The National Institue of Clinical Excellence is about to release updated guidelines for depression, and acupuncture is included!
The National Institute of Clinical Excellence (NICE), the group that advises the NHS on effective treatment strategies is updating it’s guidelines of depression and acupuncture has got a mention.
The good news: NICE, ‘agreed that [acupuncture has] potentially promising results’.
The less good news: No guidelines have been issues for acupuncture. This is a shame as acupuncture has a large body of research supporting its beneficial effects on depression, its lack of side-effects and its cost effectiveness when treating depression. So much so that The World Health Organisation states, ‘acupuncture has been proved – through controlled trials – to be an effective treatment’.
At a time when there is more and more burden on the NHS you would think that any treatment that offered at least as much benefit as drugs, without the side-effects and is cost effective would be snapped up.
Why isn’t acupuncture in the guidelines?
So why has NICE decided to not add clinical guidelines for acupuncture for depression? Because, ‘they did not feel able to make recommendations on the basis of the available evidence as they had concerns about the generalisability of the intervention.’ On one hand this makes sense, if you follow the reductionist logic that depression is a definable set of symptoms with identical underlying pathophysiology. However, drawing that logic out to its extreme it would also state that each individual with depression is identical, presenting with an identical set of symptoms and underlying biology. This is simply not the case. We are individuals with highly variable presentations and idiosyncrasies. Especially in the case of depression which often comes with a raft of other pathologies, including chronic pain and insomnia.
Acupuncture could be useful here as it we treats individuals as individuals, taking into account all of their manifold presentations and adapting the treatments suitably and, as research shows, effectively. In complex presentations, acupuncture could be effective as it is also shown to be effective for some chronic pain conditions and insomnia, again without side-effects and, importantly for the NHS, cost-effectively.
The British Acupuncture Council’s response
So the British Acupuncture Council (BAcC) submitted a response to this decision, the full version is available here. In it BAcC accuses NICE of ‘not ensuring a level playing field’, citing the decision to include Behavioural Couples Therapy, which has no cost-effectiveness data and a lesser amount and lower quality of evidence for it. The BAcC also mentions comorbidities, for which acupuncture research has shown is equal or superior to psychological therapies and pharmacological treatments, yet is not considered in the guidelines. Similar choices were enacted in NICE’s recent review of backpain, from which acupuncture was removed, even though there was more evidence than when it was first included.
For more information on acupuncture for multiple conditions and, indeed its recommendations from national and international health organisations, visit my blog
There is also great resource compiling research into acupuncture that is worth a visit – Evidence Based Acupuncture