Electroacupuncture: A novel treatment for anxiety disorder.
Hagen Rampes, Senior Registrar, Barnet Psychiatric Unit, Barnet General Hospital, Wellhouse Lane, Barnet, Herts, EN5 3DJ, UK. |
Jonathan R T Davidson, Professor, Department of Psychiatry & Behavioural Science, Duke University Medical Centre, Durham, North Carolina 27710, USA |
Summary
A 33 year old female who suffered from a generalised anxiety disorder was treated successfully with electroacupuncture. This is the first report of the use of electroacupuncture in the treatment of anxiety. The mechanism of action of electroacupuncture may be via modulation of neurotransmitters.
Key words
Anxiety; electroacupuncture; case report
Introduction
Anxiety disorders are common and cause considerable morbidity. Contemporary treatment approaches involves psychological and biological methods. Pharmacological treatments predominantly involve the use of benzodiazepines, azaspirones and antidepressants. The use of these drugs is not without problems: unpleasant adverse reactions and more importantly dependence and abuse. Moreover some pharmacological interventions may be expensive. Complementary Medicine is becoming more popular with the public and professionals. A survey (1) in 1990 revealed that Americans made an estimated 425 million visits to providers of unconventional treatments. Among all the medical conditions studied in the survey, anxiety disorders were the second most common. Acupuncture was one of 18 therapies listed in the survey. Medical acupuncture involves inserting needles either into acupuncture points or tender points in the skin. These points can be further stimulated by manipulation of the needle, applying heat to the needles (moxibustion) or by applying current to a pair of needles (electroacupuncture). There are no previous reports of the use of electroacupuncture to treat anxiety in the indexed literature.
We wish to report a case of generalised anxiety disorder which was successfully treated by electroacupuncture.
Case report
A 33 year old woman was referred to the outpatient clinic with a history of worsening anxiety. These episodes of anxiety would come on gradually and last for several hours. The patient had these episodes intermittently over the last 9 years. She had used lorazepam with success in the past to alleviate her anxiety. However she did not wish to take medication on this occasion. There was no family history of psychiatric illness. Her childhood was an unhappy one due to parental marital disharmony. She left school aged 16 with average qualifications. She had worked with a major company as an engineer since the age of 18. Her first marriage lasted seven years. Her most recent relationship lasted two years and ended two months prior to being seen. She has two young children from her first marriage. She lives in her own home and has financial debts incurred by her last boyfriend. She has never abused any illicit substances. Mental state examination revealed a tall, blond, young, white female who was casually and appropriately dressed. She had appropriate eye contact but sat uncomfortably and was restless during the interview. Her mood was anxious. There was no evidence of a depressive illness. Her speech was coherent and spontaneous. There were no obsessional phenomena present. Her cognitive functions were intact and insight was present. A diagnosis of generalised anxiety disorder was made. Treatment options were discussed with her and a course of electroacupuncture offered and accepted by the patient.
Method
Sterile disposable acupuncture needles (0.5" length and 0.22mm diameter) were inserted at the following acupuncture points: Bilaterally at Liver 3, Spleen 6, Stomach 36, Large Intestine 4 and Triple Heater 16. A needle was also inserted at Conception Vessel 13. The names of the points refer to supposed "meridians" and the numbers refer to the location on the meridian. These acupuncture points are regarded as "nervous tension points" and used as standard treatment. An electric current (square wave, frequency of 50 Hertz) was applied bilaterally to the needles at Large Intestine 4. The intensity of the current was slowly increased until the patient felt either a tingling or warm sensation at the needle site. Treatment duration was for thirty minutes and carried out once a week for six weeks. The treatment was carried out with the patient reclining in a comfortable chair. Conversation with the acupuncturist (HR) was minimal during the treatment sessions as is standard practice for this form of treatment. The 30 item General Health Questionnaire (2) and the Zung Self Rating Anxiety Scale (3) were administered at baseline, 8 weeks, 3 months and 6 months.
Results
The General Health Questionnaire and Zung Self Rating Anxiety Scale scores both reduced substantially after the treatment intervention (see Table 1).
Table 1 Scores of General Health Questionnaire (GHQ-30) and Zung Self Rating Anxiety Scale (SAS).
GHQ | SAS | |
Baseline | 25 | 55 |
8 Weeks | 8 | 31 |
3 Months | 14 | 26 |
6 Months | 0 | 21 |
The patient was followed up at 3 and 6 months from the original referral and continued to improve without any further electroacupuncture. There was initial improvement in the severity and frequency of her anxiety attacks. Following the third acupuncture treatment there was transient deterioration in her symptoms. There were no external factors to account for her deterioration. After the fourth acupuncture treatment she was much improved and at the end of the course of treatment she was almost symptom free. She remained well at three months and was discharged from the clinic.
Discussion
Anxiety disorders do of course wax and wane and a spontaneous resolution may be a possible explanation for the improvement in the above patient's mental state. The novel treatment, which includes needles being inserted and being wired up to an electronic machine may of course constitute a powerful way of eliciting the placebo response. Finally the act of simply sitting quietly for 30 minutes once a week for 6 weeks may have been akin to a form of meditation and may be a contributing factor. Although non specific factors have contributed to the treatment, we think that electroacupuncture as described above did have a specific therapeutic benefit. The patient did not report any adverse reactions of the treatment. Electroacupuncture should not be used in those patients who have a pacemaker as there is a theoretical risk of malfunction of the pacemaker (4). Basic research on animals and humans have demonstrated that electroacupuncture modulates neurotransmitters (5). The type and proportion of substances modulated depends on the frequency of the current. Low frequency (4 Hz) releases endorphins and enkephalins. High frequency modulates 5-hydroxy tryptamine, dopamine and noradrenaline. We suggest that electroacupuncture should be further researched. Its role in psychiatry looks promising if indeed it modulates 5-hydroxytryptamine.
Acknowledgement We thank Dr. A. Sanderson, Consultant Psychiatrist, South Bedfordshire Community Health Care Trust, U.K., for permission to report our findings.
References
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2. GOLDBERG DP. The detection of psychiatric illness by questionaire. Oxford University Press, 1972.
3. ZUNG WWK. A rating instrument for anxiety disorders. Psychosomatics 1971: 12: 371-379.
4. RAMPES H, JAMES RC. Complications of acupuncture. Acupuncture in Medicine 1995: 13: 26-33.
5. HAN JS. Electroacupuncture: an alternative to antidepressants for treating affective diseases? Int J Neurosci 1986: 29: 79-92.
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