Background Previous studies suggest that electroacupuncture possesses therapeutic benefits for depressive disorders. The purpose of this study was to determine whether dense cranial electroacupuncture stimulation (DCEAS) could enhance the antidepressant efficacy in the early phase of selective serotonin reuptake inhibitor (SSRI) treatment of major depressive disorder (MDD). Methods In this single-blind, randomized, controlled study, patients with MDD were randomly assigned to 9-session DCEAS or noninvasive electroacupuncture (n-EA) control procedure in combination with fluoxetine (FLX) for 3 weeks. Clinical outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), Clinical Global Impression-severity (CGI-S), and Self-rating Depression Scale (SDS) as well as the response and remission rates. Results Seventy-three patients were randomly assigned to n-EA (n = 35) and DCEAS (n = 38), of whom 34 in n-EA and 36 in DCEAS group were analyzed. DCEAS-treated patients displayed a significantly greater reduction from baseline in HAMD-17 scores at Day 3 through Day 21 and in SDS scores at Day 3 and Day 21 compared to patients receiving n-EA. DCEAS intervention also produced a higher rate of clinically significant response compared to n-EA procedure (19.4% (7/36) vs. 8.8% (3/34)). The incidence of adverse events was similar in the two groups. Conclusions DCEAS is a safe and effective intervention that augments the antidepressant efficacy. It can be considered as an additional therapy in the early phase of SSRI treatment of depressed patients. Trial Registration Controlled-Trials.com ISRCTN88008690
References
[1]
Arroll B, Macgillivray S, Ogston S, Reid I, Sullivan F, et al. (2005) Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Ann Fam Med 3: 449–456.
[2]
Blier P, de Montigny C (1994) Current advances and trends in the treatment of depression. Trends Pharmacol Sci 15: 220–226.
[3]
Blier P (2003) The pharmacology of putative early-onset antidepressant strategies. Eur Neuropsychopharmacol 13: 57–66.
[4]
Adell A, Castro E, Celada P, Bortolozzi A, Pazos A, et al. (2005) Strategies for producing faster acting antidepressants. Drug Discov Today 10: 578–585.
[5]
Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT (2010) The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis. J Affect Disord 124: 9–21.
[6]
Smith CA, Hay PP, Macpherson H (2010) Acupuncture for depression. Cochrane Database Syst Rev 20: CD004046.
[7]
Wang H, Qi H, Wang BS, Cui YY, Zhu L, et al. (2008) Is acupuncture beneficial in depression: a meta-analysis of 8 randomized controlled trials? J Affect Disord 111: 125–134.
[8]
Dhond RP, Kettner N, Napadow V (2007) Neuroimaging acupuncture effects in the human brain. Altern Complement Med 13: 603–616.
Ulett GA, Han S, Han JS (1998) Electroacupuncture: mechanisms and clinical application. Biol Psychiatry 44: 129–138.
[11]
Belmaker RH, Agam G (2008) Major depressive disorder. N Engl J Med 358: 55–68.
[12]
Zhang ZJ, Wang XY, Tan QR, Jin GX, Yao SM (2009) Electroacupuncture for refractory obsessive-compulsive disorder: a pilot waitlist-controlled trial. J Nerv Ment Dis 197: 619–22.
[13]
Huang Y, Gong W, Zou J, Zhao CH (2004) An SCL-90 analysis of scalp electroacupuncture treatment of major depressive episode. Shanghai Zhen Jiu Za Zhi 23: 5–7. (in Chinese with English abstract).
[14]
Li HJ, Zhong BL, Fan YP, Hu HT (2011) Acupuncture for post-stroke depression: a randomized controlled trial. Zhongguo Zhen Jiu 31: 3–6. (in Chinese with English abstract).
[15]
Yeung WF, Chung KF, Tso KC, Zhang SP, Zhang ZJ, et al. (2011) Electroacupuncture for residual insomnia associated with major depressive disorder: a randomized controlled trial. Sleep 34: 807–815.
[16]
Stark P, Hardison CD (1985) A review of multicenter controlled studies of fluoxetine vs. imipramine and placebo in outpatients with major depressive disorder. J Clin Psychiatry 46: 53–58.
[17]
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association Press.
[18]
Hamilton M (1960) A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry 23: 56–62.
[19]
Guy W (1976) ECDEU assessment manual for psychopharmacology. revised. Bethesda, MD: US Department of Health, Education, and Welfare.
[20]
Hong CJ, Hu WH, Chen CC, Hsiao CC, Tsai SJ, et al. (2003) : A double-blind, randomized, group-comparative study of the tolerability and efficacy of 6 weeks' treatment with mirtazapine or fluoxetine in depressed Chinese patients. J Clin Psychiat 64: 921–926.
[21]
Yu YW, Tsai SJ, Liou YJ, Hong CJ, Chen TJ (2006) Association study of two serotonin 1A receptor gene polymorphisms and fluoxetine treatment response in Chinese major depressive disorders. Eur Neuropsychopharmacol 16: 498–503.
[22]
Han JS (2003) Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 26: 17–22.
[23]
Streitberger K, Kleinhenz J (1998) Introducing a placebo needle into acupuncture research. Lancet 352: 364–365.
[24]
Enck P, Klosterhalfen S, Zipfel S (2010) Acupuncture, psyche and the placebo response. Auton Neurosci 157: 68–73.
