Repeated acupuncture treatments modulate amygdala resting state functional connectivity of depressive patients Complementary use of tai chi chih augments escitalopram treatment of geriatric depression: a randomized controlled trial. Hypothalamic–pituitary–adrenal axis activity in older persons with and without a depressive disorder A Randomized Controlled Neurophysiological Study of a Chinese Chan-Based Mind-Body Intervention in Patients with Major Depressive Disorder Psychosocial Treatment Options for Major Depressive Disorder in Older Adults Clinical research on the therapeutic effect of the electro-acupuncture treatment in patients with depression. Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong. Effects of electroacupuncture and fluoxetine on the density of GTP-binding-proteins in platelet membrane in patients with major depressive disorder. Acute inflammation and negative mood: Mediation by cytokine activation The relevance between symptoms and magnetic resonance imaging analysis of the hippocampus of depressed patients given electro-acupuncture combined with Fluoxetine intervention — A randomized, controlled trial Psycho-physical and neurophysiological effects of qigong on depressed elders with chronic illness Mild acute inflammatory stimulation induces transient negative mood [Impact on serum 5-HT and TH1/TH2 in patients of depressive disorder at acute stage treated with acupuncture and western medication]. Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial
As a widely-applied alternative therapy , acupuncture is gaining popularity in Western society . One challenge that remains , however , is incorporating it into mainstream medicine . One solution is to combine acupuncture with other conventional , mainstream treatments . In this study , we investigated the combination effect of acupuncture and the antidepressant fluoxetine , as well as its underlying mechanism using resting state functional connectivity ( rsFC ) in patients with major depressive disorders . Forty-six female depressed patients were r and omized into a verum acupuncture plus fluoxetine or a sham acupuncture plus fluoxetine group for eight weeks . Resting-state fMRI data was collected before the first and last treatments . Results showed that compared with those in the sham acupuncture treatment , verum acupuncture treatment patients showed 1 ) greater clinical improvement as indicated by Montgomery – Åsberg Depression Rating Scale ( MADRS ) and Self-Rating Depression Scale ( SDS ) scores ; 2 ) increased rsFC between the left amygdala and subgenual anterior cingulate cortex (sgACC)/preguenual anterior cingulate cortex ( pgACC ) ; 3 ) increased rsFC between the right amygdala and left parahippocampus (Para)/putamen ( Pu ) . The strength of the amygdala-sgACC/pgACC rsFC was positively associated with corresponding clinical improvement ( as indicated by a negative correlation with MADRS and SDS scores ) . Our findings demonstrate the additive effect of acupuncture to antidepressant treatment and suggest that this effect may be achieved through the limbic system , especially the amygdala and the ACC BACKGROUND Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy . In this study , we ask whether a mind-body exercise , Tai Chi Chih ( TCC ) , added to escitalopram will augment the treatment of geriatric depression design ed to achieve symptomatic remission and improvements in health functioning and cognitive performance . METHODS : One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks . Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were r and omly assigned to 10 weeks of adjunct use of either 1 ) TCC for 2 hours per week or 2 ) health education ( HE ) for 2 hours per week . All participants underwent evaluations of depression , anxiety , resilience , health-related quality of life , cognition , and inflammation at baseline and during 14-week follow-up . RESULTS Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE . Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker , C-reactive protein , compared with the control group . CONCLUSION : Complementary use of a mind-body exercise , such as TCC , may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression BACKGROUND Altered functioning of the hypothalamic-pituitary-adrenal axis ( HPA-axis ) has been associated with depression , but findings have been inconsistent . Among older depressed persons , both hyperactivity and hypo-activity of the HPA-axis were demonstrated . However , most studies were population -based studies , with single cortisol measurements , lacking insight into diurnal patterns of HPA-axis functioning . We aim to provide insight into functioning of the HPA-axis , assessed by various salivary cortisol sample s , in depressed older adults and non-depressed controls . METHODS Data were derived from the Netherl and s Study of Depression in Older Persons .  