Background:Women victims of domestic violence often present with psychiatric disorders and may benefit from nonpharmacological interventions. Acupoint stimulation therapy may be an effective approach. Aims:To examine whether a combination of electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS) can alleviate depression, post-traumatic stress disorder (PTSD) and insomnia in women victims of domestic violence. Methods:An assessor-blinded randomised controlled trial was conducted in Hong Kong, China, with 110 Chinese women with major depressive disorder who had experienced domestic violence and were randomly assigned to care as usual (CAU) alone or combined with EA + TEAS (n = 55 per group) for 12 weeks, two clinic-based EA sessions and three home-based TEAS sessions per week. The primary outcome was baseline-to-endpoint change in the Beck Depression Inventory-II (BDI-II). Secondary outcomes included the 17-item Hamilton Depression Rating Scale, 10-item Perceived Stress Scale, PTSD Check List-Civilian Version, Insomnia Severity Index and the 12-item Short Form Survey for health-related quality of life. Results:Of the 110 participants (n = 55 each group), 91.8% (101/110) completed the study. At 12 weeks, the EA + TEAS group showed a significantly greater reduction in BDI-II score than that of the CAU group (mean difference = -10.9; 95% confidence interval -16.5 to -5.4; t = -3.9; p < 0.001), exceeding the minimal clinically important difference (5 points). The superiority of EA + TEAS was also observed across secondary measures, including depression, PTSD, perceived stress, insomnia and quality of life. The EA + TEAS group had significantly higher rates of clinical response (49.1% vs. 18.2%, χ 2 = 11.770, p < 0.001) and remission (38.2% vs. 12.7%, χ 2 = 9.390, p = 0.002) at endpoint than those of the CAU group. All treatment-related adverse events were mild. Conclusions:The addition of EA + TEAS produced substantially greater improvements in depression and other psychiatric symptoms. EA + TEAS may serve as an effective intervention for women victims of domestic violence. Trial Registration:This trial was registered on www.clinicaltrials.gov (NCT05102253).

Background and Aim Evidence proved that electroacupuncture (EA) combined with antidepressants can improve the antidepressant effectiveness for depressed patients. However, the clinical mechanisms of EA remain unclear. This study aimed to observe the mechanism of EA as an adjunct therapy to escitalopram oxalate (EO) on depressed patients. Experimental procedure This study was designed as a single-blinded, double-dummy randomized controlled trial. 61 participants were diagnosed with mild-to-moderate depression according to the International Classification of Diseases 10th Edition (ICD-10, F32) were randomly allocated to receive EA+EO placebo, EO+sham EA, or EA+EO for six weeks treatment. The clinical assessment including depression severity, quality of life (QOL) and clinical safety. Biological indicators of immune-inflammation, the brain-derived neurotrophic factor and glucocorticoid inducible genes in peripheral blood of participants were measured by using enzyme linked immunosorbent assay and real-time polymerase chain reaction respectively before and after treatment. Results and conclusion Three interventions improved the depression severity and QOL (P<0.05), and no inter-group difference was found in the 6th week (P>0.05). Anxiety psychic and somatic general symptoms in the EA+EO group were improved significantly than those of the other two groups (P<0.05). After six-week treatment of EA+EO, blood SGK1 mRNA, GILZ mRNA, and BDNF levels were increased significantly (P<0.05), and IL-6 levels were decreased significantly (P<0.05) in depressed patients. IL-6 change levels were positively correlated with the change of HAMD-24 score in patients who received EA+EO treatment (P<0.05). EA as an add-on therapy of EO probably enhanced antidepressant effectiveness through regulating multiple targets involved in blood BDNF, IL-6, and glucocorticoid-inducible genes GILZ mRNA and SGK-1 mRNA.

