Antidepressants Versus Acupuncture in Postpartum Depression

DepressionEvidence-based practice (EBP) is the use of the best current evidence and practices integrated into patient care. Using EBP when caring for a patient is considered to be best practice and the hope is that it results in good outcomes for the patient (Ignatavicius, Workman & Rebar, 2018). This paper will discuss the concept of using EBP in regard to the treatment of postpartum depression. It will compare a pharmacological treatment to a non-pharmacological treatment and discuss which treatment plan has been shown to be more successful in study samples.

Postpartum depression is a significant global health issue that affects about 26% of postpartum women in the United States. Of these, 10-15% have been found to deteriorate to a major depressive disorder (Komori, 2018). The effects of postpartum depression can be upsetting. In addition to the poor physical and emotional quality of life for the Mother, some studies have shown that Mothers with postpartum depression may experience poor bonding and interaction with their child and that there is a risk of cognitive impairment of the child (Komori, 2018). The specific pathophysiology of postnatal depression is believed to be due to the rapid hormonal changes taking place during the perinatal period along with the physiological and psychosocial stressors of pregnancy and early parenthood (Komori, 2018).

Studies have shown that inflammation and immunity are involved in the pathogenesis of depression and the process of acupuncture may help reduce the inflammation process (Wang et al., 2017). While acupuncture therapy in postpartum depression may not be widely studied, acupuncture is believed to significantly reverse general depression symptoms (Wang et al., 2017). The go-to method for treating postpartum depression due to its effectiveness is antidepressant medication therapy, however antidepressants do have some adverse effects and may present potential negative effects on the infant (Komori, 2018). Some women may not find this option to be preferable due to the side effects and risks and therefore will not be adherent to the treatment plan. Because postpartum depression is a serious topic that affects so many women and families, it is worth exploring all the EBP treatment options to provide women with information and choices.

PICOT is a question format that helps the nurse to develop answerable and researchable questions. Asking the right question is vital to effective EBP because it leads to discovering relevant evidence. A well-designed clinical question includes five parts, referred to as PICOT (Case Di Leonardi & Salmon, 2014). The five parts include the following: Person or population, intervention, comparison, outcome and time.

PICOT Question: In women with postpartum depression, is acupuncture therapy more effective than antidepressant therapy in controlling symptoms within a 6-month period?

This paper examines two studies that compared acupuncture with the oral antidepressant fluoxetine in the treatment of postpartum depression. All participants were women above the age of 18 years, without previous diagnosis of other psychiatric disorders or other serious physical illnesses. The studies used the Hamilton Depression Rating Scale (HDRS) which is a widely used clinician-administered depression assessment scale. In this scale, a score of 0-6 indicates no depression, a score of 7-17 indicates mild depression and scores about 18 indicate moderate to severe depression (Komori, 2018). In the first study, the control groups received fluoxetine and the experimental groups received acupuncture treatments five times per week. This study found that the acupuncture group had an effective rate (meaning HDRS scores were reduced) of 86.7% compared to the effective rate of fluoxetine of 73.3% (Komori, 2018). A second study concluded that the available evidence suggests that the early treatment of depression using both antidepressant and electroacupuncture therapies is more efficient than treatments with antidepressants alone and leads to a better and earlier control of symptoms (Zhang, et al., 2016).

Larger studies will need to be conducted in order to come to more comprehensive conclusions, but these two studies reported no significant differences between acupuncture and fluoxetine for depression. The scope of future studies may also consider broadening to include ante and perinatal depression, considering that around 50% of women who have postpartum depression also show symptoms in the antenatal period (Komori et al., 2018). There were no adverse effects noted in the acupuncture group, but in the fluoxetine group, there were four cases of nausea, four cases of decreased appetite and two cases of dizziness (Komori et al., 2018). The studies show that acupuncture is a well-tolerated treatment option with the potential for playing a role in treating postpartum depression. They show that acupuncture is a safer option for providers and mothers to consider in the postpartum period. Further studies may also consider cognitive behavior therapy and mindfulness in conjunction with acupuncture to see if that increases the benefits of acupuncture in postpartum depression.

In conclusion, this evidence-based practice research paper provides preliminary yet encouraging results showing that acupuncture as a treatment for postpartum depression can be effective. It gives the patients more information as they are making an informed decision about their care. This research is a stepping stone for further exploration on a solution to a common problem that affects many people and may prove to be a very valuable treatment in the future.

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