[25]
Lee HC, Chiu HF, Wing YK, Leung CM, Kwong PK, et al. (1994) The Zung Self-rating Depression Scale: screening for depression among the Hong Kong Chinese elderly. J Geriatr Psychiatry Neurol 7: 216–220.
[26]
Fink M, Gutenbrunner C, Rollnik J, Karst M (2001) Credibility of a newly designed placebo needle for clinical trials in acupuncture research. Forsch Komplementarmed Klass Naturheilkd 8: 368–372.
[27]
Allen JJ, Schnyer RN, Chambers AS, Hitt SK, Moreno FA, et al. (2006) Acupuncture for depression: a randomized controlled trial. J Clin Psychiatry 67: 1665–1673.
[28]
Andreescu C, Glick RM, Emeremni CA, Houck PR, Mulsant BH (2011) Acupuncture for the treatment of major depressive disorder: a randomized controlled trial. J Clin Psychiatry 2011;72: 1129–1135.
[29]
Zhang WJ, Yang XB, Zhong BL (2009) Combination of acupuncture and fluoxetine for depression: a randomized, double-blind, sham-controlled trial. J Altern Complement Med 15: 837–844.
[30]
Zhou F, Huang D, Xia Y (2009) Neuroanatomical basis of acupuncture points (Chapter 2). In: Xia Y, Wu G, Cao X, Chen J, editors. Acupuncture therapy for neurological diseases: a neurobiological view. pp. 32–80. Tsinghua University Press, Beijing, and Springer-Verlag Berlin, Heidelberg.
[31]
Benham A, Johnson MI (2009) Could acupuncture needle sensation be a predictor of analgesic response? Acupunct Med 27: 65–67.
[32]
Arbab MA, Delgado T, Wiklund L, Svendgaard NA (1988) Brain stem terminations of the trigeminal and upper spinal ganglia innervation of the cerebrovascular system: WGA-HRP transganglionic study. J Cereb Blood Flow Metab 8: 54–63.
[33]
Kubota K, Narita N, Ohkubo K, Hosaka K, Nagae K, et al. (1988) Central projection of proprioceptive afferents arising from maxillo-facial regions in some animals studied by HRP-labeling technique. Anat Anz 165: 229–251.
[34]
Foote SL, Bloom FE, Aston-Jones G (1983) Nucleus locus ceruleus: new evidence of anatomical and physiological specificity. Physiol Rev 63: 844–914.
[35]
Simpson KL, Altman DW, Wang L, Kirifides ML, Lin RC, et al. (1997) Lateralization and functional organization of the locus coeruleus projection to the trigeminal somatosensory pathway in rat. J Comp Neurol 385: 135–147.
[36]
Simpson KL, Waterhouse BD, Lin RC (1999) Origin, distribution, and morphology of galaninergic fibers in the rodent trigeminal system. J Comp Neurol 411: 524–534.
[37]
Takahashi T, Shirasu M, Shirasu M, Kubo KY, Onozuka M, et al. (2010) The locus coeruleus projects to the mesencephalic trigeminal nucleus in rats. Neurosci Res 68: 103–106.
[38]
Clark L, Chamberlain SR, Sahakian BJ (2009) Neurocognitive mechanisms in depression: implications for treatment. Annu Rev Neurosci 32: 57–74.
[39]
Takahashi T (2006) Acupuncture for functional gastrointestinal disorders. J Gastroenterol 41: 408–417.
[40]
Kwon YB, Kang MS, Son SS, Kim JT, Lee YH, et al. (2000) Different frequencies of electroacupuncture modified the cellular activity of serotonergic neurons in brainstem. Am J Chin Med 28: 435–441.
[41]
Lee HJ, Lee B, Choi SH, Hahm DH, Kim MR, et al. (2004) Electroacupuncture reduces stress-induced expression of c-fos in the brain of the rat. Am J Chin Med 32: 795–806.
[42]
Li A, Wang Y, Xin J, Lao L, Ren K, et al. (2007) Electroacupuncture suppresses hyperalgesia and spinal Fos expression by activating the descending inhibitory system. Brain Res 1186: 171–179.
[43]
Kirkcaldie M, Pridmore S, Reid P (1997) Bridging the skull: electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) in psychiatry. Convulsive Therapy 13: 83–91.
[44]
van Dijk KR, Scherder EJ, Scheltens P, Sergeant JA (2002) Effects of transcutaneous electrical nerve stimulation (TENS) on non-pain related cognitive and behavioural functioning. Rev Neurosci 13: 257–270.
[45]
Zhang ZJ, Wang XM, McAlonan GM (2011) Neural acupuncture unit (NAU): a new concept for interpreting effects and mechanisms of acupuncture. eCAM (accepted, Article ID: 429412).
[46]
Barnes PM, Powell-Griner E, McFann K, Nahin RL (2004) Complementary and alternative medicine use among adults: United States, Adv Data 27: 1–19.
[47]
La Marca R, Nedeljkovic M, Yuan L, Maercker A, Ehlert U (2010) Effects of auricular electrical stimulation on vagal activity in healthy men: Evidence from a three-armed randomized trial. Clin Sci (Lond) 118: 537–546.
[48]
Keller MB, Berndt ER (2002) Depression treatment: a lifelong commitment? Psychopharmacol Bull 36(S2): 133–141.
