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Sommaire
Anxiété : évaluation de l'acupuncture
| Articles connexes : -Trouble de stress post-traumatique - Troubles obsessionnels compulsifs- |
1. Revues systématiques et méta-analyses
1.1. Acupuncture générique
1.1.1. Ravindran 2013 ☆
Ravindran AV, Da Silva TL. Complementary and Alternative Therapies as Add-On to Pharmacotherapy for Mood and Anxiety Disorders: A Systematic Review. J Affect Disord. 2013;150(3):707-19. [174008].
| Objectives | Depressed and anxious patients often combine complementary and alternative medicine (CAM) therapies with conventional pharmacotherapy to self-treat symptoms. The benefits and risks of such combination strategies have not been fully evaluated. This paper evaluates the risk-benefit profile of CAM augmentation to antidepressants in affective conditions. |
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| Methods | PubMed was searched for all available clinical reports published in English up to December 2012. Data were evaluated based on graded levels of evidence for efficacy and safety. |
| Results | Generally, the evidence base is significantly larger for depression than for anxiety disorder. In unipolar depression, there is Level 2 evidence for adjunctive sleep deprivation (SD) and Free and Easy Wanderer Plus (FEWP), and Level 3 for exercise, yoga, light therapy (LT), omega-3 fatty acids, S-adenosylmethionine and tryptophan. In bipolar depression, there is Level 1 evidence for adjunctive omega-3s, Level 2 for SD, and Level 3 for LT and FEWP. In anxiety conditions, exercise augmentation has Level 3 support in generalized anxiety disorder and panic disorder. Though mostly well-tolerated, these therapies can only be recommended as third-line interventions due to the quality of available evidence. LIMITATIONS: Overall, the literature is limited. Studies often had methodological weaknesses, with little information on long-term use and on potential drug-CAM interactions. Many CAM studies were not published in English. |
| Conclusions | While several CAM therapies show some evidence of benefit as augmentation in depressive disorders, such evidence is largely lacking in anxiety disorders. The general dearth of adequate safety and tolerability data encourages caution in clinical use |
| Acupuncture | To summarize, the findings are promising but poor quality and heterogeneity of published studies preclude definitive recommendations for the use of acupuncture augmentation in unipolar depression, bipolar disorder or anxiety disorders. |
1.1.2. Errington-Evans 2011 ~
Errington-Evans N. Acupuncture for anxiety. Cns Neurosci Ther. 2011;7:1-8. [156611]
| Objectifs | This review aims to examine the volume and quality of the evidence base which supports the use of acupuncture in the treatment of anxiety disorders. |
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| Méthodes | A literature review was conducted using Pubmed, Google scholar, AMED, BMJ, Embase, Psychinfo, Cochrane library, Ingenta connect, and Cinahl databases. Keywords were “anxiety,”“anxious,”“panic,”“stress,”“phobia,” and “acupuncture” limited to year 2000 onwards and English language where available. |
| Résultats | The quality of research examining the use of acupuncture in the treatment of anxiety disorders is extremely variable. There is enormous variety regarding points used, number of points used in a session, duration of sessions, frequency of treatment and duration of treatment programme. While the generally poor methodological quality, combined with the wide range of outcome measures used, number and variety of points, frequency of sessions, and duration of treatment makes firm conclusions difficult. |
| Conclusions | Against this, the volume of literature, consistency of statistically significant results, wide range of conditions treated and use of animal test subjects suggests very real, positive outcomes using a treatment method preferred by a population of individuals who tend to be resistant to conventional medicine. |
1.1.3. Ma 2007 ☆
Ma Tieming, Bai Zenghua, Ren Lu, Liu Xulai. [Meta-analysis on the effect of acupuncture treatment on anxiety]. Chinese Journal of Information on Traditional Chinese Medicine. 2007;2:101-103. [186951].
