Download files
Abstract
The World Health Organisation has recently declared depression as the number one cause of disability in the world. Treatment options include pharmacotherapy, cognitive behaviour therapy and supportive counselling. The adverse effects of pharmacotherapy (a major deterrent to patient compliance) and recent literature reporting only 6-7% of depressed patients remitting are of concern. Many patients suffering from depression turn to Complementary Medicine, including acupuncture, for answers. Acupuncture has been commonly used to treat depression, but due to the heterogeneity of acupuncture in depression studies, empirical data have been inconclusive. Acupuncture’s adverse effects profile is minimal and it is well tolerated. This thesis presents a comprehensive investigation of the use of low intensity laser acupuncture (LA) in the treatment of depression, prompted by a pilot study using the LR14, CV14, HT7, LR8 acupoints.
The significant brain effects of LA on these acupoints in healthy and depressed subjects were investigated using functional MRI (fMRI). Default mode network (DMN) modulation by LA and its relevance to depression was explored. The fMRI studies showed that LA activated brain regions relevant to emotional regulation and modulated the DMN, supporting the plausibility of LA as an antidepressant treatment. While differential activation patterns were produced by stimulation of different acupoints, it was unclear which were likely to be most effective. Stimulation of sham acupoints also produced brain activation.
The major component of this body of work was the conduct of a randomised placebo-controlled trial of LA for depression, which demonstrated its effectiveness, with the benefit being sustained at 3 months follow-up. Somatisation effects were significantly improved in the clinical study delivering a better quality of life. Transient fatigue was the only adverse effect reported. The final experiment was to test the differential brain activation between laser and needle acupuncture on the most significant acupoint within the treatment regime.
The series of studies presented in this thesis go toward establishing a body of work to substantiate acupuncture, in particular LA, as a treatment modality for depression. The results clearly suggest that this field is worthy of further exploration and likely application in practice.