Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research

https://doi.org/10.1016/j.ctcp.2018.01.008Get rights and content

Abstract

Anxiety disorders are one of the most common mental health concerns with a major contribution to the global burden of disease. When not treated, anxiety can be aggravated to more serious and complicated health problems. Pharmacology and psychotherapy stand for the conventional treatment for anxiety disorders but these present limited efficacy, especially in the case of chronic anxiety, with high relapse rates and often causing adverse side effects. Clinical research studies render acupuncture as a valid treatment therapy for anxiety disorders without significant adverse effects.

The objective of this paper is to review the literature on the effectiveness of acupuncture and electroacupuncture for the treatment of patients with anxiety disorders in order to find strong scientific evidence for its regular practice in Western culture.

The systematic review of the clinical research was focused on published clinical trials (controlled, randomized and non-randomized) regarding the treatment of anxiety with acupuncture. Only clinical trials where anxiety was treated as the therapeutic target, and not as a secondary measurement or being associated with other health condition or disease, were considered. Two authors extracted the data independently and exclusion and inclusion criteria were set. The search rendered 1135 papers addressing anxiety as a primary therapeutic target. After review, 13 papers were identified to match exclusion and inclusion criteria and were selected for this analysis. Methodology, design, and quality of the research were highly variable and are discussed and compared.

Overall, there is good scientific evidence encouraging acupuncture therapy to treat anxiety disorders as it yields effective outcomes, with fewer side effects than conventional treatment. More research in this area is however needed.

Introduction

Anxiety disorders are one of the most common mental health concerns. These disorders represent a significant public health problem and are frequently associated with complications and disability. Anxiety has been detected early in life in children within the 5–9 year range, spanning until a 55–59 year range, after which the most common mental health problem becomes depression (GBD 2015) [1].

In fact, depression and anxiety have been reported to contribute substantially to the Global Burden of Disease as stated in the 2015 report (GBD 2015) [1]. Anxiety ranks in the top ten causes of disability worldwide and is the most prevalent psychiatric condition in the European Union (EU) with over 60 million people being affected by this condition [2]. When untreated, anxiety implies significant personal and societal costs due to frequent primary and acute care visits, decreased productivity at work, unemployment and impaired social relationships. In addition, anxiety presents itself as a risk factor for the development of other anxiety-related disorders [2]. While anxiety disorders were previously related to Western countries, new evidence has recently shown that it is, in fact, a worldwide concern [3]. Anxiety is considered a deleterious mood disturbance characterized by persistent feelings of apprehension, despair, tension, and distress with developing physical symptoms such as tachycardia, nervousness and inability to relax. This condition tends to become chronic and interferes with daily life predisposing to other serious health conditions and to engage in an unhealthy lifestyle behavior [4,5]. The terminology “Anxiety disorders” are a general term comprehending several conditions such as panic disorder, social anxiety disorders, separation anxiety disorders, phobias, selective mutism, anxiety induced by substance use, anxiety associated with a medical condition, and generalized anxiety disorder [6]. Pharmacotherapy and psychotherapy are the conventional treatments for anxiety with the former being considered the standard treatment and with the latter being insufficient when used alone in most cases. Regarding pharmacotherapy, anxiolytics, antidepressants or monoamine oxidase inhibitors are used, with benzodiazepines being the most used pharmacological resource as anxiolytics [7]. Nonetheless, pharmacotherapy is not free from concern since they can lead to habituation (especially in long-term treatments), and present side effects and drug interactions, among other problems [8,9]. Due to its chronicity, high relapse rates, and the need for a long-term maintenance treatment, there is an urgent need for an effective treatment of anxiety, with less undesirable side effects. In the last years, non-conventional therapies such as acupuncture are becoming more popular to treat this health problem. Several studies have proved acupuncture as a safe therapy with rare adverse side effects [10,11]. Acupuncture is an ancient energy-based traditional Chinese medicine technique, popular in the East but still recent in Western countries. The technique aims at redirecting and harmonizing energy flow along 14 main energy channels called meridians. The technique consists of stimulating with fine needles selected points in the skin within the 360 points that were identified - acupoints. Each internal organ is linked to a specific meridian and the stimulation of a specific acupoint is believed to interact with the corresponding internal organ harmonizing the energy flow [12]. In the view of traditional Chinese medicine, anxiety is mainly a result of an impairment of the heart and kidneys vital energy flow (and lack of communication between them) and a hyperactivity of liver Yang (active and heating force). Acupuncture, by the stimulation of specific trigger points, could, therefore, improve and alleviate this condition [13].

