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The study authors, led by Rachel Manber, PhD, professor of psychiatry and behavioral sciences, said they hope the results will raise awareness of the problem of depression during pregnancy and provide patients and physicians an alternative to antidepressants. "This standardized acupuncture protocol could be a viable treatment option for depression during pregnancy," they wrote in a paper that will appear in the March issue of Obstetrics & Gynecology. Up to 14 percent of pregnant women may have major depressive disorder, a condition characterized by feelings of dread, gloom and hopelessness, and a loss of interest in normally pleasurable activities. Some women suffer from depression before becoming pregnant, stop taking their medication and then experience a relapse; in other women, pregnancy itself may cause depression.

For this study, the researchers recruited 150 women whose pregnancies were between 12 and 30 weeks gestation and who met the criteria for major depressive disorder. The women were randomized to receive one of three treatments: acupuncture specific for depression; control acupuncture, during which needles were inserted in points not known to help alleviate depressive symptoms; or massage. All of the women received eight weeks of therapy and were assessed for depression at the four- and eight-week marks by an interviewer who was unaware of the treatment each woman received. The researchers found that women who received the depression-specific acupuncture experienced a bigger reduction in depression symptoms than the women in the other groups. The response rate — defined as having a 50 percent or greater reduction in symptoms — was 63 percent for the women receiving depression-specific acupuncture, compared with 44 percent for the women in the other two treatment groups combined. The researchers weren't surprised by what they found — a pilot study yielded similar results, and other studies have shown acupuncture is an effective treatment for depression in the general public — but they were pleased with the results. "I don't think that one-size-fits-all treatments are appropriate for everyone, but acupuncture should be considered as an option," said Lyell. "I hope that people will respect the rigorous methodology used in this blinded, randomized, controlled trial and accept the result: Traditional acupuncture was associated with a significant improvement in depression."

The North American Spine Society and the Society of Interventional Radiology have pointed to flaws in both studies. And earlier studies, published over 15 years, found major benefits to kyphoplasty and a related procedure called vertebroplasty. "We're missing opportunities for patients to receive a safe and effective treatment that can significantly reduce their pain and disability," said Malamis, an interventional radiologist. The procedures are used to treat vertebral compression fractures in patients with osteoporosis and other conditions that result in brittle bones. In a vertebroplasty, an acrylic cement is injected into a fractured vertebra. In a kyphoplasty, a balloon-tipped catheter first is inserted into the fracture. The balloon is inflated to restore the height and shape of the vertebra before the cement is injected. Neva Nelson, 74, of Naperville, Ill., said a kyphoplasty that Malamis performed in October, 2009, has greatly reduced her pain in a vertebra in her lower back that she fractured after falling on ice. Before her kyphoplasty, Nelson had to sit on cushions. Walking, and especially standing, were painful. "I had to do something," she said. "I could not go on like that." Nelson said that since undergoing her kyphoplasty, "I don't have to worry about my back any more." In the controversial studies, patients were randomly assigned to receive a vertebroplasty or a placebo-like "sham" procedure. In the sham procedure, patients received an injection of anesthetic, but no cement. However, patients in severe pain are reluctant to enroll in a trial where there's a 50 percent chance of receiving a sham treatment. In one of the studies, researchers had to screen 1,813 patients to enroll just 131 subjects. In the other study, only 78 of 219 eligible patients were enrolled. This low enrollment rate raises the possibility that the patients who did enroll were not representative. Patients experience the greatest pain during the first three months after a compression fracture. Thereafter, pain gradually subsides. Thus, a vertebroplasty or kyphoplasty provides the greatest benefit when performed within a week or two of the fracture. But the studies enrolled patients up to 12 months after fractures. In addition to reducing pain and disability, a kyphoplasty can reduce the risk of subsequent fractures by improving the angle and height of the spine. The studies evaluated vertebroplasty alone, and did not include the more innovative and very different kyphoplasty procedure. Malamis suggests the medical community wait for the results of additional studies now underway before passing final judgment on vertebroplasty or kyphoplasty. In the mean time, he notes that Medicare still covers the procedures.