Medical Acupuncture
A Journal For Physicians By Physicians

Spring / Summer 2000- Volume 12 / Number 1
"Aurum Nostrum Non Est Aurum Vulgi"

ARTICLE

DEPRESSION

Magnets On Sishencong And GV 20
To Treat Depression:
Clinical Observations In 10 Patients*
Agatha P. Colbert, MD

ABSTRACT
Background Major depression is a significant medical and economic problem affecting more than 11 million people annually in the United States. Studies have shown acupuncture needling may be effective in the treatment of depression. Recent short-term studies assessing transcranial magnetic stimulation demonstrate significant benefit for patients with severe depression.
Objectives To describe a unique magnetic/ion pumping cord device used to stimulate acupuncture points Sishencong and GV 20, and to document the clinical experiences of patients diagnosed as having depression who wore the device as part of a home treatment program.
Design and Setting Clinical observations of patients in outpatient settings.
Patients Ten patients with mild to moderate depression recruited from the acupuncture practice of the author.
Intervention Headgear, in which magnets are arranged in the traditional Sishencong acupuncture point pattern around GV 20, worn for 20 to 40 minutes daily, 5 to 7 times per week for a minimum of 6 to 8 weeks.
Main Outcome Measures The Zung Self-Reported Depression Scale, a 10-point visual analog scale, and a patient satisfaction
questionnaire.
Results Significant subjective improvement of depressive symptoms was documented in 7 patients. Mean depression scale scores decreased from 57.5 to 45.1 following treatment. No adverse events were reported.
Conclusions A magnetic/ion pumping cord device on the Sishencong and GV 20 scalp acupuncture points, as a self-help device worn daily, may improve symptoms in patients diagnosed as having mild to moderate depression.

KEY WORDS
   Depression, Sishencong, Magnets, Ion Pumping Cords, Self-Help Device, Acupuncture

