Safe Treatment for Depression in Pregnancy!

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From Medscape Medical News
Acupuncture May Successfully Lift Depression in Pregnant Women

Nancy Fowler Larson
February 9, 2010 (Chicago, Illinois) — Acupuncture might be an effective method of treating depression in pregnant women, according to a study presented here at the Society for Maternal-Fetal Medicine (SMFM) 30th Annual Meeting: The Pregnancy Meeting.

Approximately 10% of women who are pregnant have clinical depression. Of those, 20% experience worsened symptoms during pregnancy. Although this rate of depression is similar to that of postpartum and nonpregnant women, concerns about using antidepressants leave pregnant women with few alternatives, lead investigator Rachel Manber, PhD, from the Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine in California, told Medscape Ob/Gyn and Women's Health.

"Women who are depressed during pregnancy need more options that don't involve medication," said Dr. Manber.

A total of 150 women who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depressive disorder participated in the study. They were randomized into 3 groups:

52 women received acupuncture for the specific purpose of relieving depression (SPEC group)
49 women received acupuncture without a stated purpose and served as a control group (CTRL group)
49 women received massage therapy and served as a second control group (MSSG group).
All women underwent 12 sessions of their particular therapy during an 8-week period. During the acupuncture sessions, junior acupuncturists who were masked to treatment needled the participants at points determined earlier by senior practitioners. Patients who received massage and their masseuses were not blinded.

The primary measurement of outcome was the Hamilton Rating Scale for Depression, administered by blinded raters at baseline, after 4 weeks, and again at 8 weeks. The results were as follows:

The severity of depression in the SPEC group was significantly lower (P < .05) than that in the CTRL group (P < .05; Cohen′s d = 0.46; 95% confidence interval [CI], −1.24 to 2.31) and in both control groups combined (Cohen′s d = 0.39; 95% CI, −1.31 to 1.65).
Those in the SPEC group also had a higher rate of response (63.0%) than those in the CTRL group (37.5%; P < .05; number needed to treat [NNT], 3.9; 95% CI, 2.2 to 19.8) and those in both control groups combined (44.3%; P < .05; NNT, 5.3; 95% CI, 2.8 to 75.0).
Between control groups, reduction of symptoms and response rates did not vary greatly (37.5% for CTRL and 50.0% for MSSG groups).
Of the 150 participants, 43 reported mild and temporary adverse effects (4 in MSSG, 19 in CTRL, 20 in SPEC). A much smaller number of the MSSG women reported adverse effects than in the other 2 groups (P < .01). Acupuncture adverse effects included discomfort at the acupuncture sites in some subjects and slight bleeding in 1 participant.

No placebo effect is indicated by the findings. "There was no difference whether the subjects believed in acupuncture or not," according to Dr. Manber. She and her colleagues concluded that acupuncture could be a viable choice for pregnant women who do not wish to take medication.

Dr. Manber noted 1 limitation of the study — that the practitioner who evaluated the subjects for acupuncture was not the same one who administered the procedure, a situation that differs from that of an actual acupuncture session.

George Macones, MD, MSCE, chair of the Ob/Gyn department at Washington University in St. Louis, Missouri, and program chair of the SMFM conference who reviewed the study abstract for the American Journal of Obstetrics and Gynecology, said the findings are too premature to advise any patient to discontinue medication during pregnancy. But, in an interview with Medscape Ob/Gyn and Women's Health, Dr. Macones said he would offer acupuncture as an option to women with unmedicated depression.

"If a patient said, 'I'm really reluctant to start a medication, is there anything else you could offer to me?' I probably would be willing to discuss acupuncture with someone in that group," Dr. Macones said.

The Agency for Healthcare Research and Quality supported the study. Dr. Manber and Dr. Macones have disclosed no relevant financial relationships.

Society for Maternal-Fetal Medicine (SMFM) 30th Annual Meeting: The Pregnancy Meeting: Abstract 8. Presented February 4, 2010.

Authors and Disclosures
Journalist

Nancy Fowler Larson

Nancy Fowler Larson is a freelance writer for Medscape.

Medscape Medical News © 2010 Medscape, LLC
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Society for Maternal-Fetal Medicine (SMFM) 30th Annual Meeting: The Pregnancy Meeting

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