This is a personal story about what happened to me when I was given a PhD fellowship award, as an acupuncture practitioner, to research depression in 2003, by the National Institute of Health Research
My first experience of acupuncture was in the 1980s when a friend who suffered with depression had her life turned around by a course of treatment, never to look back. I was motivated to try acupuncture myself and later to study it.
There are some crucial differences between acupuncture, which is a ‘traditional medicine’, and many other complementary therapies, as compared with conventional or allopathic medicine. Such characteristic features and differences are important to consider when evaluating whether the therapy can work. One premise that governs and guides our work is that of strengthening the body and person. Generally speaking, we also take a more person centred holistic approach without a clear dichotomy between body and mind, which is what first attracted me to acupuncture – choosing to study this instead of continuing a career path in the field of clinical psychology.
Evidence based medicine sounds great in theory but there are also serious limitations in that political, cultural and social factors play a huge and unacknowledged role in what is studied, who conducts research, how the research is carried out and finally how it is assessed/who evaluates the evidence for inclusion in guidelines and for policy guidance.
Much of what we do as acupuncturists, or in fact any form of treatment, may be down to what is called ‘placebo’. There is much uncertainty and debate about how best to deal with this in clinical research. Different sorts of clinical trials answer different questions. A pragmatic trial answers real world questions and is of great value to patients, doctors and funders when an intervention or treatment is already widely used – as acupuncture is. The research I was funded to conduct for my PhD was to inform the design of a pragmatic or real world study.
Depression is often an illness or condition that stops a person from being able to work. There are health inequality issues with depression that need to be considered in the context of the NHS where a basic tenet is equality of access. Acupuncture is not available on the NHS for depression. Acupuncture is available on the NHS but it is generally provided by medics and physiotherapists who employ simplified forms of treatment that are not based on traditional Chinese medicine theories. These health professionals are not usually equipped to treat depression. In conducting this research I hoped to give so many of my colleagues, many of whom struggle to earn a living in the UK, a chance to do invaluable therapeutic work that made use of their skills, training and knowledge. I hoped to help build a credible evidence base so that acupuncture could be better understood as a depression intervention, and more accessible to people in the UK who suffer with this condition, when the available treatments for their condition were not working very well.
My research position, which was funded by the National Institute for Health Research, was part of a ring fenced funding scheme to build research capacity. Practitioners of complementary medicine, working outside the NHS, do not get the same opportunities to be involved with research as conventional medicine counterparts – doctors, nurses and those working in the allied health professions.
Four years later I had done all that was asked and expected including conducting a pilot trial involving forty patients – to inform the full scale trial. This had been a lot of research for a PhD but I managed to complete it all just before my contract finished. At just this point I was matched with a child for adoption from the UK care system. For many years I had wanted to be a mother and finally this dream was to be realised. But my employers decided not to support my career at this critical juncture and I was made redundant in a traumatic manner on the last day before my adoption leave started. The management, the human resources department at the university, and the NIHR funders, who informed me I was the first person to adopt on this NIHR fellowship award scheme, had no grasp of the impact of redundancy in this situation, and no one seemed to care what would happen to the adoption. It was beyond stressful and I feared for our future, just as I needed to feel secure and convey a sense of safety and permanency, to my young son. But afterwards things just got worse.
There were so many people taking my work forwards who would not communicate with me about it. I wrote, in desperation, to the chair of the trial steering committee asking to have a voice about matters of concern, and to be heard in some way – but I was persona non grata to this individual, who responded to say that decisions had been taken by the committee, and that was that. I would be playing no role from now onwards.
The concerns I wished to be thought about were emerging from my PhD research, and were really important. Was the course of treatment right for the patients under consideration? Was it enough? Would it privilege one form of care over another because they work in different ways? Were acupuncturists being made aware of the possibility of causing a patient with severe depression temporary distress because of overstimulation? How was this all being dealt with?
It was a systemic failing that I was given no proper opportunity to talk about the preparatory trial findings – other than for purposes of my thesis being completed and publications coming out of it – as if it were purely an academic excercise. My professional body, the British Acupuncture Council, could be of little help, and the British Association of Counselling and Psychotherapy was of no help whatsoever as I tried to influence the way the research was taken forwards from outside the system. I might as well have been screaming to the wind. It was, frankly speaking, extremely distressing for me, given the responsibility I felt to patients; to help my profession, and to try to take knowledge forwards about an illness that blights so many lives.
The final research article, published in the BMJ in 2014, identified that acupuncture had some advantages over counselling and usual care, with a brief course of treatment, at three months:
“Patients with depression and pain at baseline recovered less well from treatment over 3 months than those with depression and no pain. Reductions in both depression and pain were most marked in the acupuncture group, followed by the counselling group and then the usual care group.” Hopton et al (2014) Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial, BMJ
In terms of the research findings and what these mean for people thinking about acupuncture in the context of depression treatment – the ACUDep trial was a large scale definitive trial with over 700 patients. Despite this we seem to be nowhere nearer to acupuncture being available on the NHS for depression for people who cannot afford private treatment than we were in 2003, when my journey to study depression began.
If you are suffering with depression and thinking about using acupuncture, then there is definitely good evidence it may be beneficial. Please do find a practitioner near you and just start to use acupuncture – if you can afford it. Take this article to your GP if you can’t, and draw their attention to the research that is done.
The real strength of acupuncture (and some other forms of non-conventional healing), is that our treatment approach – talking to our clients about their lives and using traditional diagnostic methods based on a different conception of the body mind, can help us understand what may go wrong in future – or where someone is a bit out of balance. A few carefully placed needles and you can be back on track – with more energy and a bit of hope. There are many different forms and methods of doing acupuncture, which is essentially, like counselling, a relational medicine, built on the understanding and connection between client and therapist. For many people acupuncture may not be the whole solution – but it can help you along, and in a different way to counselling and talking therapies, which may not be much good if you find it a struggle to talk, as many people with depression can do. I really encourage you to try acupuncture alongside other different approaches and therapies – especially if you suffer pain symptoms alonside depression. Find what works for you. Let me know how you go.
In terms of academia, I really hope things can improve in future with more commitment shown to junior researchers embarking on a research career, especially adopters, and much better support for for complementary therapy practitioners. In the meantime I continue with and love doing clinical work. If anyone wants to talk to me about acupuncture as a treatment for depression, and what I have learned from my years of research – please get in touch. I would be very grateful for the chance to be able to put my knowledge, skills and training to some use and I hope one day I might be able to do this – working with people who respect and value what I have to offer as a researcher, with an understanding of acupuncture and complementary therapies, gained over many years of clinical practice.