INTRODUCTION
   Depression is a significant medical and economic problem. In 1990, some 11 million people in the United States experienced major depression, which costs the nation $44 billion annually.1 A recent World Health Organization report predicts that depression will be the leading cause of disability and premature death in the industrialized world by the year 2020.2 Psychopharmacological approaches are successful in 70% of moderate to severely depressed patients.3 However, as a result of associated adverse effects, many patients cannot tolerate antidepressant medications and seek alternative management strategies. A 1993 study4 found that only 25% of patients who were prescribed an antidepressant by their family physician took it longer than 1 month.
   Non-pharmaceutical or complementary and alternative methods, such as stress management, diet therapy, homeopathy, and acupuncture, are increasingly being explored by the public.5 Transcranial magnetic stimulation (TMS) is also being investigated for its role in the treatment of psychiatric disorders.6
Acupuncture to Treat Depression
   The biochemical basis for acupuncture needle treatments for depression is derived from studies on acupuncture analgesia,7 which have shown activation of serotonin, norepinephrine, substance P, dopamine, adrenocorticotropic hormone, b-endorphin, enkephalin, and dynorphins in the central nervous system, primarily in the hypothalamus. This suggests a direct influence on the pathogenic mechanisms of depression.
   In clinical trials, acupuncture has been shown to provide symptom relief in depression and anxiety at rates comparable to those of conventional treatments including psychotherapy and psychopharmacology.8-13 One randomized controlled trial of 34 female patients found that after 12 acupuncture sessions, 64% had complete remission of their symptoms of major depression.10 The recent work of Luo et al13 demonstrated the therapeutic efficacy of electroacupuncture to be equal to that of amitriptyline for depressive disorders.
   A wide variety of acupuncture points are selected to treat depression, according to the preferences of the practitioner and the individualized needs of each patient.10,11,14,15 Sishencong (MH-N-1) with GV 20 form 1 set of points frequently chosen by practitioners to treat both depression and mania. This constellation of acupuncture points on the vertex of the scalp is used in the management of several other psychiatric and neurological disorders, including anxiety, agitation, insomnia, headaches, and stroke.16-19 The usual procedure for activating Sishencong and GV 20 consists of inserting needles at an oblique angle into the 5 scalp acupuncture points (Figure 1). Techniques such as mechanical stimulation with digital pressure, thermal stimulation with moxibustion, electrical stimulation, low-level laser radiation, magnetic stimulation with tiny acu-magnets, and ion pumping cords (semiconductors made with wire and a diode) are frequently used with therapeutic benefit. At a recent international meeting, Liss20 reported finding changes in serum levels of neurotransmitters, specifically a 45% increase in serotonin, after placing a 3950-G permanent magnet on acupuncture point LI 4 (Hegu) for 30 minutes.
   Japanese acupuncturists frequently apply magnets and ion pumping cords to body acupuncture points for both diagnosis and treatment.21,22 Clearfield23 demonstrated that when ion pumping cords are attached to needles inserted into paired acupuncture points, a pattern of cyclical electrical changes develops, indicative of current flow between the 2 points.
Transcranial Magnetic Stimulation
   Magnetic fields penetrate all tissues, including epidermis, dermis, subcutaneous tissue, dense connective tissue, and bone, equally and in the same way as magnetic fields penetrate air. An electromagnetic field pattern mapped on the human scalp by a highly sensitive magnetometer, the SQUID (superconducting quantum interference device), demonstrates that the acupuncture point GV 20 is a major sink in the surface magnetic field where flux trajectories converge and enter the inside of the skull.24 The area at the vertex of the skull is especially susceptible to the influences of static magnetic fields. Acupuncture theory suggests that subcutaneous tissue is the preferential conductive pathway for ionic current flow in the vascular interstitial closed circuits.25-27 Becker and Selden28 demonstrated an overall proximal-to-distal negative gradient of electrical potential along the acupuncture meridians, which they postulated were the perineural cells. Connective tissue, made up primarily of mucopolysaccharides, has a high piezoelectrical effect and appears to be the conductive pathway in the acupuncture stimulus response.
   Transcranial magnetic stimulation is being investigated in several neurophysiology laboratories as a modality for treating depression and other psychiatric disorders.6,29-37 Repetitive stimuli with an oscillating magnetic field applied to specific cortical regions can either decrease or enhance the excitability of the affected brain structures.38 Repetitive stimulation of the prefrontal regions in healthy volunteers has been shown to have a lateralized effect on mood,32,38-40 with increased sadness following left prefrontal stimulation and increased happiness following right prefrontal stimulation. Modest benefit has been reported in 2 separate trials in which the vertex of the skull was stimulated in an attempt to treat depression.41,42
   George et al6 reviewed 15 clinical trials of TMS for treating major depression. These trials varied in their sites, intensity, frequency, and duration of stimulation, and demonstrated varying antidepressant effects; many showed significant short-term therapeutic benefit in patients with severe depression. The mechanism of action of TMS for alleviating depression is unclear, although it is known that rapid TMS induces small regional currents in the brain34 and alters levels of hormones and monoamines.33,37
   The static magnetic field to which the brain is exposed when wearing the magnetic headgear described in this study was approximately 200 G; that created by TMS approximately 20,000 G.
   It should be noted, however, that a weak static magnetic field acting on a signal transduction system, such as an acupuncture point, can trigger a cascade of biochemical events leading to profound physiological effects.
The Magnetic Device
   The magnetic cap is a novel device invented by the authors. The headgear worn by the patients in this study was either in the form of a headband or a baseball cap in which magnets were arranged in the traditional Sishencong acupuncture point pattern around GV 20, and concealed on the inside surface of the headwear (Figure 1). Four magnets, located at 90° to each other, 1 cun from the center point (GV 20), were positioned in an alternating negative/ positive format and connected with ion pumping cords in a circuit so that the ion flow was in a clockwise direction. An unconnected central magnet was placed in the center of the headband or baseball cap, and oriented so that the field direction facing the scalp attracted a North-seeking compass needle. This headgear was fitted so that the central magnet was over acupuncture point GV 20. The entire arrangement of magnets and ion pumping cords was covered by moleskin, sewn to the inside of the headwear (Figure 2). Components of the magnetic cap include:
1. 5 nickel-plated round neodymium magnets, 1/8 inch (0.3 cm) in diameter and 1/16-inch thick (0.2 cm), with a manufacturer's rating of 10,000 G.
2. 2 ion pumping cords consisting of a 11/2-inch (3.8 cm) long wire with a silicone diode (50 Peak Inverse Voltage 1 amp rectifier diode).
3. A baseball cap (Figure 2).

