Ask an expert - neuro and psycho logical - Depression

10 questions

We are really sorry to hear of your wife's problems. It must be extremely hard for all of you.

First, let us say that acupuncture and herbal medicine are two distinct and separate disciplines, although in China they are usually learned together. For historical reasons in the UK there were already existing traditions of acupuncture and western herbal medicine, and the two eastern modalities developed separately. So, if you go to an acupuncturist the chances are that they will not be using Chinese herbs as well. If they are you can be assured that they are very well trained, and are particularly careful when someone is already taking medications which have a serious impact on their functioning. Herbalists will know what the potential interactions of the medications are, and will make sure that nothing they do will interfere with your wife's treatment.

Acupuncture itself is extremely unlikely to cause any problems for your wife. The main source of adverse effects from treatment, other than minor transient ones, is from insertion of the needles themselves, not from the energetics of what is going on. There are no case reports of which we are aware which suggest that acupuncture treatment can do anything other than good when treating people with serious mental health issues.

 As far as the treatment itself is concerned, we were asked a question about schizophrenia a while ago, and although this is a very different problem the response we gave captures some of what we would like to say. We responded:

We have to say that although the World Health Organisation's list of treatable conditions does include schizophrenia as a condition for which some evidence of efficacy exists, the overall position is that there is nowhere enough evidence to suggest that acupuncture would be able to deliver a solution to this problem.

However, when we talk about evidence in this context, we are talking about the kind of randomised control trials beloved of drug testing regimes, which are not the most suitable way of testing a complex multivariate process like traditional acupuncture. Is there a history of acupuncture and herbal medicine for serious mental disorder? Well, the answer would be a qualified yes. There are a number of presentations for groups of symptoms which could well be characterised as psychosis which are recognised syndromes in Chinese medicine with clear treatment protocols. This is even more the case with Tibetan medicine which uniquely in Far Eastern medicine has a very complex and enduring tradition of using herbal medicines to treat a number of what we regard as sectionable mental disorders. However, this tradition has barely travelled to the West, and few practitioners have the necessary skills to offer solutions.

The major issue would be to locate someone with the requisite skills and experience. Although we have few recognised specialisms in traditional acupuncture we have been developing areas like paediatrics, obstetrics and mental health issues where we believe the special nature of the client group may require additional skills which we would recognise as expert practice. Although in theory, as generalists we should all be able to help any patient we take the view that serious mental disease needs some familiarity with the field and some experience of how to work with people in extremely distressed states. Not everyone has this experience or skill, and it would not help your wife is someone is out of their depth. With that caveat it may be possible to locate someone through our searchable database who is skilled in this area and willing to have a try. The chances are that anyone working in an area will know which of their colleagues is most likely to be able to help,

We think that there is still some wisdom in these words, and our advice is pretty much always to visit a local BAcC member for a brief informal assessment of what might be possible. These situations are so very complex that it is nigh on impossible to give a definitive view at arm's length. We always feel confident that we can help everyone to a degree, but when a situation is quite fraught it is always best to make sure that a patient gets the help they need, even if that means referring them to other forms of treatment.

 

 

Q: I've been diagnosed with serious depression and anxiety for the last 14 months. I'm currently taking Venlafaxine and having EDMR therapy. But still keep having out-bursts of crying and was wondering if acupuncture would help me?

A: We are happy to say that we have been asked these questions many times before and are able to give some very positive and upbeat advice. Drawing together a couple of strands from previous answers we can say:

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, 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 condition 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.

The great strength of Chinese medicine, however, is not that it treats this or that condition, but that it treats the person. This is why twenty people with headaches may be treated twenty different ways. Clearly some points will have a direct effect, but treatment is not the equivalent of an aspirin, and the practitioner will be at pains to discover why this symptom appears in you and not in someone experiencing similar external stresses. The best treatment always combines treating the symptoms within the context of their overall pattern, and the pattern is the primary factor. Indeed, in ancient times some of the older systems used to treat the people without necessarily taking any notice of individual symptoms, in the simple but effective belief that a system in balance took care of its own problems.

The best advice we can offer is that you visit a BAcC member local to you, and see if they are prepared to give up a little time without charge to discuss whether your specific presentation. Anxiety and depression are rather broad labels which cover a huge range of possibilities, and sometimes we have to say to patients that what they are dealing with requires more of a talking therapy approach than we can offer. Given that it is rare for mental and emotional issues to arise without accompanying physical changes, even where these do now generate symptoms, a practitioner of Chinese medicine may well be able to see overall patterns which give them confidence that they may be able to help.

We think that this still represents very good advice. There is also a fact sheet on anxiety in the same location, and using the 'site search' facility on our home page will generate a large number of hits for answers we have given and for news articles where celebrities and people in the media have spoken of the value of acupuncture treatment for dealing with both problems.

We are interested to hear that you are using EDMR therapy, though. In our experience this is often linked to specific events or specific situations, and our experience as traditional acupuncturists is that some of these problems can be considerably helped by the use of acupuncture. There are many ways of understanding shocks or distress in the system and its effects on the energetic balance of the individual, and some of them are amenable to treatment. A skilled practitioner, and our members all are, would take this into account into putting a treatment plan together and might well be able to achieve a degree of synergy with your other treatments to help you get out from under.

The advice we gave in the earlier answer, visiting a local BAcC member for an informal chat, holds particularly good in your case. Although a good rapport is not an essential feature of treatment it can be a crucial aspect of the therapeutic relationship when people are dealing with distressing events and background; you need to be able to trust and feel confidence in the person treating you. We hope that you manage to find someone who fits the bill.

Can you advise if it is necessary to have a specialist for depression to treat with accupuncture. 

There is no need to seek out a specialist to treat depression with acupuncture. We are all generalists who treat people rather than conditions, and the huge strength of Chinese medicine is that it looks at the unique and individual presentation of every patient. It would not be unusual for twenty people with the same named condition to be treated in twenty entirely different ways. The practitioner will work to find out exactly what 'depression' means for someone - it's a name that covers a huge range of possible disturbances of the system - and then look at why these problems have arisen in these individuals.

 

There has been a fair bit of research into the use of acupuncture to treat depression, as our factsheet shows

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html

 

but by far the most interesting result was a study recently conducted by one of our leading researcher/practitioners

 

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001518

 

which showed some very positive outcomes. Hugh has also written several follow-up articles looking at the data he and his colleagues collected, but these are a little on the scholarly side.

 

Most of us have treated people with depression as a primary referral because friends, family and colleagues who have come for a problem like backache or headache have found that acupuncture has helped depression too, and have referred on friends for whom depression is the main issue. The only time any of us might be cautious in taking on a case would be if someone's depression was linked to a serious psychiatric illness. Here we do recognise that there are special skills which might be needed, but there are very few patients in this category who present for treatment.

 

Sadly we can't recommend individual practitioners - we have no criteria to go for one over another - but also it follows from what we have said is that we think all of our members are suitably qualified to address the problem you have. If you use the postcode search facility on our home page you will find a number of people who are geographically closest, and most are willing to give up a little time, often without charge, to discuss whether acupuncture treatment is the best option for you. This also has the advantage that you can meet them and see where they work before committing to treatment. 

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.

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