The objective of this literature review is to summarize clinical research regarding acupuncture in anxiety in the last 10 years to prove the efficacy and consistency of this technique in the treatment of this disorder. Acupuncture has rather recently branched into laser acupuncture and electroacupuncture. This review will only focus on acupuncture (A: body (BA) and auricular (AA)) and electroacupuncture (EA).

Section snippets

Literature search and inclusion criteria

A systematic search was performed on the months of July to September of 2017 (Fig. 1) on relevant electronic databases (B-On, PubMed, Scielo, Science Direct and Scopus) and included both the broad term ‘anxiety [all fields]’ AND ‘Acupuncture [all fields]’ OR ‘Electroacupuncture’ [all fields]. Results were limited to ‘human’ studies published from 2007 to 2017. Only peer-reviewed English-language publications were considered. Titles and abstracts were scanned to identify papers containing

Acupuncture or electroacupuncture for anxiety treatment

All 13 studies reported an anxiety decrease for their treatment group relative to the control groups. These results were consistent across clinical studies from different countries and cultures. Of the 13 papers selected, only one paper regarding electroacupuncture (EA) and anxiety was elected [16]. In fact, most of the papers found using EA keywords concerned animal studies or were study protocols. One other trial was found but was excluded due to the lack of confidence of the results as TENS

Discussion

The interest of researchers in the treatment of anxiety disorders using acupuncture is a worldwide trend, as observed by the country of origin of the selected studies for this review. This trend is supported by several factors such as growing knowledge on the anatomophysiologic mechanism of action of acupuncture, an empirical validation of acupuncture's benefits and results, and the growing interest of the general public regarding this therapy. Recent studies stress the safety of acupuncture

Conclusions

The information gathered in this systematic review leads to a first observation and conclusion that is that different methodologies (different acupoints, design, duration, type of acupuncture) lead to similar results which are decreased levels of anxiety. This fact urges for more research in this area to attest if the results are indeed a result of acupuncture therapy. For this purpose, parametrization of a method seems to be of paramount importance. The call for parametrization perhaps demands

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author disclosure statement

No competing financial interests exist.

References (37)

  • S. Goyatá et al.

    Effects from acupuncture in treating anxiety: integrative review

    Rev. Bras. Enferm. [Internet]

    (2016)
  • L. Arranz et al.

    Effect of acupuncture treatment on the immune function impairment found in anxious women

    Am. J. Chin. Med.

    (2007)
  • A. White

    A cumulative review of the range and incidence of significant adverse events associated with acupuncture

    Acupunct. Med.

    (2004)
  • C.M. Witt et al.

    Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form

    Forsch Komplementmed

    (2009)
  • R. Liebowitz et al.

    The Duke Encyclopedia of New Medicine: Conventional and Alternative Medicine for All Ages

    (2006)
  • N. Samuels et al.

    Acupuncture for psychiatric illness: a literature review

    Behav. Med.

    (2008)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    PLoS Med.

    (2009)
  • S. Zarei et al.

    Acupuncture decreases competitive anxiety prior to a competition in young athletes: a randomized controlled trial pilot study

    J. Compl. Integr. Med.

    (2016)
  • Cited by (88)

    • Acupoint stimulation for long COVID: A promising intervention

      2023, World Journal of Acupuncture - Moxibustion
    View all citing articles on Scopus
    View full text