PATIENTS AND METHODS
   Twenty-eight patients between the ages of 26 and 64 years diagnosed as having various neurological conditions, including attention-deficit disorder, status post-cerebrovascular accident, anxiety, and depression, were identified from the clinical acupuncture practice of the author and given the magnetic headgear to wear to alleviate the presenting neurological or psychiatric complaints. Patients were offered the magnetic device on the basis: "try it, it might help." Seventeen of the 28 patients who presented with symptoms of depression were selected for further study and were asked retrospectively to be interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I)43 to confirm a diagnosis of major depression. Two of the 17 refused to undergo the SCID-I evaluation. Ten of the 15 patients administered the SCID-I met the strict diagnostic criteria for major depression at the onset of wearing the magnetic device. Clinical observations on these 10 individuals are presented.
Outcome Measures
   During the initial year of the project, patients' clinical experiences associated with magnetic device wearing were observed but not quantified. In the second year, more formalized data were collected. The database included spontaneous comments by patients as well as results of the Zung Self-Reported Depression Scale (SDS),44 a visual analog scale (VAS) assessing perceived benefits, and a patient satisfaction questionnaire inquiring about ease of use of the device, adverse effects associated with its wear, and usage durations. The SDS is a screening tool for depression with scores ranging from 25 to 100. A score below 50 is considered within normal range; 50 to 59 corresponds with minimal to mild depression; 60 to 69 indicates moderate to marked depression; and scores of 70 and above correspond with severe to extreme depression. The VAS consisted of a 10-cm horizontal line (0 = "not at all useful," to 10 = "extremely useful").

Table 1. Patients’ Characteristics and Results of Treatment

* Based on SDS (Self-Reported Depression Scale) change scores, 62.5% (5/8) of patients improved. Using the paired sample t test, the difference between baseline and posttreatment Zung scores (average [SD] of 12.38 [13.06]) for 8 patients was statistically significant (P=.03).
** Definitions of change: improved, SDS score decreased by Ž10 points; regressed, SDS score increased by Ž10 points; same, SDS score between time periods ranged from 0-9. See the "Outcome Measures" section of the text for a definition of the instruments and their scoring.
*** Not included in the calculation of the posttreatment mean.

