Acupuncture treatment combined with antidepressants can improve the treatment of depression, according to a study published online this July in NeuroImage: Clinical. The findings point to an effect on the limbic system, especially the amygdala and the anterior cingulate cortex.

Acupuncture has recently become a promising and effective alternative treatment for depression. Research suggests that it may work by affecting the release of the neurotransmitters norepinephrine, serotonin, and dopamine, all of which play a role in the processes involved in depression. However, acupuncture is still not incorporated into mainstream medicine.

One solution is to combine acupuncture with other treatments. For example, increasing evidence has shown that acupuncture combined with antidepressant medications is more effective than antidepressants alone. However, there is a need to develop understanding of how this works within the brain.

Many brain regions are involved in the pathology and development of depression (e.g. major depressive disorder), in which the amygdala appears to play an important role. The amygdala is part of the limbic system, and is important for emotional processing, fear learning, and motivation behaviors. For example, research has shown that major depressive disorder patients show higher activity in the amygdala when processing negative information, and that antidepressant medication works by decreasing activity in the amygdala during negative emotions and increasing activity during positive emotions.

The study, led by Xiaoyun Wang of the Traditional Chinese Medicine Hospital of Guangdong province, investigated the combination effect of abdominal acupuncture and the antidepressant fluoxetine (Prozac) on the clinical outcome of depression. 46 female depressed patients were randomized to an acupuncture + fluoxetine group or a sham acupuncture + fluoxetine group for 8 weeks. For the sham acupuncture, plastic needle sheaths not containing any needles were tapped against the skin of the patients. Before the first and last treatments, resting-state functional connectivity data was collected using functional magnetic resonance imaging (fMRI), and measures of clinical depression were also recorded.

Results showed that compared with those in the sham acupuncture treatment, acupuncture treatment patients showed greater clinical improvement in depression. They also showed increased resting-state functional connectivity between the left amygdala and anterior cingulate cortex (ACC), and the right amygdala and left parahippocampus/putamen. Furthermore, the strength of the increases was positively associated with improvement in measures of clinical depression.

The researchers concluded, “Our findings demonstrate the additive effect of acupuncture to antidepressant treatment and suggest that this effect may be achieved through the limbic system, especially the amygdala and the ACC.”