Acupuncture for Anxiety, Depression, and Sleep in Veterans with Combat-Related Posttraumatic Stress Disorder: A Randomized Controlled Trial

<b>Objective</b>: Current interventions for anxiety, depression, and insomnia are efficacious, yet effectiveness may be limited by side effects and/or high withdrawal rates. Other desirable treatment options are needed. Many veterans and civilians are turning to acupuncture as an emerging therapy. Our objective was to conduct a more definitive study comparing verum with sham acupuncture (minimal needling). <b>Methods</b>: A two-arm, single-blinded randomized controlled trial (RCT) hypothesizing that both verum and sham acupuncture are effective and the effects of verum are superior to those of sham acupuncture. We recruited subjects from a single outpatient-based site, the Tibor Rubin VA Medical Center, Long Beach, CA, USA. A total of 93 treatment-seeking combat Veterans with posttraumatic stress disorder (PTSD), aged 18-55, were allocated to groups by adaptive randomization, and 71 participants completed the intervention protocols. Verum and sham were both offered as 1 h sessions, twice a week, and participants were allowed 15-weeks to complete up to 24 sessions. This was a secondary analysis from a larger study about the efficacy of acupuncture for PTSD. Outcomes for the current study were pre- to post-intervention change in the Hamilton Anxiety Rating Scale, Beck Depression Inventory, and Pittsburgh Sleep Quality Index. Outcomes were assessed pre-, mid-, and post-treatment. General Linear Models comparing within- and between-group results were analyzed in both intention-to-treat (ITT) and treatment completer models. <b>Results</b>: In total, 85 males and 8 females, with a mean age of 39.2 (median = 37.0), were randomized. For anxiety, the verum acupuncture showed a large treatment effect (<i>d</i> = 1.3), whereas sham acupuncture showed a moderate effect (<i>d</i> = 0.9). There was no statistical difference between the verum and sham acupuncture groups. Similar effects were found for depression and insomnia symptoms. Withdrawal rates were low. <b>Conclusions</b>: Both verum and sham acupuncture were efficacious in the treatment of anxiety, depression, and insomnia in a population of veterans with PTSD. However, there was no clinical difference between the verum and sham acupuncture groups. These data build on extant literature and suggest that further research on the clinical implementation and durability of acupuncture for anxiety, depression, and insomnia is warranted.