RESULTS
   The patient satisfaction questionnaire and the VAS were completed by all 10 patients. The SDS was completed by 8 of 10 patients. Mean response on the VAS was 7.2. Of the 10 wearers, 7 found the cap very helpful (VAS score, >7.0) in relieving symptoms of depression. Two found it moderately helpful (VAS, 6.5-7.0), and 1 found no benefit despite the fact that it was used for a full 6 weeks. (The most benefits regarding the usefulness of the magnetic headgear for symptoms of depression are listed in Table 2.) On the average, patients wore the cap from 20 to 60 minutes a day with daily use varying from 5 to 7 days a week. The duration of use ranged from 6 weeks to 2 years, 5 months. (The results are summarized in Tables 1 and 2.)
   Eight of the 10 patients completed the SDS prior to wearing the device and after a minimum of 6 weeks of use. Mean scores on the SDS for these patients decreased from a baseline of 57.5 to a post-treatment mean of 45.1. The paired sample t test was used to analyze the results, and demonstrated a statistically significant change between baseline and post-treatment Zung scores (P=.03). The average improvement over time on the SDS scores (Table 1) was 12.4 points (SD, 13.06) .
   Two additional patients who had not completed SDS inventories reported positive results, with an average VAS score of 8.5. Two patients completed additional periodic SDS inventories while continuing to wear the headgear another 20 to 24 months. Their scores stayed well within the normal range with no evidence of recurrent depressive symptoms. Most of the compliant patients developed a routine of wearing the cap at a particular time each day. All 10 study patients reported that the device was either "moderately" or "very easy" to use, whereas 4 of the general group of 17 depressed patients found it "difficult to wear." Five of the original 28 patients who were given the device chose not to wear it after less than 2 weeks of use.
Adverse Effects
   Three patients in the initial group of 17 reported a vague sense of tightness and pressure when first wearing the magnetic headgear. They described a "hyper" or agitated feeling if worn for longer than 1 hour. The patients who noticed the sense of pressure in their heads were instructed to wear the device for shorter periods (5 minutes only) initially, and over a month, gradually increase to 20 or 30 minutes a day. Patients who reported becoming "hyper" when wearing it longer than 1 hour were instructed to wear it for only 30 minutes a day. All patients stated that any uncomfortable sensations were immediately alleviated if the cap was removed.
   None of the 28 patients who were given the magnetic cap developed seizures, a known complication of TMS (occurring primarily with very rapid rate stimulation, but less likely if the frequency of stimulation is less than 1 Hz). 30

Table 2. Patients' Comments About Study Treatment

DISCUSSION
The clinical observations noted in this review of 10 patients indicate that wearing magnets and ion pumping cords on Sishencong and GV 20 for 20 to 60 minutes daily may have therapeutic benefit in the treatment of patients with mild to moderate depression.
   The mechanism of action for this magnetic device is unclear, but a hypothesis can be made based on TMS studies and the SQUID mapping of the electromagnetic field around the vertex of the skull. Acu-magnets, when connected to ion pumping cords and placed on Sishencong and GV 20, might achieve a physiological effect by inducing small electromagnetic currents in the scalp that are then transmitted to the brain via the major magnetic sink surrounding GV 20. This electromagnetic stimulus would then trigger a cascade of biochemical events, producing alterations in brain hormone and monoamine levels, ultimately leading to a homeostatic adjustment in the concentration of neurotransmitters in the brain.
   Further basic science investigations are essential and should include the following: (1) Precise measurements of the electrophysiological changes occurring at the acupuncture points as a result of attaching magnets and ion pumping cords. (2) An evaluation of the biochemical changes in the cerebrospinal fluid resulting from the application of ion pumping cords and magnets to scalp acupuncture points. (3) A determination of the optimal static magnetic field dosage to be delivered to the acupuncture points.

CONCLUSION
   This preliminary study demonstrates that 7 of 10 patients who wore a magnetic device consisting of 5 acu-magnets, positioned in an alternating negative/positive format and connected with ion pumping cords in a circuit to stimulate Sishencong and GV 20, obtained substantive, long-lasting relief of depressive symptoms with no evidence of adverse effects or recurrence of depression. All 10 patients found it easy to wear the device as a cap or a headband. The clinical observations of these 10 patients also demonstrated that the magnetic headgear appears to be safe and at least as effective as most currently available therapies for patients with mild to moderate depression.
   The findings from these clinical observations warrant a double-blind, randomized controlled trial with larger numbers of patients to evaluate the potential long-term benefits and safety of this device.

ACKNOWLEDGMENT
   The author would like to thank Deborah Risotti, RN for her assistance with the magnetic cap design, and Jayne Ronsicki, MAc for her assistance with the study design and data collection.

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AUTHORS' INFORMATION
Dr Agatha Colbert practices Medical Acupuncture, specializing in the use of magnets and ion pumping cords, in Waltham, Massachusetts. She is a Clinical Assistant Professor in the Department of Physical Medicine and Rehabilitation at Tufts University School of Medicine.

Agatha P. Colbert, MD
25 Grant St., #4
Waltham, MA 02453
Phone: 781-899-2121
Fax: 781-899-9794
E-mail: apcolbert@mediaone.net

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