Published on 09-29-2015
Around 18% of people who have a stroke or TIA end up experiencing varying degrees of depression. This can be due to changes in the brain, of course, but also the anger, frustration, and other associated emotions involved in trying to regain functioning. Further there is some overlap between pre-existing cases of depression being a possible contributor to stroke - which may then end up worsening.
A group of researchers from Duke University in the US published a study a few years ago said that nearly 70% of all patients experiencing depression following a stroke or TIA were not being treated at 3, 6 and 12 month follow ups.
Acupuncture is commonly used for stroke rehabilitation, and there are many unique protocols, one within our Tam Healing System. There is an interesting DVD which shows one mans rehabilitation process through acupuncture from a stHe journeyed to China to the well known stroke center at Tianjin University, where he received daily treatment and walked out nearly unaided.
Technically speaking stroke can be related to Liver Qi Stagnation which theoretically better explains the overlap between stroke and depression both pre-existing and post-stroke depression (there are other patterns, but this is a likely one). For general information on the liver system in Chinese Medicine, you can read "My Liver is What?" or for the basics of how we treat causal patterns and not symptoms in Chinese Medicine, you can read "What Does Acupuncture Treat?".
One of the items which makes acupuncture effective for treating stroke is the broader range of effects it has. In other words, in general by treating the pattern you would already account for either outright depression or even a tendency towards depression when working with a stroke patient. Specific to this discussion, however, is what should physicians be recommending to patients with depression following a stroke?
In the parts of the world where western medicine is the dominant medicine, the treatment would often involved anti-depressant medication. In parts of the world where complementary approaches (i.e. eastern and western medicine) are more common, the approaches may vary more widely from acupuncture, to Chinese herbal medicine, to medical qigong, to combinations.
The study I wanted to discuss today was a single-blind, double-simulated controlled clinical trial comparing the overall effectiveness and the quickness of effect between fluoxetine (Prozac) and TCM style acupuncture. In this study researchers from the Changhai Hospital of Traditional Chinese Medicine recruited 68 patients from the inpatient wards in their neurology and rehabilitation departments.
Patients in either group were treated daily for 6 weeks. They were evaluating using a range of depression scales before treatment started, then at week 2, week 6 and a 3 month follow up.
The researchers found that both groups did well, but the acupuncture group responded quicker and had fewer side effects. They concluded that, "Body acupuncture was effective in reducing stroke patients' depressive symptoms and had fewer side-effects. It should be considered as an option for neuropsychiatric sequelae of stroke".
This is a very good result which can limit the patient from requiring another medication. This is important in my mind to avoid further side effects and/or cognitive issues (flat line emotions, etc.) which could confuse practitioners at treatment trying to judge what is from the medicine and what is from the stroke.
As with most studies, you would get broader and cleaner results by most clinical accounts by treating correctly (i.e. without a fixed protocol such as those in studies). Some of the protocols linked to above give ideas on how to approach this. Regardless, acupuncture seems like a good option to avoid side effects and obtain faster results for clinical depression following a stroke. Other studies should be done to see if treatment would be needed daily vs. weekly (as done in many clinics) or some variation. These will undoubtedly be explored further as the cost of stroke to the healthcare system (~$70 billion/year in the US) could be greatly decreased by using complementary approaches.
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Patterns: liver qi stagnation
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