Purpose:Cancer pain management remains a significant clinical challenge. While acupuncture has shown potential in alleviating cancer pain, its underlying mechanisms are not yet fully understood. This study investigates the neurophysiological mechanisms underlying acupuncture's analgesic effects using multimodal bioelectrical signal analysis. Patients and Methods:Fifteen cancer pain patients underwent acupuncture while wearing portable, multi-sensor devices to capture bioelectrical signals. Pain levels were assessed using the Numerical Rating Scale (NRS) before and during needle retention. Neurophysiological changes were evaluated using Principal Component Analysis, Joint Time-Frequency Analysis, power spectrum analysis, spectral analysis, and dynamic functional network analysis. Results:There was a significant reduction in NRS scores from pre-treatment to the retention period, indicating pain relief. Principal component analysis showed significant differences in bioelectrical signals between these periods. Power spectrum analysis revealed decreased signal power during retention. Functional network analysis demonstrated a reduction in connectivity strength between electroencephalography and electromyography signals. Spectral analysis identified distinct real-time and staged characteristics of bioelectrical signals, with correlation analysis confirming a positive relationship between NRS score changes and bioelectrical signal alterations. Conclusion:Acupuncture alleviates cancer pain by reducing functional connectivity between injured tissues and the brain, with immediate effects. Prolonging needle retention may enhance therapeutic outcomes. These findings provide new insights into the neurophysiological basis of acupuncture's analgesic effects, supporting its role in cancer pain management.

Purpose:Anxious depression (AD) is a common, distinct depression subtype. This exploratory subgroup analysis aimed to explore the effects of acupuncture as an add-on therapy of selective serotonin reuptake inhibitors (SSRIs) for patients with AD or non-anxious depression (NAD). Patients and Methods:Four hundred and sixty-five patients with moderate-to-severe depression from the AcuSDep pragmatic trial were included in analysis. Patients were randomly assigned to receive MA+SSRIs, EA+SSRIs, or SSRIs alone (1:1:1) for six weeks. AD was defined by using dimensional criteria. The measurement instruments included 17-items Hamilton Depression Scale (HAMD-17), Self-Rating Depression Scale (SDS), Clinical Global Impression (CGI), Rating Scale for Side Effects (SERS), and WHO Quality of Life-BREF (WHOQOL-BREF). Comparison between AD and NAD subgroups and comparisons between groups within either AD or NAD subgroups were conducted. Results:Eighty percent of the patients met the criteria for AD. The AD subgroup had poorer clinical manifestations and treatment outcomes compared to those of the NAD subgroup. For AD patients, the HAMD response rate, remission rate, early onset rate, and the score changes on each scale at most measurement points on the two acupuncture groups were significantly better than the SSRIs group. For NAD patients, the HAMD early onset rates of the two acupuncture groups were significantly better than the SSRIs group. Conclusion:For AD subtype patients, either MA or EA add-on SSRIs showed comprehensive improvements, with small-to-medium effect sizes. For NAD subtype patients, both the add-on acupuncture could accelerate the response to SSRIs treatment. The study contributed to the existing literature by providing insights into the potential benefits of acupuncture in combination with SSRIs, especially for patients with AD subtypes. Due to its limited nature as a post hoc subgroup analysis, prospectively designed, high-quality trials are warranted. Clinical Trials Registration:ChiCTR-TRC-08000297.

Recently, emerging evidence has identified that stress-induced activation of neuroinflammation is considered to be one of the most prevalently precipitating factors in the pathogenesis of depression. Data from clinical trials and experimental findings has verified the efficacy and safety of acupuncture in the prevention and treatment of depression. However, the mechanism of the preventive effect of acupuncture for depression has not been fully elucidated. The current study aimed to investigate the preventive effect and mechanism of acupuncture through modulating the neuroinflammation mediated by toll-like receptor 4 (TLR4) signaling pathway in rats exposed to chronic restraint stress (CRS). All rats were subjected to CRS for 21 days, with the exception of rats in control group. One hour before CRS, rats in acupuncture group were exposed to acupuncture at Baihui (GV20) and Yintang (GV29). The depression-like behaviors were evaluated by body weight assessment and sucrose preference test at 0, 7, 14, and 21 days. The expression of activated microglia in hippocampus was detected by immunofluorescence. The expression of key proteins on TLR4 signaling pathway of TLR4, MyD88, TRAF6, NF-κB p65, TNF-α, and mRNA of TLR4 in the hippocampus was detected by western blot and real-time quantitative polymerase chain reaction to investigate the effect of acupuncture on stress-induced activation of neuroinflammation. The present study provided evidence that acupuncture exerted potential preventive effect that might be mediated in part by suppressing the neuroinflammation induced by TLR4 signaling pathway, which may be a promising treatment target to improve current treatments for depression.

