The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial [Study on clinical effect enhancement of acupuncture for depression with chronic pain treated with SSRI antidepressants]. Validating a New Non-Penetrating Sham Acupuncture Device: Two Randomised Controlled Trials Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials [Clinical observation on depression treated by electroacupuncture combined with western medicine]. Effect of acupuncture ‘dose’ on modulation of the default mode network of the brain Clinical observation on treatment of depression by electro-acupuncture combined with Paroxetine Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey Development of an instrument to assess the quality of acupuncture: results from a Delphi process. Patients’ experiences of acupuncture and counselling for depression and comorbid pain: a qualitative study nested within a randomised controlled trial Cross validation of a general population survey diagnostic interview: a comparison of CIS-R with SCAN ICD-10 diagnostic categories. Acupuncture for residual insomnia associated with major depressive disorder: a placebo- and sham-controlled, subject- and assessor-blind, randomized trial. Using acupuncture to treat depression: a feasibility study. [Assessment of effectiveness of electroacupuncture and fluoxetine for treatment of depression with physical symptoms]. [Acupuncture for treatment of depressive neurosis: a multi-center randomized controlled study]. Antidepressant Mechanism Research of Acupuncture: Insights from a Genome-Wide Transcriptome Analysis of Frontal Cortex in Rats with Chronic Restraint Stress Electroacupuncture for residual insomnia associated with major depressive disorder: a randomized controlled trial. Acupuncture Combined with An Antidepressant for Patients with Depression in Hospital: A Pragmatic Randomised Controlled Trial 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 Acupuncture for the treatment of major depressive disorder: a randomized controlled trial. [Clinical study on needling method for regulating mental activities and soothing liver for treatment of melancholia]. Introducing a placebo needle into acupuncture research [Global improvement in agitated depression treated with the alliance therapy of acupuncture and seroxat and the observation of the quality of life]. Laser Acupuncture for Mild to Moderate Depression in a Primary Care Setting – a Randomised Controlled Trial [Impact on serum 5-HT and TH1/TH2 in patients of depressive disorder at acute stage treated with acupuncture and western medication]. Laser acupuncture for depression: a randomised double blind controlled trial using low intensity laser intervention.
Objectives We examined the effect of changing treatment timing and the use of manual , electro acupuncture on the symptoms of  primary dysmenorrhea .  Methods A r and omised controlled trial was performed with four arms , low frequency manual acupuncture ( LF-MA ) , high frequency manual acupuncture ( HF-MA ) , low frequency electro acupuncture ( LF-EA ) and high frequency electro acupuncture ( HF-EA ) . A manualised trial protocol was used to allow differentiation and individualized treatment over three months . A total of 74 women were r and omly assigned to one of the four groups ( LF-MA n = 19 , HF-MA n = 18 , LF-EA n = 18 , HF-EA n = 19 ) . Twelve treatments were performed over three menstrual cycles , either once per week ( LF groups ) or three times in the week prior to menses ( HF groups ) . All groups received a treatment in the first 48 hours of menses . The primary outcome was the reduction in peak menstrual pain at 12 months from trial entry . Results During the treatment period and nine month follow-up all groups showed statistically significant ( p < .001 ) reductions in peak and average menstrual pain compared to baseline but there were no differences between groups ( p > 0.05 ) . Health related quality of life increased significantly in six domains in groups having high frequency of treatment compared to two domains in low frequency groups . Manual acupuncture groups required less analgesic medication than electro-acupuncture groups ( p = 0.02 ) . HF-MA was most effective in reducing secondary menstrual symptoms compared to both – EA groups ( p<0.05 ) . Conclusion Acupuncture treatment reduced menstrual pain intensity and duration after three months of treatment and this was sustained for up to one year after trial entry . The effect of changing mode of stimulation or frequency of treatment on menstrual pain was not significant . This may be due to a lack of power . The role of acupuncture stimulation on menstrual pain needs to be investigated in appropriately powered r and omised controlled trials OBJECTIVE To compare the difference in the clinical efficacy on depression with chronic pain between the simple medication of selective serotonin uptake inhibition antidepressants ( SSRIs ) and the combined therapy of acupuncture and SSRIs . METHODS Ninety cases of depression were r and omized into an acupuncture + medication group ( combined therapy of acupuncture and western medication ) and a medication group ( simple medication ) , 45 cases in each one . In the medication group , the western medicine was adopted . According to the condition of disease , SSRIs was prescribed such as fluoxetine and