Acupuncture Anti-Inflammatory Effects on Post-Stroke Depression

Ask your competent? doctor to explain the mechanism of action since energy meridians have never been proven to exist.

 No mechanism of action is possible except as a placebo.

Acupuncture Anti-Inflammatory Effects on Post-Stroke Depression

 

A randomized clinical trial from clinicians affiliated with Nanjing University of Chinese Medicine reports that a six-week course of acupuncture produced clinically meaningful reductions in post-stroke depression severity comparable to escitalopram, while also shifting serum inflammatory markers in an anti-inflammatory direction, including lower IL-1β, IL-6, TNF-α, and IFN-γ and higher IL-10. At follow-up four weeks after treatment ended, the electroacupuncture (EA) group maintained lower depression scores than the escitalopram group, suggesting a short-term durability advantage after discontinuation of therapy. [1]

The study enrolled 150 adults aged 20–70 years with ischemic stroke confirmed by CT or MRI and mild-to-moderate post-stroke depression defined by a Hamilton Depression Scale–17 item (HAMD-17) score between 8 and 24. Participants were randomized to electroacupuncture with oral placebo or to escitalopram with sham electroacupuncture. Seventy-two participants in the EA arm and seventy-one in the escitalopram arm completed the protocol. Both groups continued standard secondary stroke prevention medications and rehabilitation programs, but acupuncture was not otherwise incorporated into routine rehabilitation care.

Clinical outcomes included clinician-rated and self-rated depression scales. In the electroacupuncture group, mean HAMD-17 scores decreased from 18.88 at baseline to 13.75 at week 6 and to 10.47 at the four-week post-treatment follow-up. In the escitalopram group, HAMD-17 scores decreased from 18.52 at baseline to 12.92 at week 6 and to 12.10 at follow-up. Self-rated depression assessed using the Zung Self-Rating Depression Scale (SDS) showed similar changes. EA reduced SDS scores from 62.06 at baseline to 48.18 at week 6 and 42.47 at follow-up, while escitalopram reduced SDS scores from 62.93 to 46.79 and 44.35 over the same time points.

Functional outcomes were assessed using the Modified Barthel Index (MBI), a scale measuring independence in activities of daily living. In the EA group, MBI scores increased from 58.54 at baseline to 69.44 at week 6 and 73.64 at follow-up. The escitalopram group improved from 59.82 to 70.44 and 74.87 over the same period. These functional improvements occurred alongside reductions in depressive symptoms in both treatment arms.

The electroacupuncture protocol was narrowly defined and fully reproducible. Four acupuncture points were used: GV20 (Baihui), GV29 (Yintang), LV3 (Taichong), and LI4 (Hegu), with LV3 and LI4 needled bilaterally. Electrical stimulation was applied between GV20 and Yintang and between ipsilateral LV3 and LI4. Patients were treated in the supine position after skin disinfection with iodophor.

Needle specifications and insertion techniques were explicitly reported. GV20 was needled using a 0.30 mm × 25 mm sterile disposable needle inserted at a 45-degree angle to a depth of approximately 15–20 mm. Yintang was needled with a 0.30 mm × 25 mm needle directed downward at a 15-degree angle to a depth of approximately 10–15 mm. LV3 and LI4 were needled perpendicularly using 0.30 mm × 40 mm needles to a depth of approximately 25–30 mm. Manual manipulation consisting of lifting, thrusting, and twirling was applied until deqi sensations were elicited.

Electrical stimulation was delivered using an electronic acupuncture apparatus. A alternating frequency of 2/15 Hz was used, with intensity adjusted to patient tolerance. Each session lasted 30 minutes and treatments were administered once daily, five days per week, for six consecutive weeks, totaling 30 sessions. All treatments were performed by a licensed acupuncture physician with more than ten years of clinical experience.

The escitalopram group received oral escitalopram at a dose of 10–20 mg daily for 40 days and concurrent sham electroacupuncture. Sham needling used 0.30 mm × 15 mm needles inserted superficially to a depth of 3–5 mm at sites located 0.5–1.0 cm away from the true acupuncture points. Electrodes were attached, but electrical output was set to zero. [1]

Objective biological outcomes focused on inflammatory cytokines. Fasting venous blood samples were collected at baseline and within 48 hours after completion of the six-week intervention. Serum IL-1β, IL-6, IL-10, TNF-α, and IFN-γ levels were measured using immunofluorescence on a BD FACSCanto II flow cytometer. In the electroacupuncture group, IL-1β decreased from 10.59 to 5.62 pg/mL, IL-6 decreased from 36.21 to 23.16 pg/mL, TNF-α decreased from 12.94 to 7.37 pg/mL, and IFN-γ decreased from 15.52 to 10.11 pg/mL. IL-10 increased from 10.12 to 17.22 pg/mL. These are beneficial effects since the aforementioned cytokines are pro-inflammatory with the exception of of IL-10, which is anti-inflammatory. [1]

Comparable cytokine shifts were observed in the escitalopram group, with IL-1β decreasing from 10.99 to 6.14 pg/mL, IL-6 decreasing from 36.57 to 22.13 pg/mL, TNF-α decreasing from 12.93 to 7.49 pg/mL, IFN-γ decreasing from 16.06 to 10.58 pg/mL, and IL-10 increasing from 9.49 to 16.75 pg/mL.

Adverse events were mild and self-limited. In the electroacupuncture group, four participants experienced localized pain or hematoma at needle sites. In the escitalopram group, dizziness and drowsiness were reported, and several participants experienced short-lived discontinuation symptoms lasting less than 48 hours. No serious adverse events occurred.

This trial demonstrates that a focused acupuncture protocol delivered at high frequency can reduce depressive symptoms after ischemic stroke while producing measurable reductions in proinflammatory cytokines. For licensed acupuncturists, the study provides a clearly defined point prescription, needle specifications, stimulation parameters, and treatment frequency associated with both clinical and biological effects in post-stroke depression. [1]

Reference:

1. Ma, Feixiang, Guiping Cao, Lu Lu, Yingling Zhu, Wanlang Li, and Li Chen. “Electroacupuncture versus Escitalopram for Mild to Moderate Post-Stroke Depression: A Randomized Non-Inferiority Trial.” Frontiers in Psychiatry 15 (2024): Article 1332107.