EDITORIAL article Front. Psychiatry, 12 July 2023Sec. Anxiety and Stress Disorders Volume 14 - 2023 | https://doi.org/10.3389/fpsyt.2023.1217886

Data from clinical and experimental studies have verified the efficacy and safety of acupuncture in the treatment of post-traumatic stress disorder (PTSD). However, the concrete mechanism has not been well elucidated. The stress-induced activation of inflammatory response is involved in the development and pathogenesis of PTSD. Here, we aimed to investigate the effects of acupuncture on regulating the hippocampal inflammatory response in rats exposed to PTSD. Forty male rats were randomly divided into control, model, acupuncture and sertraline group. Within 1 day after adaptive feeding, all rats were exposed to single prolonged stress (SPS), except for the rats in the control group. Rats in acupuncture group were exposed to acupuncture intervention at the acupoints of Baihui (GV20) and Yintang (GV29), 20 min once per day for 15 days. Rats in sertraline group were exposed to a suspension of sertraline and distilled water (0.2 mg/ml), once per day for 15 days continuously. Body weight and elevated plus maze experiment were detected at different time-points to evaluate the behavioral changes of rats. HE staining method was used to observe the basic pathological morphological changes in hippocampus. Immunofluorescence staining method was used to observe the activation of hippocampal microglia. The content of IL-6 and IL-18 in serum were detected by ELISA method. Compared with the control group, the body weight of rats in model group significantly decreased on 8 days, and the percentage of time in open arms and open arm entries decreased significantly on 15 days after SPS procedures, which indicated that SPS induced PTSD-like behavior in rats. Acupuncture exerted therapeutic effect. Simultaneously, the result of HE staining confirmed that SPS induced hippocampal morphological changes in SPS rats. Notably, acupuncture reversed the reduction and pathological injury to some extent. The results have also shown that acupuncture intervention effectively reversed the activated microglia of the hippocampus in rats. Moreover, the expression of IL-18 in serum was significantly decreased by acupuncture intervention. In summary, the present study demonstrated that the role of acupuncture in eliminating PTSD-like behavior might be connected with reversing the pathological process of the inflammatory response mediated by the activation of microglia induced by SPS.

BackgroundThe highly heterogeneous pathogenesis of depression and limited response to current antidepressants call for more objective evidence for depression subtypes. Reactive and endogenous depression are two etiologically distinct subtypes associated with different treatment responses. This study aims to explore the potential biomarkers that differentiate reactive and endogenous depressions.MethodsThe clinical manifestations and biological indicators of 64 unmedicated mild-to-moderate depression patients (32 reactive depression patients and 32 endogenous depression patients) and 21 healthy subjects were observed. The 24-item Hamilton rating scale for depression (HAMD-24) was used to evaluate the severity of depression. Serum levels of depression-related biological indicators were measured by using the enzyme-linked immunosorbent assay.ResultsThe NLRP3 level of reactive depression was significantly lower than those of endogenous depression and healthy controls. There was a significant negative correlation between the BDNF level and the HAMD-24 total scores for patients with reactive depression.ConclusionOur findings suggested the serum NLRP3 and BDNF levels could be potential biomarkers for detecting and evaluating the severity of reactive depression.

