Acupuncture: A Promising Approach for Comorbid Depression and Insomnia in Perimenopause

Abstract

Comorbid depression and insomnia are ubiquitous mental complaints among women going through the perimenopausal stage of life and can result in major decline in quality of life. Antidepressive agents combined with/without hypnotics, and/or hormone therapy are currently the most common treatment for perimenopausal depression (PMD) and insomnia (PMI). Balancing the benefits of these pharmacotherapies against the risk of adverse events (AEs) is a difficult task for both clinicians and women. There has been a growing body of research regarding the utilization of acupuncture for treatment of PMD or PMI, whereas no studies of acupuncture for comorbid PMD and PMI have appeared. In this review, we summarize the clinical and preclinical evidence of acupuncture as a treatment for PMD or PMI, and then discuss the potential mechanisms involved and the role of acupuncture in helping women during this transition. Most clinical trials indicate that acupuncture ameliorates not only PMD/PMI but also climacteric symptoms with minimal AEs. It also regulates serum hormone levels. The reliability of trials is however limited due to methodological flaws in most studies. Rodent studies suggest that acupuncture prolongs total sleep time and reduces depression-like behavior in PMI and PMD models, respectively. These effects are possibly mediated through multiple mechanisms of action, including modulating sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis/hypothalamic-pituitary-ovary axis, oxidative stress, signaling pathways, and other cellular events. In conclusion, acupuncture is a promising therapeutic strategy for comorbid depression and insomnia during perimenopause. Neuroendocrine modulation is likely to play a major role in mediating those effects. High-quality trials are required to further validate acupuncture's effectiveness.

The Efficacy and Safety of Acupuncture for Depression-Related Insomnia: Protocol for a Systematic Review and Meta-Analysis

“… 10 , 40 Although the mechanisms underlying acupuncture for treating depression-related insomnia are not fully elucidated, as a key component of traditional Chinese medicine, acupuncture is likely to work through multi-level and multi-target pathways, and the therapeutic effect of acupuncture on depression-related insomnia is possibly mediated through a variety of actions and mechanisms, such as modulating neurotransmitter, oxidative stress, signaling pathways, hypothalamic-pituitary-adrenal axis, and other cellular events. 40 For instance, experimental studies reveal that the antidepressant-like effect of acupuncture can be mediated by inhibition of inflammatory mediators via modulation of NF-κB in the prefrontal cortex and hippocampus. 41 The present study has several advantages to be addressed as follows.…”

Effect of Electroacupuncture on Insomnia in Patients With Depression

“…Acupuncture has been regarded as a potentially effective drug-free approach for helping to treat mental illness and sleep disorders. 17 , 18 , 19 A previous study 20 demonstrated that acupuncture effectively improves sleep efficacy and prolongs total sleep time in patients with primary insomnia. A pilot study on electroacupuncture (EA) for the treatment of depression-related insomnia 21 found that patients experienced significant improvement in sleep quality after receiving EA treatment during a 12-week study period.…”

Acupuncture combined with SSRIs in the treatment of perimenopausal depressive disorder

“…[ 13 ] Acupuncture treatment upholds a holistic concept, so it can regulate and treat PDD at multiple levels, links, and targets, such as regulation of sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-ovarian axis, oxidative stress, signaling pathways, and other cellular events. [ 14 ] Acupuncture can compensate for the inability of SSRIs to address multisystem disorders in PDD. Unluckily, acupuncture is difficult to achieve short-term results for severe depressive disorder.…”

“…The combination of acupuncture and SSRIs in the treatment of depressive disorder has been proven to have increased efficacy and reduced side effects, which may provide a new direction for clinical treatment [13] . Acupuncture treatment upholds a holistic concept, so it can regulate and treat PDD at multiple levels, links, and targets, such as regulation of sex hormones, neurotransmitters, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-ovarian axis, oxidative stress, signaling pathways, and other cellular events [14] . Acupuncture can compensate for the inability of SSRIs to address multisystem disorders in PDD.…”