Discussion
depression, hyperactive
ADVERSE EVENTS, ADVERSE EFFECTS, REMISSION
The results of this randomized clinical trial showed no difference in depression recovery between the groups at 3 months. However, depression remission at 3 months was significantly higher in the SA group. In addition, no significant differences were observed in the rates of adverse events and adverse effects, and no severe adverse events were recorded, evidencing practice safety. To our knowledge, this is the first randomized clinical trial on the effectiveness of SA using a semipermanent needle with NSA directed at depression as the comparator group. However, previous studiesThese preliminary findings are promising and support the use of SA in depression treatment. The rates of recovery (58%) and remission (46%) from depression in the present study are similar to those observed in meta-analyses of pharmacological treatmentsThe absence of statistically significant differences between the groups for depression recovery can be explained. First, the small sample size resulted in insufficient power and may have underestimated true efficacy. Second, considering the economic cost of time and participant adherence, we provided only 12 sessions over 6 weeks in this study. Therefore, adding AA doses by increasing the treatment duration (eg, 16-18 sessions over 8-12 weeks) may be an effective way to streamline the treatment program. Third, the manual stimulation of the semipermanent needle (known as de qi induction) is a factor that affects the efficacy of AA. To maintain the blinding of the study, the NSA group also used this daily stimulation, which may have contributed to an increased effect size of the technique in this group. Fourth, the study’s follow-up loss (36%) may have impacted the results. However, adherence to depression treatment remains a relevant and common challenge to overcome in clinical trials. A study by Olfson et alFirst-line therapy for depression is medication, but several factors interfere with treatment access and adherence, such as system barriers and clinical and individual factors.Besides the technique’s safety, patients in the SA group had increased rates of symptom remission between 6 weeks and 3 months, which may be associated with the delayed effects of AA treatment.An additional hypothesis is that AA may reduce serotonin depletion by inhibiting the hyperactive hypothalamic-pituitary-adrenal axis, which would explain the technique’s prolonged effect at the 3-month follow-up.This study has strengths. First, the research addressed the selection of AA points, providing a solid foundation for future large-scale studies. In addition, the study included a more extended study period and experienced acupuncturists who used semipermanent needles, which are considered more effective than other stimuli. The control group received needling in nonspecific areas, and blinding measures were implemented for assessors, participants, and the statistician.