BackgroundPrevious studies in animals and humans indicated that transcutaneous vagus nerve stimulation (tVNS) and transcutaneous electrical acupoint stimulation (TEAS) on trigeminal nerve-innervated forehead acupoints can relief the symptoms of depression. However, due to the limited investigations on these two interventions, more research are needed to confirm their efficacy in depression. To improve the efficacy of the single treatment, we combined two treatments and created a novel non-invasive stimulation, transcutaneous electrical cranial-auricular acupoint stimulation (TECAS). To assess the efficacy and safety of TECAS, we compare it with a selective serotonin reuptake inhibitor (SSRI), escitalopram, for the treatment of depression.Methods/DesignThis is a multi-center, non-inferiority, randomized controlled trial that will involve 470 patients with mild to moderate depression. Patients will be randomly assigned to either the TECAS group or the escitalopram group in a 1:1 ratio. The TEAS group will receive two sessions of treatments per day for 8 consecutive weeks, and the escitalopram group will receive 8 weeks of oral escitalopram tablets prescribed by clinical psychiatrists as appropriate for their condition. The primary outcome is the clinical response as determined by Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week 8, with −10% as the non-inferior margin. The secondary outcomes include the response rate determined by 17-item Hamilton Depression Rating Scale (HAMD-17), remission rate, changes from baseline in the scores on the MADRS, the HAMD-17, the Hamilton Anxiety Rating Scale (HAMA), the Pittsburgh Sleep Quality Index (PSQI), and the Short Form 36 Health Survey (SF-36).DiscussionThis will be the first randomized controlled trial to compare the efficacy of TECAS with escitalopram for depression. If effective, this novel intervention could have significant clinical and research implications for patients with depression.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT03909217].

Aim: Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is a novel non-invasive therapy that stimulates acupoints innervated by the trigeminal and auricular vagus nerves. An assessor-blinded, randomized, non-inferiority trial was designed to compare the efficacy of TECAS and escitalopram in mild-to-moderate major depressive disorder. Methods: 468 participants received two TECAS sessions per day at home (n = 233) or approximately 10-13 mg/day escitalopram (n = 235) for 8 weeks plus 4-week follow-up. The primary outcome was clinical response, defined as a baseline-to-endpoint 50% reduction in Montgomery-Asberg Depression Rating Scale (MADRS) score. Secondary outcomes included remission rate, changes in the severity of depression, anxiety, sleep and life quality. Results: The response rate was 66.4% on TECAS and 63.2% on escitalopram with a 3.2% difference (95% confidence interval [CI], -5.9% to 12.9%) in intention-to-treat analysis, and 68.5% versus 66.2% with a 2.3% difference (95% CI, -6.9% to 11.4%) in per-protocol analysis. The lower limit of 95% CI of the differences fell within the prespecified non-inferiority margin of -10% (P <= 0.004 for non-inferiority). Most secondary outcomes did not differ between the two groups. TECAS-treated participants who experienced psychological trauma displayed a markedly greater response than those without traumatic experience (81.3% vs 62.1%, P = 0.013). TECAS caused much fewer adverse events than escitalopram. Conclusions: TECAS was comparable to escitalopram in improving depression and related symptoms, with high acceptability, better safety profile, and particular efficacy in reducing trauma-associated depression. It could serve an effective portable therapy for mild-to-moderate depression.

焦虑性抑郁症属于一种比非焦虑性抑郁症更为严重的抑郁类型.焦虑性抑郁症的诊断主要依赖于维度标准、综合征性标准和伴焦虑痛苦标注.焦虑性抑郁症患病率高,通常具有比非焦虑性抑郁症更加复杂的临床表现和更差的治疗结局,并且具有独特的神经生物学特征.一线抗抑郁疗法对焦虑性抑郁症疗效均不理想,新型抗抑郁药、联合用药、重复经颅磁刺激和针刺疗法表现出较好的应用前景.临床诊疗工作中应关注对焦虑性抑郁症患者的早期识别,通过新型药物和联合治疗等手段提高疗效,同时密切监测治疗安全性.未来研究应采用统一的诊断标准,结合神经生物学测量手段探索焦虑性抑郁症潜在疗法的效应机制,开展具有充足把握度的随机对照试验优化临床治疗.

