Efficacy and Safety of Auricular Acupuncture for Depression: A Randomized Clinical Trial

• Published in: JAMA network open 2023-11, Vol.6 (11), p.e2345138
• Main Authors: de Oliveira Rodrigues, Daniel Maurício, Menezes, Paulo Rossi, Machado Ribeiro Silotto, Ana Elise, Heps, Artur, Pereira Sanches, Nathália Martins, Schveitzer, Mariana Cabral, Faisal-Cury, Alexandre
• Format: Article
• Language: English
• Subjects: Acupuncture; Acupuncture Therapy; Acupuncture, Ear; Adult; Brazil; Clinical trials; Depression - therapy; Depressive Disorder; Female; Humans; Mental depression
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2023.45138

Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple, low-cost, and well-tolerated option, but further studies are needed to establish its efficacy and safety. To estimate the efficacy and safety of auricular acupuncture as a treatment for depression. This randomized clinical trial was conducted at 4 university research centers in Brazil, from March to July 2023. Eligible patients were adults aged 18 to 50 years whose score on the Patient Health Questionnaire-9 (PHQ-9) indicated moderate depression (score 10-14) or moderately severe depression (score 15-19). Exclusion criteria included previous application of AA, risk of suicidal ideation, or severe depression (PHQ-9 score >20). An intent-to-treat analysis and modified intent-to-treat analysis were conducted. Participants were randomized into 2 treatment groups, which included specific AA (SA) and nonspecific AA (NSA). Both groups received 12 sessions of AA with semipermanent needles with daily stimulation twice a week over 6 weeks and were followed-up for 3 months. All participants continued with their usual care for ethical reasons. The SA group's treatment protocol consisted of 6 acupuncture points on the auricular pavilion chosen according to the diagnosis of depression by traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver, and kidney). The NSA group's acupuncture points were the external ear, the cheek and face area, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm which areas had neuroreactive points. The primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months. Secondary outcomes included depression recovery at 4 and 6 weeks; depression remission (PHQ-9 score