Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial

Insomnia and depression are conditions that often go hand in hand, creating a harmful cycle in which one worsens the other. In Brazil and around the world, millions of people face this dual condition, which can be more challenging to treat than each problem in isolation. Patients with depression and insomnia have a higher risk of suicidal ideation and difficulties in social functioning, in addition to a higher chance of relapse of depression. Although pharmacologic and psychological treatments exist, many antidepressants may initially worsen sleep or cause excessive drowsiness, and therapies such as cognitive behavioral therapy are not always widely available or culturally adapted.

Acupuncture, especially electroacupuncture (which adds electrical stimulation to the needles), has been used for thousands of years in traditional Chinese medicine to treat sleep and mood problems. However, until recently, there was a lack of rigorous scientific studies demonstrating its efficacy for this specific combination of problems. This study was conducted to scientifically evaluate whether electroacupuncture could be an effective and safe treatment for people who suffer from both insomnia and depression.

The investigators conducted a randomized controlled clinical trial, considered the gold standard of medical research, in three hospitals in Shanghai, China, between 2016 and 2019. They recruited 270 participants, the majority of whom were women (72%), with a mean age of 50 years, who had both insomnia and depression diagnosed according to specific medical criteria. Participants were randomly divided into three groups: one received active electroacupuncture plus standard care, another received sham acupuncture (placebo) plus standard care, and the third received standard care alone. Treatment lasted 8 weeks, with 30-minute sessions three times per week, totaling 24 sessions.

The acupoints were chosen specifically for sleep and mood problems, including points on the top of the head and on the arms and legs. To ensure the reliability of the results, neither the patients nor the assessors knew which treatment was being applied, and the participants were followed for an additional 24 weeks after the end of treatment.

The results were highly encouraging for those who received active electroacupuncture. The primary outcome was the Pittsburgh Sleep Quality Index, a scale on which higher scores indicate poorer sleep quality. After 8 weeks of treatment, the active electroacupuncture group showed a mean improvement of 6.2 points on this scale, while the sham acupuncture group improved only 2.5 points and the standard care group improved only 1.1 points. This difference was considered both statistically and clinically significant — that is, it represents a real, perceptible improvement in patients' lives.

In addition to improvement in sleep, participants who received electroacupuncture also showed a significant reduction in depression and anxiety symptoms and in insomnia severity. Objective sleep measurements via a wrist-worn device confirmed that these patients slept longer and with better efficiency. It is important to note that these benefits were maintained throughout the 24-week follow-up period after the end of treatment, suggesting durable effects.

For patients suffering from insomnia and depression, these results offer a hopeful prospect of a non-pharmacologic treatment option that may complement or, in some cases, serve as an alternative to conventional treatments. Electroacupuncture proved to be safe, with few reported side effects, mainly small hematomas or local pain at the needle site. No serious adverse events were recorded throughout the study. For clinicians, the study provides robust scientific evidence that electroacupuncture can be integrated into treatment plans, especially considering that many patients are looking for alternatives to medications or do not respond adequately to conventional treatments.

The technique requires qualified and experienced clinicians but can be a valuable tool in the management of these complex conditions.

Like any study, this one also has limitations that should be considered. The acupuncturists could not be blinded to the treatment they were administering, which may have unconsciously influenced the results. In addition, the primary outcome measures were based on questionnaires completed by the patients themselves, which can be influenced by expectations and subjective perceptions. Objective sleep monitoring was limited to only one or two nights at certain time points, which may not accurately reflect long-term sleep patterns.

The study was also conducted in a specific cultural context (China), where acupuncture is more accepted and integrated into the healthcare system, and may produce different results in other populations.

In conclusion, this study represents a significant advance in the scientific understanding of the benefits of electroacupuncture for people with insomnia and depression. The results suggest that 8 weeks of treatment can provide sustained improvements in sleep quality and mood, offering a safe and effective therapeutic option. For patients interested in this approach, it is important to seek qualified clinicians and discuss with their physicians how electroacupuncture may fit into their overall treatment plan. Future studies should explore longer treatment periods and include more diverse populations to confirm and extend these promising findings.