Depression is a common psychiatric illness affecting over 300 million people globally. Acupuncture has been reported to be a safe complementary treatment for depression. This study is aimed to investigate the efficacy and mechanism of combining acupuncture with antidepressants in treating depression compared to the sole use of antidepressants. Seventy depression patients were randomly assigned to the treatment group ( n = 50) and control group ( n = 20). The treatment group received acupuncture combined antidepressants treatment for 3 weeks, while the control group took antidepressants monotherapy for 3 weeks. Among the 70 patients, 40 participants (20 control; 20 treatment) were randomized for studying functional connectivity (FC) of the dorsolateral prefrontal cortex (DLPFC) measured by the functional near-infrared spectroscopy. The primary outcome was HAMD-17 and secondary outcomes were PHQ-9, and the relationships of resting-state FC (rsFC) with the depression severity. PHQ-9 and HAMD-17 scores in the treatment group were significantly lower than those in the control group at Week 3 ( p = 0.01) with effect sizes of −0.4 and −0.61 respectively. The rsFC in F1, F3, AF3, AF7, FC3, FC5 (left DLPFC, 10–20 system), AF8, and F6 (right DLPFC) in the treatment group had significant temporal correlation ( p < 0.05, FDR corrected) in DLPFC compared to the channels in the control group. No significant correlation was found between the changes of rsFC and depression severity. In conclusion, depressed patients receiving acupuncture combined with antidepressants have improvement of depressive symptoms and the stronger rsFC in the DLPFC compared to those using antidepressants alone.

目的:观察针刺对慢性不可预知应激抑郁大鼠前额叶皮质c-Jun末端激酶(JNK)信号通路上下游JNK、c-Jun、p-c-Jun表达的影响,探讨针刺抗抑郁的作用机制.方法:将80只SD大鼠,随机分为8组:正常组、模型组、模型+SP组(SP组)、模型+DMSO组(DMSO组)、氟西汀组、氟西汀+SP组、针刺组、针刺+SP组,每组10只.慢性不可预知应激方法诱导抑郁造模,采用侧脑室注射技术侧脑室注射SP600125阻断JNK.针刺穴位选择内关和三阴交,每日于造模前干预,每次20min;阳性对照药采用氟西汀1.8mg/kg灌胃,每日1次.采用旷场实验和体质量来评价抑郁实验的行为学,Western blot法检测大鼠前额叶JNK、c-Jun、p-c-Jun蛋白的表达.结果:行为学:与正常组比较,CUMS模型组大鼠体质量、旷场实验水平与竖直得分显著减少(P＜0.01);与模型组比较,针刺组可以显著上调体质量和旷场实验得分(P＜0.01).JNK信号通路相关蛋白:与正常组比较,模型组、DMSO组的JNK、c-Jun、p-c-Jun表达明显上升(P＜0.01);与模型组比较,氟西汀+SP组、针刺组、针刺+SP组JNK蛋白表达显著上升(P＜0.01),SP组、氟西汀组、氟西汀+SP组、针刺组、针刺+SP组c-Jun蛋白表达显著下降(P＜0.05,P＜0.01),氟西汀组、氟西汀+SP组、针刺组、针刺+SP组p-c-Jun蛋白表达显著下降(P＜0.01).结论:针刺可以通过下调前额叶皮质JNK信号通路相关蛋白表达,发挥抗抑郁作用.

Mitochondrial dysfunction with oxidative damage plays the fundamental roles in the pathogenesis of Alzheimer’s disease. In traditional Chinese medicine (TCM) practice, animal tissue-derived gelatins are often used as nootropic agents to treat cognitive deterioration and senile dementia. Tortoise plastron gelatin (TPG) and deer antler gelatin (DAG) are the two most commonly used gelatins for this purpose. This study sought to examine the effects of the two gelatins in preventing neuronal mitochondria from oxidative damage. PC12 cells, a cell line derived from rat pheochromocytoma, exposed to the neurotoxin Aβ 25–35 served as an in vitro model of Alzheimer’s disease. The cells were separately pre-treated with TPG and DAG at various concentrations ranging from 6.26 µg/ml–200 µg/ml, followed by co-incubation with 20 μM Aβ 25–35 for different duration. Cell viability, mitochondrial membrane potential (MMP) and ultrastructure, intracellular ATP, reactive oxygen species (ROS) and calcium (Ca 2+ ) level, the expression of mitochondrial dynamic proteins and biomarkers of apoptosis were measured. Pretreatment with TPG and DAG reversed the Aβ-induced reduction of cell viability in a dose-dependent manner. Both TPG and DAG significantly increased MMP and ATP, alleviated the accumulation of damaged mitochondrial fragments, and normalized the aberrant expression of multiple mitochondrial dynamic proteins of the Aβ-exposed cells. Both gelatins also suppressed intracellular ROS overproduction and Ca 2+ overload, overexpression of cytochrome c and pro-apoptosis biomarkers induced by the Aβ exposure. These results suggest that TPG and DAG may have the anti-dementia potential by preventing neuronal mitochondria from oxidative damage.

