Study data published in JAMA Network Open support the efficacy of electroacupuncture for the treatment of insomnia in patients with depression. Compared with a placebo, electroacupuncture was associated with significantly improved sleep quality over 32 weeks of follow-up.
This randomized controlled trial was conducted from September 1, 2016 to July 30, 2019 at 3 tertiary hospitals in Shanghai, China. The study enrolled patients aged 18 -to 70 years who met the diagnostic criteria for both depression and insomnia. Eligible patients were randomly assigned in a 1:1:1 ratio to receive 8 weeks of electroacupuncture plus standard care, sham acupuncture plus standard care, or standard care only.
Acupuncture was administered 3 times a week, for a total of 24 sessions. The 8-week intervention period was followed by a 24-week observational period. The primary outcome was change in the Pittsburgh Sleep Quality Index (PSQI) from baseline to week 8. Secondary outcomes included changes in the PSQI at weeks 12, 20, and 32, respectively; sleep parameters as recorded by actigraphy; the Insomnia Severity Index; the 17-item Hamilton Depression Rating Scale (HDRS-17) score; and the Self-rating Anxiety Scale score.
The intention-to-treat analysis included 270 patients of mean age 50.3±14.2 years, among whom 194 (71.9%) were women and 76 (28.1%) were men. Overall, 247 (91.5%) patients completed all outcome measurements at week 32, while 23 (8.5%) dropped out of the trial.
At week 8, the electroacupuncture group had a mean reduction of -6.2 points (95% CI, -6.9 to -5.6) in PSQI score from baseline, indicating substantial improvements in sleep quality. Week 8 PSQI scores were significantly reduced in the electroacupuncture group compared with the sham acupuncture (-3.6; 95% CI, -4.4 to -2.8) and standard care groups (-5.1; 95% CI, -6.0 to -4.2) (both P <.001). The PSQI improvements observed in the electroacupuncture arm were sustained over 24 weeks of follow-up.
Electroacupuncture was also associated with substantial reductions on the HDRS-17 (-10.7 point change; 95% CI, -11.8 to -9.7), Insomnia Severity Index (-7.6; 95% CI, -8.5 to -6.7), and Self-Rating Anxiety Scale (-2.9; 95% CI, -4.1 to -1.7) at 8 weeks. Total sleep time per actigraphy increased by a mean value of 29.1 (95% CI, 21.5-36.7) minutes after 8 weeks of electroacupuncture. At week 24, the electroacupuncture group had significantly lower HDRS-17 scores compared with the sham acupuncture (−5.8; 95% CI, −6.8 to −4.7) and standard care (-5.8; 95% CI, −7.1 to −4.5) groups (P <.001). There were some acupuncture-related unfavorable events which happened in 7 patients (7.8%) in the electroacupuncture group and 4 patients (4.4%) in the sham acupuncture group. The most common adverse events were hematoma and local pain. No severe side effects were observed.
These data support the efficacy of electroacupuncture as an insomnia treatment for patients with comorbid depression. Compared with control conditions, electroacupuncture was associated with greater improvements in sleep quality, sleep duration, and depression symptoms. As study limitations, the investigators noted that the study was not double-blinded; acupuncturists were aware of assignment due to the treatment procedure. Further, actigraphy data were limited.
“Our findings constitute subjective and objective evidence of the efficacy and safety of [electroacupuncture] with standard care in treating comorbid depression and insomnia compared with [sham acupuncture] with standard care or standard care alone,” investigators wrote. “Further studies should focus on a longer treatment period with precise objective outcome assessment.”
Yin X, Li W, Liang T, et al. Effect of electroacupuncture on insomnia in patients with depression: a randomized clinical trial. JAMA Netw Open. 2022;5(7):e2220563. doi: 10.1001/jamanetworkopen.2022.20563