Electroacupuncture for insomnia significantly improves sleep quality in patients with depression

A 32-week randomized clinical trial (NCT03122080) in Shanghai, China, showed in its findings that electroacupuncture treatment for insomnia in patients with depression significantly improved sleep quality compared to the sham acupuncture or control group for 8 weeks, and was sustained until the last week of the intervention.1

In particular, the efficacy of using electroacupuncture as a treatment for insomnia was also maintained during the 24-week post-intervention follow-up. The difference in sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) score at week 8 of the intervention was –3.6 (95% CI, –4.4 to –2.8; P <.001) between electroacupuncture and sham acupuncture groups.1 In addition, the difference in sleep quality was -5.1 (95% CI, -6.0 to -4.2; P <.001) between the electroacupuncture and control groups. Electroacupuncture as a therapy for depression and sleep disorders in clinical practice is well known, but the effectiveness of the treatment of comorbid insomnia and depression is still unclear.Xuan Yin, MD, of Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, and colleagues wrote that their "findings provide subjective and objective evidence of the efficacy and safety of standard-of-care electroacupuncture in the treatment of comorbid depression and insomnia compared to standard care sham acupuncture or standard care alone.” Also, the findings showed that the patients in the electroacupuncture group had greater reductions in the severity of insomnia, depressed mood, and anxiety symptoms by the end of the intervention.The study recruited 270 patients, of whom 71.9% were female (n = 194) and 28.1% male (n = 76). The mean for the age of the participants was 50.3 years (SD, 14.2).1 The intention-to-treat analysis included 91.5% of participants (n = 247) who completed all outcome measures at week 32, with only 8.5% of patients (n = 23) dropping out.

The PSQI, from baseline to week 8, within the electroacupuncture group had a mean difference of -6.2 (95% CI, -6.9 to -5.6). There was significant improvement with the 17-item Hamilton Depression Rating Scale (–10.7; 95% CI, –11.8 to –9.7, P < .001), the Insomnia Severity Index (–7.6; 95% CI, –8.5 to –6.7, P < .001), and the Self-rating Anxiety Scale (–2.9; 95% CI, –4.1 to –1.7, P < .001) scores. Total sleep time recorded was increased to 29.1 min (95% CI, 21.5-36.7, P < .001) in the electroacupuncture group during the 8-week actigraphy intervention period. Overall, there were no differences between groups in the frequency of sleep awakening and no serious adverse events were reported.“To our knowledge, there have been no comparable large-scale, multicenter, randomized clinical trials examining the effects of EA on the treatment of comorbid depression and insomnia. This rigorously designed, rigorously conducted study provides important clinical evidence on the role and value of EA as an alternative therapy for the treatment of insomnia and depressive moods,” noted Yin et al.The trial was conducted from September 1, 2016 to July 30, 2019 and took place in 3 tertiary hospitals in Shanghai, China. The patients were then randomly assigned to either electroacupuncture treatment and standard care, sham acupuncture treatment and standard care, or standard care only as a control group. To be eligible for the trial, the criteria of patients aged 18 to 70 years, with insomnia and who met the benchmark for depression, were classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The patients in the 3 groups received standard care supervised by psychiatrists. Those who were in the electroacupuncture and sham acupuncture groups received true or sham acupuncture treatment with 3 sessions over a period of one week for 8 weeks. The sessions totaled 24, which the patients completed during the intervention time. The change in PSQI from baseline to week 8 was set as the primary outcome. Subsequently, the secondary outcomes for the trial were the PSQI at 12, 20, and 32 weeks of follow-up; Insomnia Severity Index; sleep parameters recorded in actography; Self-Assessment Anxiety Scale Score; and the 17-item Hamilton Depression Rating Scale score.

Previous research has shown that acupuncture has little effect on the treatment of depression combined with insomnia.2.3 After 8 weeks of electroacupuncture treatment, this clinical trial showed that it is an alternative therapy that is safe and effective for the treatment of insomnia in patients with depression. Yin and colleagues noted that future studies “should focus on a longer treatment period with accurate objective assessment of outcome.”

For more information on clinical depression, check out our sister publication, PsychiatricTimes.

REFERENCES
1. Yin X, Li W, Liang T, et al. Effect of electroacupuncture on insomnia in patients with depression: a randomized clinical trial. JAMA Network Open. 2022;5(7):e2220563. Published July 1, 2022. doi:10.1001/jamanetworkopen.2022.20563
2. Chung KF, Yeung WF, Yu YM, et al. Acupuncture for residual insomnia associated with major depressive disorder: a placebo- and sham-controlled, subject- and rater-blind, randomized trial. J Clin Psychiatry. 2015;76(6):e752-e760. doi:10.4088/JCP.14m09124
3. Zhao FY, Fu QQ, Kennedy GA, et al. Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis. sleep med. 2021;80:244-259. doi:10.1016/j.sleep.2021.01.053
Electroacupuncture for insomnia significantly improves sleep quality in patients with depression

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