Open-label, randomized, parallel-group controlled clinical trial of massage for treatment of depression in HIV-infected subjects

Abstract

Objectives: The study objectives were to determine whether massage therapy reduces symptoms of depression in subjects with human immunodeficiency virus (HIV) disease.

Design: Subjects were randomized non-blinded into one of three parallel groups to receive Swedish massage or to one of two control groups, touch or no intervention for eight weeks.

Settings/location: The study was conducted at the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai Medical Center in Los Angeles, California, which provided primary clinical care in an institutional setting.

Subjects: Study inclusion required being at least 16 years of age, HIV-seropositive, with a diagnosis of major depressive disorder. Subjects had to be on a stable neuropsychiatric, analgesic, and antiretroviral regimen for >30 days with no plans to modify therapy for the duration of the study. Approximately 40% of the subjects were currently taking antidepressants. All subjects were medically stable. Fifty-four (54) subjects were randomized, 50 completed at least 1 week (intent-to-treat; ITT), and 37 completed the study (completers).

Interventions: Swedish massage and touch subjects visited the massage therapist for 1 hour twice per week. The touch group had a massage therapist place both hands on the subject with slight pressure, but no massage, in a uniform distribution in the same pattern used for the massage subjects.

Outcome measures: The primary outcome measure was the Hamilton Rating Scale for Depression score, with the secondary outcome measure being the Beck Depression Inventory.

Results: For both the ITT and completers analyses, massage significantly reduced the severity of depression beginning at week 4 (p ≤ 0.04) and continuing at weeks 6 (p ≤ 0.03) and 8 (p ≤ 0.005) compared to no intervention and/or touch.

Conclusions: The results indicate that massage therapy can reduce symptoms of depression in subjects with HIV disease. The durability of the response, optimal "dose" of massage, and mechanisms by which massage exerts its antidepressant effects remain to be determined.

FIG. 1.

Hamilton Depression Rating Scale (HAM-D) scores in the three study groups [no intervention (NI), touch, and massage] over the 8 weeks of the study. Intent-to-treat (ITT) subjects are shown in the top graph and completers in the bottom graph. *Asterisks signify location of significant differences. In ITT, HAM-D scores were significantly lower in the massage group at weeks 4, 6, and 8 (p≤0.03, p≤0.006, and p≤0.001, respectively). Similarly, in completers, HAM-D scores were significantly lower in the massage group at weeks 4, 6, and 8 (p≤0.03, p≤0.02, and p≤0.003, respectively). See Results section for further details.