Auricular acupuncture, recommended by the World Health Organization (WHO) and already offered as an integrative practice by the Unified Health System (SUS) since 2006, is safe in patients with depression and was able to reduce symptoms of the disease in a study carried out by researchers from the University of São Paulo (USP) and the University of Southern Santa Catarina (Unisul). The results of the work were published recently in the journal JAMA Network Open and reinforce the potential of therapy as a complementary treatment for a problem that motivates more and more consultations in the public network, according to data from the Ministry of Health.
Depression is one of the main causes of disability worldwide, according to the WHO. In Brazil, lifetime prevalence is among the highest: around 15.5%. It is also responsible for 10.3% of the years of life lost (a concept used to quantify the number of years of life that a population loses in the case of premature death).
However, less than half of the people affected in the world receive treatment considered appropriate, with psychotherapy and medication – in some countries, this number is less than 10% –, due to obstacles such as high cost and side effects (e.g. gastric discomfort and changes in libido resulting from the use of drugs). This scenario increases interest in more affordable and non-pharmacological options – in the United States, a third of the population is a fan of these alternatives.
This is the case of auricular acupuncture, an ancient Chinese technique that uses affordable needles – to give you an idea, the pack with 50 units, enough for ten sessions, costs less than R$10 – to stimulate nerves in the ear, mainly the vagus, and activate areas of the brain linked to depression. Simple and quick (lasts five to 15 minutes), it also does not require extensive training on the part of the health professionals (nurse, doctor, acupuncturist, physiotherapist, naturopath) who perform it, unlike traditional acupuncture. However, its efficacy and safety for treating specific psychiatric disorders are not yet fully established.
It was evidence of this type that the researchers looked for in the study financed by FAPESP, which monitored, between March and July 2023, 74 patients with moderate or moderately severe depression (according to score on the Patient Health Questionnaire-9 a questionnaire used in diagnosis, and without prior application of auricular acupuncture or risk of suicidal ideation) underwent 12 sessions of 15 minutes each for six weeks.
The participants, who had an average age of 29 years and were mostly women, were divided into two groups of 37 people each: while the first underwent specific auricular acupuncture, stimulating six points in the ear corresponding to the diagnosis of depression by the traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver and kidney), the second received applications in areas not associated with mental health symptoms – external ear, cheek, face and four points of the helix (upper portion of the external ear). For ethical reasons, all patients continued their usual treatments. The efficacy and safety of the therapy were evaluated at four weeks, six weeks and three months.
At the end of follow-up, 58% of patients in the first group showed an improvement of at least 50% in depressive symptoms. This number was 43% in the second group, which does not indicate a statistically significant difference. Despite this, the study brings promising findings: after four weeks of starting applications, more patients treated with specific auricular therapy had recovery and remission of the disease and, after three months, this proportion was even more relevant.
“Our results show that specific auricular acupuncture for depression recovered almost 60% of people, a number similar to the rate of medications, according to other studies published on the subject”, says Daniel Maurício de Oliveira Rodrigues, professor of naturology at Unisul and first study author. “In addition, 46% of these participants reported no longer experiencing symptoms, in contrast to 13% of the group that underwent the non-specific technique – for comparison purposes, this rate is around 35% for drugs.”
Another positive point of the treatment was the absence of severe adverse effects, with no significant differences between the groups. The majority of participants (94% in the specific auricular acupuncture group and 91% in the generic practice group) reported only mild pain at the needle site. “This demonstrates the safety of the intervention for more than six weeks”, states Rodrigues.
More security
“We are experiencing a true epidemic of mood disorders – I believe we have never been as anxious and depressed as we are post-COVID – and acceptance of the gold standard of treatment is far from ideal,” he says. Alexandre Faisal Cury, researcher at the Department of Preventive Medicine at the Faculty of Medicine (FM-USP). “In clinical practice, we are faced with patients with chronic depression, who have been taking medication for a long time, with side effects and relapses, and we need complementary options that bring proven benefits.”
Faisal highlights the three main repercussions of the study: for the SUS, it is the validation of a technique already widely used (it is the integrative practice most carried out in the public system); for the patient, an additional safe option in mental health treatment; and, for the health professional, the destigmatization of non-allopathic therapy.
Even with the encouraging results, the researchers remember that, to better investigate the effectiveness of auricular acupuncture in treating depression, longer studies with a larger number of participants are needed, one of the main limitations of the current work. “I believe that the participation of more people would bring even more favorable results to the intervention”, concludes Faisal.
The article Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial can be read at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812388.
Julia Moióli | FAPESP Agency