Background: Subthreshold depression (StD) is a prevalent condition that may increase the risk of incident major depressive disorder (MDD). However, the relationship between StD and MDD remains unclear. Methods: A total of 153 adult subjects, including 53 drug-naive MDD, 50 StD and 50 healthy control (HC) subjects, underwent a T1-weighted magnetic resonance imaging scan, and the gray matter volume (GMV) alterations among the three groups were quantitatively analyzed using voxel-based morphometry (VBM). Then, to capture the whole-brain connectivity characteristics, we constructed morphological brain networks (MBN) based on the similarity among brain regions of individual VBM images and compared the network connection strengths among the three groups. Results: The StD and MDD subjects had similar patterns of GMV reductions in the orbitofrontal cortex and left temporal gyrus, although the magnitude of the reductions was smaller in StD subjects. Moreover, a total of 21 morphological connections were significantly different among the three groups. For the majority of the different connections (15/21), the connection strength of the StD group took an intermediate position between that of the MDD and HC groups. Limitations: There is still a lack of a consistent definition of StD, and the age range of the subjects in this study was wide. Meanwhile the mechanisms and biological significance of the MBN remains to be clarified. Conclusions: These results may support the hypothesis that depression is better expressed as a spectrum and that StD exists on a spectrum with MDD.

Background: There is evidence supporting electroacupuncture (EA) for the treatment of major depressive disorder (MDD), but its characteristics have not been well investigated. Objective: To investigate the effectiveness and characteristics of EA in MDD. Methods: 60 subjects were enrolled—35 in the EA group and 25 in the selective serotonin reuptake inhibitor (SSRI) group based on their preferences—in an 8-week non-randomised controlled clinical trial. The 24-item Hamilton depression rating scale (HAMD-24) and clinical global impression (CGI) were adopted for clinical assessment. The Columbia suicide severity rating scale and adverse event form were used to measure safety and tolerability. The characteristics of EA and SSRIs were compared by analysing seven factors of the HAMD-24. Results: There was no significant difference between the two groups in terms of HAMD-24 response rate after intervention (P>0.05). Patients treated with EA demonstrated a significant reduction in CGI scores (P<0.05) with fewer adverse events compared with SSRIs (P<0.01). Although HAMD-24 factor analysis showed both EA and SSRIs could improve factor scores in cognitive impairment, diurnal variation, retardation, sleep disturbance, anxiety/somatisation and feelings of despair, EA showed greater improvement in anxiety/somatisation and feelings of despair than SSRIs (P<0.05). Conclusions: There was no significant difference between EA and SSRIs in the treatment of MDD with respect to our primary outcome. However, as a potential therapy for MDD, EA appeared to result in greater symptom improvement than SSRI treatment with respect to anxiety/somatisation and feelings of despair. The results of this secondary analysis should be interpreted cautiously given the inherent issues of multiple testing.