Cortisol levels  of older persons without a lifetime diagnosis of depression and /or anxiety ( n=109 ) were compared with older persons with a 6-month major depression diagnosis ( n=311 ) . ANCOVA analyses and r and om coefficient analysis on the four morning cortisol sample s were performed . A possible U-shaped association between cortisol and depression status was examined . RESULTS Depressed older persons showed higher morning cortisol levels at awakening ( T1 ) and a less dynamic awakening response compared to non-depressed older persons . Dexamethasone suppression did not differ across groups . No U-shaped association between HPA-axis activity and depression was observed . CONCLUSION We demonstrated a hypercortisolemic state and a diminished ability to respond to the stress of awakening among depressed older persons . Previously it was shown , that hypercortisolemic states may indicate a lifelong biological vulnerability for depression . Our findings exp and on previous literature by demonstrating that in older persons the HPA-axis may become less responsive to stress , culminating in a further dysregulation of the diurnal cortisol-rhythm , superimposed on - possibly lifelong - hypercortisolemic states Our previous studies have reported the therapeutic effects of 10-session Chinese Chan-based Dejian mind-body interventions ( DMBI ) in reducing the intake of antidepressants , improving depressive symptoms , and enhancing the attentional abilities of patients with depression . This study aims to explore the possible neuroelectrophysiological mechanisms underlying the previously reported treatment effects of DMBI in comparison with those of cognitive behavioral therapy ( CBT ) .  Seventy-five age- , gender- , and education-matched participants with depression were r and omly assigned to receive either CBT or DMBI or placed on a waitlist .  Eyes-closed resting EEG data were obtained individually before and after 10 weeks . After intervention , the DMBI group demonstrated significantly enhanced frontal alpha asymmetry ( an index of positive mood ) and intra- and interhemispheric theta coherence in frontoposterior and posterior brain regions ( an index of attention ) . In contrast , neither the CBT nor the waitlist group showed significant changes in EEG activity patterns . Furthermore , the asymmetry and coherence indices of the DMBI group were correlated with self-reported depression severity levels and performance on an attention test , respectively . The present findings provide support for the effects of a Chinese Chan-based mind-body intervention in fostering human brain states that can facilitate positive mood and an attentive mind Opinion statementLate-life  depression ( LLD ) is a public health concern with deleterious effects on overall health , cognition , quality of life , and mortality . Although LLD is relatively common , it is not a normal part of aging and is often under-recognized in older adults . However , psychotherapy is an effective treatment for LLD that aligns with many patients ’ preferences and can improve health and functioning . This review synthesized the current literature on evidence -based psychotherapies for the treatment of depression in older adults . Findings suggest that active , skills-based psychotherapies ( cognitive behavioral therapy [ CBT ] and problem-solving therapy [ PST ] ) may be more effective for LLD than non-directive , supportive counseling . PST may be particularly relevant for off setting skill deficit associated with LLD , such as in instances of cognitive impairment ( especially executive dysfunction ) and disability . Emerging treatments also consider context ual factors to improve treatment delivery , such as personalized care , access , and poverty .  Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults . Although these strategies hold promise , further investigation via r and omized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD . Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence -based psychosocial interventions for LLD Electroacupuncture ( EA ) stimulation has been found to influence the brain ( norepinephrine metabolism in experimental animals ) . Preliminary clinical research has shown that EA treatment is as effective as amitriptyline for patients with depression . In this study , two consecutive clinical studies on the treatment of depression with EA are conducted . The first study was double blind placebo controlled , in which 29 depressed in patients were recruited . Patients were r and omly divided into three groups : EA + placebo ; amitriptyline ; and EA + amitriptyline . They received EA and /or amitriptyline treatment for 6 weeks . The Hamilton Rating Scale for Depression , Clinical Global Impression and ASBERG scales for the side effect of antidepressants were used to evaluate the therapeutic efficacy and side effects . Based on the results and research protocol of the first study , a multi-centered collaborative study was conducted , in which 241 in patients with depression were