An observational study of acupuncture and complementary treatments for major depression: Case series from a preliminary study of proposed collaborative care model

10.1016/j.jtcme.2022.03.002

Sara Maria Tamayo；Tsu-Hsuan Wei；Liang-yu Chen；Wen-Chao Ho；Gil Ton；Yu-Chen Lee

Acupuncture ； Mind-body therapies ； Collaborative care model ； Major depressive disorder

Journal of Traditional and Complementary Medicine

12卷5期（2022 / 09 / 01）

499 - 504

英文

Background: Major depressive disorder is identified as a mood disorder characterized by episodically recurring and potentially life-threatening negative symptoms. It is currently important for study, as it involves high morbidity, mortality and prevalence, as well as unsatisfactory treatment results. Aim: Establish an outpatient model from an integrative approach promoting the diversified development of traditional Chinese and Western medicine cooperation, leading to a holistic intervention for patients with depression. Experimental procedure: Fifteen participants with moderate to severe depression were followed up for eight weeks in the Acupuncture Department of the China Medical University Hospital in Taichung, Taiwan, under a collaborative outpatient model that combined Western psychiatry and traditional Chinese medicine (TCM). Interdisciplinary Intervention included manual acupuncture twice a week (16 sessions), tai chi, yoga meditation, and nutritional assessment. Symptomatology was measured with primary outcomes (self-reporting via questionnaires) and secondary outcomes (heart rate variability [HRV] and blood samples to measure inflammation via high-sensitivity C-reactive protein [hs-CRP]). Results: The response rate was 80% (12/15 participants), with a statistically and clinically significant decrease in depression severity according to the 21-question Hamilton depression rating scale (HDRS_(21)) (p ＜ 0.001), the Beck Depression Inventory (BDI) (p ＜ 0.003), and quality of life (QoL) questionnaires (p ＜ 0.002). We found body constitution heterogeneity in the participants with major depressive disorder (MDD), predominantly blood stagnation and Qi stagnation (in 70% of participants). Conclusion: An interdisciplinary outpatient treatment method of complementary therapies can be applied successfully with pharmacological treatment in clinical practice to reduce depression symptomatology. Section: Physical/Mental practices. Taxonomy: Major Depressive Disorder, Collaborative healthcare Treatment, Observational study.

