Depression is an unfortunately common condition for which people often seek alternative (non-western) treatments, perhaps because conventional treatments do not consistently provide lasting relief. A pilot study (Allen, Schnyer, & Hitt, 1996) suggests that acupuncture, a popular but under-researched alternative treatment derived from Chinese medicine, holds sufficient promise as a treatment for depression to warrant a larger-scale clinical trial. We propose to test the efficacy acupuncture designed specifically to treat depression by comparing it to acupuncture treatment designed to treat symptoms that are not part of the depressive symptom picture and to a wait list control group. Because relapse and recurrence of Major Depression are quite common, we also propose to assess the clinical status of participants for 18 months after treatment concludes, to examine whether the dose of treatment predicts the likelihood of relapse or recurrence. In the first phase of this double-blind randomized clinical trial, 150 men and women meeting DSM-IV criteria for Major Depression will be randomly assigned to one of three conditions: (a) eight weeks of acupuncture designed specifically to address depression; (b) eight weeks of nonspecific acupuncture treatments designed to treat valid symptom pattens other than depression; (c) or a waitlist control condition. At the end of this first phase, blind assessments will be used to compare treatment effects from the perspectives of both western psychiatry and Chinese medicine. After this phase, all participants will receive specific treatment. This experimental design will thus address the following specific aims: (1) to evaluate the efficacy of acupuncture treatments for Major Depression relative to both a waitlist control and to nonspecific acupuncture treatments desired to treat symptoms that are not part of depression; (2) to evaluate the clinical significance of acupuncture as a treatment for Major Depression by assessing the impact of acupuncture not only on depression but also on functioning in social and work arenas; and (3) to examine whether a dose-response relationship exists, such that the number of specific acupuncture treatments is related to the likelihood of remission during treatment, or the likelihood of recurrence or relapse following treatment. Secondary aims are: (1) to assess the efficacy of acupuncture treatments using measures of outcome derived from the principles of Chinese medicine; (2) to examine the convergence of western-based and Chinese-medicine-based outcome measures in terms of clinical significance; (3) to determine whether changes in energetic pattern mediate changes in western defined depression severity; and (4) to explore whether patient and history variables predict response to acupuncture treatments.