recruited . Patients were r and omly divided into two treatment groups : the EA + placebo and the amitriptyline groups . The results from both studies showed that the therapeutic efficacy of EA was equal to that of amitriptyline for depressive disorders ( P > 0.05 ) . Electro-acupuncture had a better therapeutic effect for anxiety somatization and cognitive process disturbance of depressed patients than amitriptyline ( P < 0.05 ) . Moreover , the side effects of EA were much less than that of amitriptyline ( P < 0.001 ) . The article suggested that EA treatment was an effective therapeutic method for depressive disorders . Particularly , it was a treatment of choice for depressed patients who were unable to comply with the classic tricyclic antidepressants because of their anticholinergic side effects . The possible mechanism of EA treatment is discussed BACKGROUND The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago . The lifetime prevalence rates of DSM-III major depressive disorder ( females 2.44 % and males 1.29 % ) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong . METHODS Each of 5004 adults r and omly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode ( MDE ) , sociodemography , help-seeking , and other  epidemiological data . RESULTS Twelve-month prevalence of MDE was 8.4 % . The female-to-male ratio was low but typical of surveys in Chinese communities . Female sex and unemployment were associated with increased risk . 32.5 % of respondents with MDE reported frequent thoughts of suicide . Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low . LIMITATIONS Response rate was low though cooperation rate was moderately high . Detailed demography , comorbidity , and clinical re appraisal interviews were not covered . CONCLUSIONS Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people . Although longitudinal studies are needed to confirm a genuine increase in prevalence , depression is likely to be more common in Hong Kong than previously suggested . High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment BACKGROUND Electroacupuncture ( EA ) has been used to treat Major Depressive Disorder ( MDD ) . However , its efficacy is inconclusive and the mechanism is still unclear . Thus , the objective of this study is to investigate the therapeutic effect of EA on GTP-binding-protein ( G protein ) in platelet membrane using fluoxetine as a comparison . METHODS A r and omized controlled trial ( RCT ) was performed on 90 MDD patients , who were divided into three groups treated with fluoxetine , EA and sham EA respectively . Antibodies were utilized to quantify the levels of G protein alpha subtypes in the platelet membrane before and after 6-week anti-depressive treatment .  Thirty age and sex-matched normal individuals were used as controls . RESULT All the treatments had the same therapeutic effects in treating moderate depression . Both levels of Galphai and Galphaq in depression patients were significantly higher than those in controls and were not reduced by treatments , although the severity was considerably relieved . LIMITATIONS The duration of treatment was limited to six weeks only . CONCLUSION EA might be served as an alternative treatment for moderate depression and we further demonstrate that the abnormal levels of Galpha protein in platelet membrane might be a potential risk factor for MDD Inflammatory diseases are commonly associated with depressed mood . This association may be influenced by the production of proinflammatory cytokines . Accordingly , we assessed whether cytokine levels and mood ( measured with the profile of mood states ) could be altered by a mild , non-sickness inducing , acute inflammatory stimulus . Using a r and omised placebo-controlled , double-blind design , 30 healthy male volunteers were injected with Salmonella typhi vaccine or placebo .  Assessment s of mood , symptoms of illness and temperature were made at baseline and at 1.5 , 3 , and 6 h post-injection . Plasma concentrations of interleukin-6 ( IL-6 ) , interleukin-1 receptor antagonist ( IL-1Ra ) , and tumour necrosis factor-alpha ( TNF-alpha ) were assessed at baseline and 3 h post-injection . No significant symptoms of illness were reported in either group . Mood was more negative following injection in the vaccine than the placebo group , and the vaccine group experienced a 106 % increase in IL-6 concentration . Negative changes in mood following injection were significantly correlated with increases in IL-6 production . No changes in TNF-alpha or IL-1Ra concentration were recorded in either group . It is concluded that S. typhi vaccination may be a useful model of mild inflammatory challenge , producing a significant transient cytokine-induced decrease in mood in the absence of any febrile response . Implication s for depressed mood in physical illness are discussed Objective To probe the relevance between depressive symptoms and hippocampal volume and its metabolites