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Ask an expert - neuro and psycho logical - Depression

7 questions

Q:  I am currently having acupuncture by a Chinese trained TCM practitioner for a respiratory infection. She has suggested taking Chinese herbs as a tea to boost my immune system in addition to acupuncture.

I have bipolar affective disorder (manic depression) and know that some immune supporting Chinese herbs are not suitable as they could trigger a manic episode. My previous acupuncturist would leave some herbs out of her immune mix - but I don't know which ones!

The Chinese acupuncturist I am currently seeing speaks fairly good English, but I am not sure she has understood why I am cautious about taking herbs as I'm not convinced she understands what bipolar is or the potential risks associated (psychotic episode requiring hospital admission).

Please could anyone provide a list of Chinese herbs that are not suitable for someone with bipolar (in Chinese and English if at all possible please). I would like to show the acupuncturist a list of contraindicated herbs in bipolar before agreeing to take Chinese herbs as tea.

A:  It is a rather anomalous fact that Chinese medicine, which is largely acupuncture and herbal medicine, is represented by two parallel sets of organisations in the UK. This has a great deal to do with the fact that there was a strong tradition of medical acupuncture and western herbs already in existence, and the separate elements of TCM grouped around them.

As a consequence, although we have a number of members who practise Chinese Herbal medicine their herbal medicine regulation is undertaken by the Register of Chinese Herbal Medicine, to which most of them belong. The expertise necessary to respond to your question lies there, and I am sure that if you contact them at http://rchm.co.uk/ they will be more than happy to oblige with the information which you need.

The RCHM is a smaller organisation than the BAcC, and not quite so well resourced, so it may take a few days before you get a response.

 

Q:  I am currently having acupuncture by a Chinese trained TCM practitioner for a respiratory infection. She has suggested taking Chinese herbs as a tea to boost my immune system in addition to acupuncture.

I have bipolar affective disorder (manic depression) and know that some immune supporting Chinese herbs are not suitable as they could trigger a manic episode. My previous acupuncturist would leave some herbs out of her immune mix - but I don't know which ones!

The Chinese acupuncturist I am currently seeing speaks fairly good English, but I am not sure she has understood why I am cautious about taking herbs as I'm not convinced she understands what bipolar is or the potential risks associated (psychotic episode requiring hospital admission).

Please could anyone provide a list of Chinese herbs that are not suitable for someone with bipolar (in Chinese and English if at all possible please). I would like to show the acupuncturist a list of contraindicated herbs in bipolar before agreeing to take Chinese herbs as tea.

A:  It is a rather anomalous fact that Chinese medicine, which is largely acupuncture and herbal medicine, is represented by two parallel sets of organisations in the UK. This has a great deal to do with the fact that there was a strong tradition of medical acupuncture and western herbs already in existence, and the separate elements of TCM grouped around them.

As a consequence, although we have a number of members who practise Chinese Herbal medicine their herbal medicine regulation is undertaken by the Register of Chinese Herbal Medicine, to which most of them belong. The expertise necessary to respond to your question lies there, and I am sure that if you contact them at http://rchm.co.uk/ they will be more than happy to oblige with the information which you need.

The RCHM is a smaller organisation than the BAcC, and not quite so well resourced, so it may take a few days before you get a response.

Q:  I have several health issuse's where i feel mainsteam medical isn't helping.  I have joint problems which are getting worse, depression ( and related illness to this such as stress etc).  I am  looking for advice reguarding this and to see if acupuncture or related treatments could help and advise as to where to go. 

A:This is not unique to Chinese medicine and the best of conventional medicine will offer the same. It was, after all, the great Canadian physician William Osler who said,' don't tell me what disease the patient has, tell me what kind of patient has the disease'. This, however, is at the heart of what we do as Chinese medicine practitioners, and informs how we work.

As such the best advice that we can offer is that you visit a BAcC member local to you and ask their advice about whether treatment could work for you. Most are more than happy to give up a few minutes without charge to give someone a better informed view, and most are honest enough to say that there may be other and better options if they believe this to be the case. You can find the nearest people to you simply by using the postcode search facility on our home page.

We think that acupuncture treatment may be an ideal starting place, though. The worst problem with having a number of conditions which all combine is that they feed on each other and create a downward spiral of discontent. If something can break that cycle then the body and mind can start to heal. Less stress can mean a better flow of energy and more chance for joints to recover, less pain can mean less depression and so on. With its track record for treating all three issues as a part of treating the whole person there should be some benefits, and the only issue would be likely to be how much benefit and how sustainable the effects of treatment would be.

Q:  My wife had a spinal fusion 3 years ago Although this was a success she is in severe pain due to scar tissue touching the nerves in the back In addition she suffers severe depression which is historical and increased by her continuous pain and lack of movement Can acupuncture help her?

A:  There is some increasingly good evidence for the use of acupuncture in the treatment of depression, as out factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html
 
and as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently

 
 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001518

Where the depression is linked to a continuing health problem, however, the situation becomes a little more complex. We find that when someone has a chronic and unpleasant physical pain which does not yield it can become a great deal more difficult to deal with the depression that this causes and the underlying depression to which this has added.

If your wife's pain results from scar tissue, then this will take a finite time for the body to deal with. Evidence suggests that this can reduce in impact over time, but some does not. We are reluctant to commit ourselves on whether internal scarring is treatable with acupuncture. We have certainly a great deal of anecdotal evidence about helping with problems at a superficial level by reinstating the flow of energy across operation scars, but less clearly demonstrable evidence for the internal scarring which occurs after lower back operations or disc herniations.