1. Andrade, L,Caraveo-Anduaga, JJ,Berglund, P(2003).The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys.Int J Methods Psychiatr Res,12(1),3-21.
2. Blair-West, GW,Cantor, CH,Mellsop, GW,Eyeson-Annan, ML(1999).Lifetime suicide risk in major depression: sex and age determinants.J Affect Disord,55(2-3),171-178.
3. Burckhardt, CS,Anderson, KL(2003).The Quality of Life Scale (QOLS): reliability, validity, and utilization.Health Qual Life Outcome,1,60.
4. Buysse, DJ,Reynolds, CF, 3rd,Monk, TH,Berman, SR,Kupfer, DJ(1989).The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.Psychiatr Res,28(2),193-213.
5. Cabýoglu, MT,Ergene, N,Tan, U(2006).The mechanism of acupuncture and clinical applications.Int J Neurosci,116(2),115-125.
6. Chan, Y-Y,Lo, W-Y,Yang, S-N,Chen, Y-H,Lin, J-G(2015).The benefit of combined acupuncture and antidepressant medication for depression: a systematic review and meta-analysis.J Affect Disord,176,106-117.
7. Di, YM,Yang, L,Shergis, JL(2019).Clinical evidence of Chinese medicine therapies for depression in women during perimenopause and menopause.Compl Ther Med,47,102071.
8. Dinan, TG,Cryan, JF(2013).Melancholic microbes: a link between gut microbiota and depression?.Neuro Gastroenterol Motil,25(9),713-719.
9. Dong, B,Chen, Z,Yin, X(2017).The efficacy of acupuncture for treating depression-related insomnia compared with a control group: a systematic review and meta-analysis.BioMed Res Int,2017,9614810.
10. Elliott, TE,Renier, CM,Palcher, JA(2003).Chronic pain, depression, and quality of life: correlations and predictive value of the SF-36.Pain Med.,4(4),331-339.
11. Fu, TS,Lee, CS,Gunnell, D,Lee, WC,Cheng, AT(2013).Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey.Lancet,381(9862),235-241.
12. Gagnier, JJ,Kienle, G,Altman, DG(2013).The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development.Glob Adv Health Med
13. Gartlehner, G,Hansen, RA,Morgan, LC(2011).Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis.Ann Intern Med.,155(11),772-785.
14. Gilbody, S,Bower, P,Fletcher, J,Richards, D,Sutton, AJ(2006).Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes.Arch Intern Med.,166(21),2314-2321.
15. Grosso, G,Pajak, A,Marventano, S(2014).Role of omega-3 fatty acids in the treatment of depressive disorders: a comprehensive meta-analysis of randomized clinical trials.PLoS One,9(5),e96905.
16. Huang, C-J,Lin, H-J,Liao, W-L,Ceurvels, W,Su, S-Y(2019).Diagnosis of traditional Chinese medicine constitution by integrating indices of tongue, acoustic sound, and pulse.Eur J Integr Med,27,114-120.
17. Hui, KK,Liu, J,Makris, N(2000).Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects.Hum Brain Mapp,9(1),13-25.
18. Katon, W,Russo, J,Lin, EH(2012).Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial.Arch Gen Psychiatr,69(5),506-514.
19. Katon, WJ,Lin, EH,Von, Korff, M(2010).Collaborative care for patients with depression and chronic illnesses.N Engl J Med.,363(27),2611-2620.
20. Kessler, RC,Bromet, EJ(2013).The epidemiology of depression across cultures.Annu Rev Publ Health,34,119-138.
21. Kessler, RC,Gruber, M,Hettema, JM,Hwang, I,Sampson, N,Yonkers, KA(2008).Comorbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up.Psychol Med.,38(3),365-374.
22. Kou, RZ,Chen, H,Yu, ML,Xu, TC,Fu, SP,Lu, SF(2017).Acupuncture for behavioral changes of experimental depressive disorder: a systematic review and meta-analysis.Sci Rep,7(1),9669.
23. Kuyken, W,Warren, FC,Taylor, RS(2016).Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials.JAMA Psychiatr,73(6),565-574.
24. Le, JJ,Yi, T,Qi, L,Li, J,Shao, L,Dong, JC(2016).Electroacupuncture regulate hypothalamic-pituitary-adrenal axis and enhance hippocampal serotonin system in a rat model of depression.Neurosci Lett,615,66-71.
25. Lee, MJ,Ryu, JS,Won, SK(2019).Effects of acupuncture on chronic stress-induced depression-like behavior and its central neural mechanism.Front Psychol,10,1353.
26. Leonard, BE(2010).The concept of depression as a dysfunction of the immune system.Depression: From psychopathology to pharmacotherapy,27,53-71.
27. Li, H,Sang, L,Xia, X(2019).Therapeutic duration and extent affect the effect of moxibustion on depression-like behaviour in rats via regulating the brain tryptophan transport and metabolism.Evid Based Complement Alternat Med,2019,7592124.
28. Liu, Q,He, H,Yang, J,Feng, X,Zhao, F,Lyu, J(2020).Changes in the global burden of depression from 1990 to 2017: findings from the global burden of disease study.J Psychiatr Res,126,134-140.
29. MacPherson, H,Altman, DG,Hammerschlag, R(2010).Revised Standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement.J Evid Base Med.,3(3),140-155.
30. Napadow, V,Makris, N,Liu, J,Kettner, NW,Kwong, KK,Hui, KK(2005).Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI.Hum Brain Mapp,24(3),193-205.
31. Olfson, M,Marcus, SC,Tedeschi, M,Wan, GJ(2006).Continuity of antidepressant treatment for adults with depression in the United States.Am J Psychiatr,163(1),101-108.
32. Park, HJ,Park, HJ,Chae, Y,Kim, JW,Lee, H,Chung, JH(2011).Effect of acupuncture on hypothalamic-pituitary-adrenal system in maternal separation rats.Cell Mol Neurobiol,31(8),1123-1127.
33. Parletta, N,Zarnowiecki, D,Cho, J(2019).A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: a randomized controlled trial (HELFIMED).Nutr Neurosci,22(7),474-487.
34. Paul, NA,Stanton, SJ,Greeson, JM,Smoski, MJ,Wang, L(2013).Psychological and neural mechanisms of trait mindfulness in reducing depression vulnerability.Soc Cognit Affect Neurosci,8(1),56-64.
35. Pirnia, B,Mohammadzadeh Bazargan, N,Hamdieh, M(2019).The effectiveness of auricular acupuncture on the levels of cortisol in a depressed patient.Iran J Public Health,48(9),1748-1750.
36. Richter, P,Werner, J,Heerlein, A,Kraus, A,Sauer, H(1998).On the validity of the Beck depression inventory.Psychopathology,31(3),160-168.
37. Smith, CA,Armour, M,Lee, MS,Wang, LQ,Hay, PJ(2018).Acupuncture for depression.Cochrane Database Syst Rev.,3(3),Cd004046.
38. Sun, Y,Zhao, Y,Xue, SA,Chen, J(2018).The theory development of traditional Chinese medicine constitution: a review.J Traditional Chin Med Sci,5(1),16-28.
39. Wong, W,Lam, CL,Wong, VT,Yang, ZM,Ziea, ET,Kwan, AK(2013).Validation of the constitution in Chinese medicine questionnaire: does the traditional Chinese medicine concept of body constitution exist?.Evid Based Complement Alternat Med,2013,481491.
40. Wong, W,Lam, CLK,Wong, VT,Yang, ZM,Ziea, ET,Kwan, AKL(2013).Validation of the constitution in Chinese medicine questionnaire: does the traditional Chinese medicine concept of body constitution exist?.Evid base Compl Alternative Med,2013
41. Zhang, ZJ,Chen, HY,Yip, KC,Ng, R,Wong, VT(2010).The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and metaanalysis.J Affect Disord,124(1-2),9-21.
42. Zhao, Z-Q(2008).Neural mechanism underlying acupuncture analgesia.Prog Neurobiol,85(4),355-375.
43. Zheng, W,Su, Z,Liu, X(2018).Modulation of functional activity and connectivity by acupuncture in patients with Alzheimer disease as measured by resting-state fMRI.PLoS One,13(5),e0196933.
44. Zhichao, H,Ching, LW,Huijuan, L(2021).A network meta-analysis on the effectiveness and safety of acupuncture in treating patients with major depressive disorder.Sci Rep,11(1),1-18.
45. Zimmerman, M,Martinez, JH,Young, D,Chelminski, I,Dalrymple, K.(2013).Severity classification on the Hamilton depression rating scale.J Affect Disord.,150(2),384-388.