detected by magnetic resonance imaging ( MRI ) in depressed patients who were given electro-acupuncture ( EA ) combined with Fluoxetine  before and after treatment . Methods A r and omized , controlled trial was conducted . A total of 75 cases of mild or moderate depression were r and omly assigned to two groups : the EA group which received EA combined with Fluoxetine ; the Fluoxetine group which received Fluoxetine only as the control . The 17-item Hamilton Scale for Depression ( HAMD ) was used to assess the depression level . The relevance between the changes of the hippocampal volume and its metabolites , including N-acetyl aspartate (NAA)/creatine ( Cr ) and choline containing compounds (Cho)/Cr , and the reduction rate of the HAMD score before and after treatment of the two groups were analyzed . Results At the end of the treatment , the therapeutic response rates were not statistically different between the two groups ( 73.53 % for the Fluoxetine group and 83.33 % for the EA group , respectively ) . Compared to that of the Fluoxetine group , a significant difference was shown in the EA group in the reduction rate of the HAMD scores ( P<0.05 ) . There was a negative correlation between the therapeutic effect and the HAMD scores before treatment in both groups of patients . There was no significant difference in the hippocampal volume before and after treatment . The NAA/Cr ratio of both groups increased after treatment , with the EA group increasing more . There was a negative correlation between the rate of change of the NAA/Cr after treatment and the HAMD scores before treatment in the two groups . In the Fluoxetine group , the Cho/Cr ratio showed no significant difference before and after treatment , which had no relevance with the HAMD scores before treatment either . Meanwhile , in the EA group , the Cho/Cr ratio showed a significant difference before and after treatment , which also had a positive relevance with the HAMD scores before treatment . Conclusions There was a significant improvement in the hippocampal metabolites in depressed patients who treated by EA combined with Fluoxetine . Those differences showed relevance with the HAMD scores before treatment This r and omized controlled trial examined the psychological , physical , and neurophysiological effects of a qigong exercise program on depressed elders with chronic medical illness . The experimental group ( n = 21 , 80 ± 7 years ) was given a 12-week qigong exercise program , while the comparison group ( n = 17 , 81 ± 8 years ) participated in a newspaper reading program with the same duration and frequency . Measurement of depression symptoms , psychosocial functioning , muscle strengths , salivary cortisol , and serum serotonin was conducted . At 12 weeks , the qigong group had significant reduction in depressive symptoms ( F = 11.68 ; p < 0.025 ) . Improvement in self-efficacy ( F = 4.30 ; p < 0.050 ) , self-concept of physical well-being ( F = 6.82 ; p < 0.025 ) , and right-h and grip strength ( F = 5.25 ; p = 0.034 ) was also found when compared with the comparison group . A change in salivary cortisol level was found marginally insignificant between groups ( F = 3.16 ; p = 0.087 ) . However , a decreasing trend of cortisol level was observed . The results provided preliminary evidence for the hypotheses that the antidepressive effect of qigong exercise could be explained by improvement in psychosocial functioning and possibly down-regulation of hyperactivity of the hypothalamic – pituitary – adrenal axis Abstract Objective This study aims to assess the mood changes induced by mild acute inflammatory stimulation ( typhoid vaccination ) . Methods Using a double blind study design , 26 healthy volunteers underwent baseline assessment s of mood , financial strain and work stress and were r and omised to injection of Salmonella typhi vaccine or placebo injection .  Mood , symptoms and body temperature was assessed by a modified version of the Profile of Mood States at 1 , 2 , 3 , 4 , 6 and 8 h post injection . Results Typhoid vaccination induces no increases in physical symptoms or temperature . Mood improved over the day in the placebo but not in the vaccine condition . Negative changes in mood following injection were correlated with chronic stress ( financial strain ) in the vaccination condition ( r=−.65 , P<.025 ) . Conclusion A mild acute inflammatory stimulus induces transient negative mood , and responses were modulated by chronic stress . Implication s for depressed mood in physical illness are discussed OBJECTIVE To compare the difference in depression relief in the treatment of depressive disorder at the acute stage between the combined therapy of acupuncture and 5-HT ( 5-hydroxytryptamine ) selective serotonini reuptake inhibitors ( SSRIs ) and the single application of SSRIs and explore the impact on the imbalance of 5-HT and TH1/TH2 . METHODS Ninety cases of depressive disorder at the acute stage were r