of the spleen, that the criteria set in the research foe the
stagnation of the liver-qi and phlegm and commonly-seen TCM syndromes of
deficiency of both the heart and spleen depression can not only reflect the
and 96.4% in the syndrome of characteristics of the disease. But also the
yin-deficiency of both the liver and essence of the syndromeviii.
kidney, suggesting that mental
depression is the characteristic symptom The results of the studies concluded that
of depression and is thus taken as the the acupuncture has positive effects
essential symptom in the various TCM treating patients with depression but there
syndromes of depression. According to are no concrete data that can prove it.
the results of factorial analysis, mental Only in one of the studies is seen that
depression, pessimism and depressed there was a full remission of all the
expression dominated by Public Factor 1 symptoms of the patients (J.J.B.Allen,
are taken as the basic symptoms for “liver 1998).
depression” in the syndromes of In other article is written how they
stagnation of the liver-qi stagnation of the compare the effectiveness of acupuncture
liver-qi and deficiency of the spleen and versus massage and in the results the
stagnation of the liver-qi and phlegm. In conclude the acupuncture to be more
addition to the basic symptoms .the effective, but the problem they have is
syndrome of stagnation of the liver-qi that the time for the massage session and
and deficiency of the spleen is also acupuncture session is in both 20min,
complicated with symptoms indicating being a normal session of massage longer
spleen figure and allow complexion; the so this results does not conclude the
syndrome stagnation of the liver-qi and effectiveness of acupuncture over
phlegm is complicated sensation in the massage.
throat and sticky tongue coating,
indicating obstructing of turbid phlegm; Comparing these results to those found in
the syndrome of deficiency of both the the systematic review we have shown
heat and spleen is not only complicated that we have the same level of
significance in the outcome.
14
What can we improve? Therefore, future research can address
whether the treatment gains are
maintained or whether less-frequent
1. more articles, more could give us more continuation or maintenance treatment
significant results are required after the initial set of
treatments.
2. more money, because lot of full articles
is not for free from the database. If we
have more money, then we can pay for CONCLUSION
them and get them for our research.
Based upon our results of the 7 articles
3. more time, because due to the school we propose that acupuncture might be
schedule .we only have no more than 15 beneficial in reducing the symptoms of
weeks ( a Christmas holiday between) for depression either as an adjunctive
organization and transportation for treatment or instead of medication. We
finding more articles. also suggest that acupuncture is more
favorable than social interaction and
If additional research corroborates that contact. The treatment dose is not yet
acupuncture is an effective treatment for established .for side-effect from
depression, further research should medication .acupuncture seems to be a
address several issues. First, good way for reducing depression..
acupuncture’s effectiveness remains to be However most of the studies have
determined foe severe of chronic methodological limitations. To establish
depressions (e.g., chronic major the effects of acupuncture as an
depression, dysthymia) as well as for intervention in reducing depression more
persons with comorbid disorders ( e.g. research and evidence is needed.
anxiety disorders , substance
dependence ). Second, the long term
prognosis of patients who respond to
acupuncture treatment is unknown.
AKNOWLEDGMENTS
15
APPENDIX A: Literature Grading List
Article Title:
Graded by:
GRADING CRITERIA
16
Research question: Use of the PICO method –
Max score 8 points
17
Blinding of administrators. 1
Sampling method properly described. 1
Procedure clearly defined. 1
Have materials selected been clearly
described? 1
Is evidence of tool reliability and validity
described? 1
Is exact procedure given in a format that
would allow a reader to reproduce the
experiment exactly: 1
9. Results: Maximum score 8 points
18
Appendix B. Articles used for the thesis.
2. Macpherson. H, Thorpe L,. Thomas K., and Geddes D., Acupuncture for depression: First steps
toward a clinical evaluation. The journal of alternative and complementarz medicine, 2004;
Volume 10, Number 6, pp. 1083–1091
4. Wolf.Ch, Muller.M.J, Wagner.P, Mann.K, Bech.S. The benefit from whole body acupuncture in
major depression. Journal of Affective Disorders. 2000: 57; 73–81
19
REFERENCES
i
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-Tr. 4th ed.
Washington DC: American Psychiatric Publishing Inc; 2005
ii
Murray CJ, Lopez AD. The global burden of disease. Geneva: World Health Organisation and Harvard University
Press, 1996.
iii
McQuaid, J.R., Stein, M.B., Laffaye, C., McCahill, M.E., 1999.
iv
Schwenk, T.L., Evans, D.L., Laden, S.K., Lewis, L., 2004. Treatment outcome and physician–patient
communication in primary care patients with chronic, recurrent depression. Am. J. Psychiatry 161 (10), 1892–1901.).
v
Docherty, J.P., 1997. Barriers to the diagnosis of depression in primary care. J. Clin. Psychiatry 58 (Suppl 1), 5–10..
vi
Cuijpers, P., de Graaf, R., Van Dorsselaer, S., 2004. Minor depression: risk prof iles, functional disability, health care
use and risk of developing major depression. J. Affect. Disorder. 79 (1–3), 71–79.
vi
Goldney, R.D., Fisher, L.J., Dal Grande, E., Taylor, A.W., 2004. Subsyndromal depression: prevalence, use of health
services and quality of life in an Australian population. Soc. Psychiatry Psychiatr. Epidemiol. 39 (4), 293–298)
vii
Macpherson. H, Thorpe L,. Thomas K., and Geddes D., Acupuncture for depression: First steps toward a clinical
evaluation. The journal of alternative and complementarz medicine,2004; Volume 10, Number 6, pp. 1083–1091
viii Field T. Massage therapy effects. Am psychol 1998; 53: 1270-1281
ix(Dr.chen,Dr.Zeqi,Dr. Hu suiyu, Dr.Zhang Hainan, Dr. Zhang Honggeng, Dr. Zheng Lin, Dr. Li Xiaozhao A Study
on the Criteria for the Commonly Seen TCM Syndromes of Depression, The European journal ,august 2005)
x Barros da Silva.A.F, Pio de Almeida. M. Subsyndromal depression: An impact on quality of life?. Journal of
Affective Disrders. 2006
20