Jie-Yu Pill (JYP) is a proprietary herbal medicine initially developed to treat menstrual mood disorders. This study sought to determine whether JYP could alleviate menopausal psychiatric symptoms in ovariectomized (OVX) mice, an animal model of estrogen deprivation, exposed to chronic unpredictable mild stress (CUMS) and the underlying mechanisms in comparison with estrogen therapy. The OVX+CUMS mice were treated with 0.3 mg/kg estradiol (E2), 2.5 g/kg or 5 g/kg JYP for 36 days, and tested in multiple behavioral paradigms. Serum, uterus, and brain tissues were collected for the measurement of hypothalamus-pituitary-ovarian axis (HPO) and hypothalamus-pituitary-adrenal (HPA) axis hormones, γ-aminobutyric acid (GABA), glutamate, neurotrophins, and estrogen receptors. JYP and E2 had comparable efficacy in reducing anxiety- and depression-like behavior and cognitive impairment of the OVX+CUMS mice. E2 strikingly increased ratio of uterus to body weight of the OVX+CUMS mice, but JYP did not. Both agents suppressed HPO-axis upstream hormones, inhibited HPA-axis hyperactivity by reinstating hypothalamic GABA, restored hippocampal and prefrontal glutamate contents and its receptor expression in the OVX+CUMS mice. While JYP and E2 protected against decreases in hippocampal and prefrontal neurotrophins and estrogen receptors of the OVX+CUMS mice, unlike E2, JYP had no significant effects on these biomarkers in the uterus. These results suggest that JYP has comparable efficacy in ameliorating mood disorder-like behavior and cognitive impairment induced by a combination of estrogen deprivation and chronic stress in association with certain differential uterus-brain mechanisms compared to estrogen therapy. JYP may be a potential therapy for menopause-associated psychiatric disorders.

Objectives: To explore the effects of acupuncture (manual acupuncture or electroacupuncture) combined with SSRIs for moderate to severe depression improving major clinical symptoms and life quality of the patients on secondary outcomes. Design: Pragmatic, parallel, randomized controlled trial. Setting: 6 hospitals in China. Interventions: 6 weeks of manual acupuncture (MA) + selective serotonin reuptake inhibitors (SSRIs), electro-acupuncture (EA) + SSRIs, and SSRIs alone. Main outcome measures: The primary outcome was response rate of 17-item Hamilton Depression Scale (HAMD- 17) total score at 6th week. The secondary outcomes reported in this analysis were HAMD-17 factor scores at 1st, 2nd, 4th, 6th, 10th week and WHO Quality of Life-BREF (WHOQOL-BREF) scores at 6th week. Results: 477 patients were randomly assigned into MA + SSRIs (n = 161), EA + SSRIs (n = 160), or SSRIs alone (n = 156) groups. For HAMD-17 (at 6th week), the MA + SSRIs group was significantly better than the SSRIs alone group in retardation factor (p = 0.008), while the EA + SSRIs group was significantly better than the SSRIs alone group in anxiety/somatization factor (p < 0.001) and sleep disturbance factor (p = 0.002). For WHOQOL-BREF (at 6th week), the EA + SSRIs group, compared with the SSRIs alone group, produced a more significant improvement in the overall quality of life, general health, physical health, and psychological health (p < 0.05). While, the MA + SSRIs group, compared to the SSRIs alone group, showed significant advantage only in psychological health (p = 0.023). Conclusions: Either MA or EA combined SSRIs treatment could improve symptoms and quality of life for patients with moderate to severe depression. The main limitation of this trial was not using a sham control therefore the placebo effect could not be excluded.

目的:描述针刺治疗抑郁症的患者困扰及治疗后症状缓解的情况.方法:通过目的性和饱和抽样原则进行抽样,在受访者治疗前、后(6周)对13例患者进行半结构式定性访谈,资料分析采用扎根原理提取核心理论.结果:困扰可以分为生理方面、情绪情感方面和外在环境压力.受访者在表述这一理论时,愿意与访谈者倾诉,且容易表述为多方面问题,同一受访者具有多种困扰,不同受访者的困扰也容易交叉重叠.治疗后症状缓解分为生理缓解、心理缓解和总体缓解,受访者总体回答有明显缓解,针对此理论,访谈对象表现出的倾诉欲较强,且同“困扰”这一理论,受访者回答的交叉性和重叠度较高.通过受访者的回答可见,针刺治疗抑郁症有一定疗效,尤其是在情绪情感、缓解躯体疼痛和改善睡眠方面.结论:通过针刺治疗,抑郁患者状态可以得到明显改善.