and omized into a combined therapy group and a medication group , 45 cases in each one . In the medication group , SSRIs were prescribed forl oral administration , once or twice a day , continuously for 4 weeks . In the combined therapy group , on the basis of treatment as the medication group , acupuncture was combined . The main acupoints were Baihui ( GV 20 ) , Yintang ( GV 29 ) , Shenting ( GV 24 ) , Fengchi ( GB 20 ) , Dazhui ( GV 14 ) and Sishencong ( EX-HN 1 ) , once every two . days , continuously for 4 weeks . Before treatment , and after the 1st , 2nd and 4th weeks of treatment , the Hamilton depression scale ( HAMD ) was used to evaluate the depression severity . Separately , before and after the 4 weeks of treatment , the levels of serum 5-HT , interleukin-1 beta ( IL-1β ) , interleukin-6 ( IL-6 ) , interleukin-4 ( IL-4 ) and interleukin-10 ( IL-10 ) were determined and compared with those in 45 cases of the healthy group . RESULTS HAMD score was reduced in the 1st , 2nd and 4th weeks of treatment as compared with that before treatment in the combined therapy  group ( all P<0 01 ) . HAMD score was reduced in the 2nd and 4th weeks of treatment as compared with that before treatment in the medication group ( all P<0 . 01 ) . HAMD scores in the combined therapy group were lower than those in the medication group in the 1st , 2nd and 4th weeks of treatment ( all P < 0 . 01 ) . Before treatment , in the combined therapy group and the medication group , the levels of serum 5-HT , IL-4 and IL-10 were all lower than those in the healthy group ( all P<0 . 01 ) ; the levels of IL-1β and IL-6 were higher than those in the healthy group ( all P<0 . 01 ) . In the combined therapy group and the medication group , the levels of 5-HT , IL-4 and IL-10 in 4 weeks of treatment were all increased as compared with those before treatment ( all P<0 . 01 ) , and the levels of IL-1β and IL-6 were lower than those before treatment ( all P<0 . 01 ) . In the combined therapy group , the levels of IL-1β and IL-6 in 4 weeks of treatment were lower than those in the medication group , and the levels of 5-HT , IL-4 and IL-10 were higher than those in the medication group ( P<0 . 01 , P < 0 . 05 ) . CONCLUSION The combined therapy of acupuncture and SSRIs achieves much quicker and more effective re- ' sult for relieving depression in the patients of depressive disorder as compared with simple oral administration of ' SSRIs , and much more contributes to adjust the imbalance of serum 5-HT and TH1/TH2 Background Transdiagnostic Cognitive Behavior Therapy ( TCBT ) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals . We have translated and modified the “ The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ” ( UP-CBT ) for group delivery in Mental Health Service ( MHS ) , and shown effects comparable to traditional CBT in a naturalistic study . As the use of one manual instead of several diagnosis-specific manuals could simplify logistics , reduce waiting time , and increase therapist expertise compared to diagnosis specific CBT , we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT . Methods / design The study is a partially blinded , pragmatic , non-inferiority , parallel , multi-center r and omized controlled trial ( RCT ) of UP-CBT vs diagnosis specific CBT for Unipolar Depression , Social Anxiety Disorder and Agoraphobia/Panic Disorder . In total , 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms . The primary outcome is patient-ratings of well-being ( WHO Well-being Index , WHO-5 ) , secondary outcomes include level of depressive and anxious symptoms , personality variables , emotion regulation , reflective functioning , and social adjustment . Assessment s are conducted before and after therapy and at 6 months follow-up . Weekly patient-rated outcomes and group evaluations are collected for every session . Outcome assessors , blind to treatment allocation , will perform the observer-based symptom ratings , and fidelity assessors will monitor manual adherence . Discussion The current study will be the first RCT investigating the dissemination of the UP in a MHS setting , the UP delivered in groups , and with depressive patients included . Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS . The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect . Trial registration Clinical trials.gov NCT02954731 . Registered 25 October
Background Depression is a common disease affecting a large number of people across the world .
Many research ers have focused on treatment for depression based on Western scientific approaches , but research based on traditional Chinese medicine ( TCM ) interventions , study ing its clinical effectiveness and the underlying mechanisms involved , has been limited .
The aim of this review is to conduct a pioneering systematic review with meta- analysis of existing studies that investigate the neuroscience basis of nonpharmacological traditional Chinese therapy ( NTCT ) .