BY CHRISTOPHER VAUGHAN

Acupuncture is usually thought of as a way to treat physical pain, but researchers at Stanford University Medical Center are conducting two innovative studies to determine whether acupuncture could be useful in treating the psychological torment of clinical depression.

In one study, the efficacy of acupuncture is being compared with a standard drug for treating depression. The other study compares acupuncture and therapeutic massage as treatments for clinical depression in pregnant women.

These investigations are among the few well-controlled studies in the world examining acupuncture and depression, said Rachel Manber, PhD, assistant professor of psychiatry and behavioral sciences and principal investigator on both studies. Manber became interested in studying acupuncture's effects on depression after a pilot study at the University of Arizona showed some positive results. Manber is also taking part in a larger, follow-up trial at the University of Arizona.

Acupuncture, a procedure in which fine needles are inserted into the body, has been an accepted part of Chinese medicine for thousands of years. Chinese medical texts dictate that the needles be inserted at very specific points, with each disorder requiring a different constellation of needle insertions. Western medical experts have historically been skeptical of acupuncture's usefulness but in recent decades they have come to accept its value in alleviating pain.

There are various theories about how acupuncture works, but none is yet established scientifically -- a fact that does not deter Manber. "We need to first determine that acupuncture works for before we launch into finding out why it works," she said.

The two acupuncture studies at Stanford stand out because of their tight methodology, due in large part to Manber's background. "I have no background in acupuncture," she said. "My interest has been in study design and methodology in depression-outcome research."

Manber came to Stanford in 1999 to conduct research on insomnia and depression and to direct the new insomnia program at the Stanford Sleep Disorders Clinic. She became interested in the study of acupuncture and depression because it posed methodological challenges like those encountered in studies of psychotherapy and depression. "I also have a general interest in women's health, so it was natural to look at pregnancy and depression," she said.

Clinically depressed women who are pregnant face a dilemma because they are reluctant to use anti-depressant medication that could affect the development of their babies, she said. On the other hand, the chronic stress of depression can itself be detrimental for mother and infant.

Manber's study of acupuncture and massage for treating depression during pregnancy uses a double-blind design. Participants are randomly assigned to receive one of two acupuncture treatments or massage. The treatment protocols are designed by one acupuncturist and administered by another.

"Because the treatment is complex, the acupuncturist who needles the patient cannot tell whether the treatment provided is addressing depression or other symptoms of pregnancy. We do not use sham acupuncture in which needles are inserted at non-acupuncture points," Manber said. "Even in the control group, all needle-insertion points are real acupuncture points."

The study is funded by the Agency for Health Research and Quality and by the National Institutes of Health.

Participants in the other study are randomly assigned to one of three groups: those who receive acupuncture for depression; those who receive an established anti-depressant medication (Paxil); and those who receive a pill placebo.

Manber said the acupuncture group is conducted on an open-label basis, meaning that both the patient and the person administering the treatment know what type of treatment the patient is receiving. The medication and placebo groups are using the double-blind process in which neither the patient nor the person administering the treatment knows whether the patient is receiving the actual medication or a placebo.

For both studies, acupuncturists follow a standardized treatment manual developed by co-investigator Rosa Schnyer of the University of Arizona.

Manber is still looking for volunteers for both studies. Volunteers are given a complete physical and psychological screening to determine if they meet the strict criteria for clinical depression. One advantage of both studies is that the researchers have contracted with acupuncturists and massage therapists in the Bay Area to provide treatment, so volunteers only need to come to Stanford occasionally.

Those interested in participating in the pregnancy study can call 724-4431, and those interested in the study comparing anti-depressants and acupuncture can call 723-5886.