| Objectives | To assess the effectiveness of the acupuncture treatment on anxiety compared with non-acupuncture intervention. |
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| Methods | All of the randomized or quasi-randomized trials involving were reviewed systemantically with the Meta-analysis method. The homogeneity test was mode, the standandised mean difference (95% CI) and add risk (OR, 95% CI) were tested. |
| Results | Homogeneity test was made among the trials and no significant difference between the acupucture and non-acupuncture groups. Fixed effect model was used. ORP =1. 759 419 579, 95% CI (1. 336 391, 2. 316 356), there was significant difference between the acupuncture group and medicine group as the interventions used to treat anxiety while there was no difference between the two group on the influence in HAMA. |
| Conclusions | The Meta-analysis results was a trend in favor of acupuncture effectiveness. It seems no serious adverse reactions have been found. But there was no sufficient reliable evidence due to the low quality of the trials and possible publication bias. Further randomized, double blind controlled trials are needed. |
1.1.4. Pilkington 2007
Pilkington K, Kirkwood G, Rampes H, Cummings M, Richardson J. Acupuncture for anxiety and anxiety disorders–a systematic literature review. Acupunct Med. 2007. 25(1-2):1-10. [146405].
| Introduction | The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research. |
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| Methods | Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes. |
| Results | Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period. No studies were located on the use of acupuncture specifically for panic disorder, phobias or obsessive-compulsive disorder. In generalised anxiety disorder or anxiety neurosis, it is difficult to interpret the findings of the studies of acupuncture because of the range of interventions against which acupuncture was compared. All trials reported positive findings but the reports lacked many basic methodological details. Reporting of the studies of perioperative anxiety was generally better and the initial indications are that acupuncture, specifically auricular acupuncture, is more effective than acupuncture at sham points and may be as effective as drug therapy in this situation. The results were, however, based on subjective measures and blinding could not be guaranteed. |
| Conclusions | Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies. |
1.2. Techniques particulières
1.2.1. Au 2015 (acupression) ☆
Au DW, Tsang HW, Ling PP, Leung CH, Ip PK, Cheung WM. Effects of acupressure on anxiety: a systematic review and meta-analysis. Acupunct Med. 2015. 33(5):353-9. [182989].
| Objective | To evaluate the evidence from randomised controlled trials (RCTs) and quantify the effects of acupressure on anxiety among adults. |
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| Methodology | RCTs published between January 1997 and February 2014, comparing acupressure with sham control, were identified from the databases Science Citation Index/Social Sciences Citation Index, Scopus, PubMed and PsycINFO. Meta-analysis of eligible studies was performed and the magnitude of the overall effect size was calculated for the anxiety outcome. Revised STRICTA (the Standards for Reporting Interventions in Clinical Trials of Acupuncture) criteria were used to appraise the acupressure procedures, and the Cochrane risk of bias tool was used to assess the methodological quality of the studies. |
| Results | Of 39 potentially relevant studies, seven RCTs met the inclusion criteria for review while five studies met the criteria for meta-analysis. All studies reported the positive effect of acupressure on relieving anxiety from the anticipation of surgery or treatment. EX-HN3 ( yintang ), HT7 (Shenmen) were the commonest points selected and two studies used bilateral points. The acupressure procedure was generally well reported and studies had a low risk of bias. The combined results of the five trials showed a greater overall reduction in anxiety in the acupressure group than in the sham controls (standardised mean differences (SMD)=-1.11; 95% CI -1.61 to -0.61; p<0.0001 heterogeneity: I2=75%; χ2=16.17; p=0.003; r=0.485). |
| Conclusions | Acupressure seems to be effective in providing immediate relief of pretreatment anxiety among adults, and has a medium effect size. However, conflicting results were found for the improvements on physiological indicators. More rigorous reporting, including allocation concealment procedure, is needed to strengthen the results. |
1.3. Formes cliniques particulières
1.3.1. Syndrome anxio-dépressif de la grossesse
| Voir l' article correspondant |
1.3.2. Anxiété pré-opératoire
| Voir l' article correspondant |
1.3.3. Anxiété des soins dentaires
2. Revues de revues systématiques
2.1. Sarris 2012
Sarris J, Moylan S, Camfield DA, Pase MP, Mischoulon D, Berk M, Jacka FN, Schweitzer I. Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: a review of current evidence. Evid Based Complement Alternat Med. 2012. [168031].
Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.