However, as a general principle, traditional acupuncture is concerned with the maintenance of a good flow of energy in well-defined pathways in the body, and any major surgery or injury will interfere with this flow. Using needles to restore as much flow as possible to its original state can never do harm and may do a great deal of good. The term 'speeding up the healing process' is often used and this is what many patients believe that we achieve, but one has to be careful because trials designed to validate this are hard to construct, expensive and not always reliable.

Where there is an interaction between two problems such as these, we tend to believe that the best advice we can give is to visit a BAcC member local to you and get a brief face to face assessment of what may be possible. Nearly all of our members are happy to give up a small amount of time without charge to assess someone's suitability for treatment, and because we look at everything which is going on in the person we can often make some very rapid but valuable assessments of the context and backdrop against which the presenting problems have appeared. This can make a very substantial difference to the kind of prognosis a practitioner might offer. It is also possible to direct someone to other forms of treatment if that would be more appropriate, and this often allows for the kind of personal referral which helps prospective patients find their way through the very large number of complementary therapists practising in their area.

Q:  I am suffering with bad depression & anxiety related to body dismorphia. I have had it since I was 18 & I am 63 now. It has been triggered again
recently by a tragic loss. I took antidepressants for 2 years and managed to come off them gradually and have been okay until a month ago. Could acupuncture help with my symptoms?

A:  As you can imagine we have been asked about both anxiety and depression a number of times, and a typical, if rather long answer, was:

Is acupuncture any good for relieving depression or anxiety?

A:  We have produced factsheets on both of these areas:
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html
 
and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html
 
which give some cause for optimism, as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently
 
 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001518

There is also a link on our home page today to a new study about anxiety

http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3546-anxiety-the-silent-sufferers.html

However, we could do worse than reproduce the text of a piece we provided for Anxiety UK some months ago.

ANXIETY AND ACUPUNCTURE

 

Anxiety is more than just being anxious. Just as migraine sufferers get righteously indignant when someone claims to be a fellow sufferer but can still get to work, eat and stand the daylight, so anxiety sufferers know that they bear only the slightest resemblance to people who feel a bit nervous or have ‘butterflies in the tummy.’ Clinical anxiety is a crippling affliction which can sometimes defy all of the medications and talking therapies that someone can throw at it.

Why, then, has acupuncture been found to be successful in treating it? The main reason is that in conventional medicine, there is no single treatment for each sufferer as each person has differing symptoms. However, in traditional acupuncture every patient is considered to be unique, and this means that the practitioners will be looking and listening very carefully to everything that the patient says to establish a diagnosis and find the specific keys to unlocking the patterns of the symptoms the patient is suffering. They will aim to identify the imbalances which cause the symptoms of anxiety, not just treat the symptoms themselves. This whole ‘package’ – taking the patient’s individual story seriously and giving them time to tell it, trying to hone precisely the diagnosis, and selecting the optimum way to use the least needles to achieve the greatest effect – has been found to be very effective.

The theory of traditional acupuncture is very straightforward. The free flow and internal balance of energy (Qi) is seen in eastern medicine as essential for good health. Any prolonged exposure to extremes or intense situations, be they physical, mental, emotional or spiritual, will cause the flow and balance to be affected. This disruption in balance then ripples through the whole system, causing symptoms which sometimes bear little apparent relation to the underlying causes. An acupuncturist’s skill lies in making sense of seemingly unconnected symptoms and understanding the unique nature of someone’s energies in such a way as to restore balance. A treatment plan may simply involve needles and moxibustion, the use of a warming herb, and tui na, a form of traditional Chinese massage, but can extend to address issues in someone’s diet, their exercise patterns and their lifestyle.

People sometimes ask why, if acupuncture is so successful, there isn’t much research to back up its claims and make it more freely available within conventional care. A major reason for this is the unique nature of treatment which resists putting people in pigeon holes and which changes as the person’s balance begins to improve. Both of these confound attempts to organise research according to western models where a named condition receives a single treatment and all other variables are taken out of the equation. In Chinese medicine the variables are called patients!

Where do our patients with anxiety come from? Word of mouth still remains the most common and most reliable form of referral, and more people have had acupuncture than you think. If you ask around your support groups you are almost certain to find someone who has tried acupuncture and found that it works. Perhaps this time it’s your turn!

People also usually want to know whether the treatment will ‘stick’, whether they have to keep on having acupuncture. Some don’t – a single course of treatment can set them on a good path which, as long as their life remains well-balanced and relatively stress-free, means that they will stay anxiety-free. Many, though, like to keep ‘tuned up’, and realise that spending a fraction of what they spend on keeping their cars roadworthy keeps the driver in good shape too.

As always, though, we still think that the best advice we can give is that you contact a BAcC member local to you to see if acupuncture would be appropriate for your own unique circumstances. 

We think that this covers most of the basics. Your case is obviously a little different, with a much more specific cause, and it also appears that you have a strategy from previous episodes which works, albeit slowly. We do not think that there would be any disadvantage to trying acupuncture treatment, and it may well be a suitable alternative to medication. However, if medical advice is to proceed with medication again there is no harm in having acupuncture at the same time; the two systems of medicine are like apples and oranges, so there is little or no chance that either will interfere with the effects of each other.

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