paroxetine . In the acupuncture + medication group , on the basic treatment of western medication , acupuncture was applied to Baihui ( GV 20 ) , Yintang ( GV 29 ) , Shenting ( BL 24 ) , Fengchi ( GB 20 ) , etc . HAMD scale , VAS and SERS were used to evaluate the clinical efficacy in terms of depression symptoms , pain and side reactions of antidepressants before treatment and in the 1st , 2nd and 4th weeks after treatment in the patients and the differences between the two groups . RESULTS The differences in HAMD and VAS scores were not apparent before treatment between the two groups ( P>0.05 ) . HAMD score and VAS score in the 1st , 2nd and 4th weeks of treatment in the acupuncture + medication group were lower apparently than those in the medication group ( all P<0.01 ) . SERS score in the 1st , 2nd and 4th weeks of treatment in the acupuncture + medication group was lower apparently than that in the medication group ( all P<0.01 ) . CONCLUSION Acupuncture enhances the clinical efficacy on depression with chronic pain treated with SSRI antidepressants and reduces the adverse reactions For clinical trials of acupuncture , it would be desirable to have a sham procedure that is indistinguishable from the real treatment , yet inactive . A sham needle has been design ed which telescopes instead of penetrating the skin . The Park Sham Device involves an improved method of supporting the sham needle and requires validation . The objective of these studies was to test whether the sham procedure using the new device was 1 ) indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and 2 ) inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . The studies were design ed as subject and assessor blind , r and omised controlled trials . Study 1 ) included 58 patients enrolled in a clinical trial of acupuncture for acute stroke . Study 2 ) included 63 healthy , acupuncture naïve , adult volunteers . The interventions used were real or sham acupuncture using the Park Sham Device . Study 1 ) was set in a district general hospital , and study 2 ) in a university laboratory . The outcome measure in study 1 ) was the form of treatment that patients believed they had received . In study 2 ) the outcome measure was experience of de qi , as judged by three acupuncture experts . No patient in either group ( study 1 ) believed he or she had been treated with the sham needle . In 40 volunteers ( study 2 ) for whom experts achieved consensus , the relative risk of experiencing de qi with real acupuncture to that with sham acupuncture was 15.38 ( 95 % CI 2.26 to 104.86 ) . The inter-rater reliability of all 13 experts ( study 2 ) , calculated from their judgements on 10 subjects selected by r and omisation , was 0.52 ( 95 % CI 0.19 to 0.61 ) . In conclusion , the results suggest that the procedure using the new device is indistinguishable from the same procedure using real needles in acupuncture naïve subjects , and is inactive , where the specific needle sensation ( de qi ) is taken as a surrogate measure of activity . It is therefore a valid control for acupuncture trials . The findings also lend support to the existence of de qi , a major concept underlying traditional Chinese acupuncture In a r and omized controlled trial , Hugh MacPherson and colleagues investigate the effectiveness of acupuncture and counseling compared with usual care alone for the treatment of  depression symptoms  in primary care setting s. Please see later in the article for the Editors ' Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . OBJECTIVE To evaluate the clinical therapeutic effect of depression treated by acupuncture and electroacupuncture combined with western medicine . METHODS Seventy-five patients were r and omly divided into 3 groups . In control group , 30 cases were treated by SSRI with oral administration ; in observation group 1 , 25 cases were treated by acupuncture therapy combined with SSRI , and Shenting ( GV 24 ) , Baihui ( GV 20 ) , Dazhui ( GV 14 ) , Shendao ( GV 11 ) and Zhiyang ( GV 9 ) etc . were selected with regulating qi needling method ; in observation group 2 , same acupoints were selected with routine needling method , and 20 cases were treated by electroacupuncture therapy combined with SSRI , Baihui ( GV 20 ) and Yintang ( EX-HN 3 ) etc . were treated by electroacupuncture . The clinical therapeutic effects and Hamilton Depression Scale scores were evaluated after 1 , 2 , 4 and 6 weeks treatment . RESULTS The total effective rates of observation group 1 and 2 were 100.0 % , superior to that of 73.3 % in control group ( both P < 0.05 ) . The total scores of HAMD on each time point dropped , and there were significant differences compard with those before treatment in 3 groups ( P < 0.01 , P < 0.05 ) ; the total scores of HAMD after 1 , 2 and 4 weeks improved more obviously than that in control group ( P < 0.01 , P < 0.05 ) , and there was no significant difference among groups after 6 weeks ( all P > 0.05 ) . After one week treatment , the comparison of total scores of HAMD in observation group l and 2 indicated significant differences ( P < 0.05 ) ; after 2 , 4 and 6 weeks treatment , there were no significant differences between groups ( all P > 0.05 ) . CONCLUSION The acupuncture therapy and electroacupuncture combined with western medicine for treating depression have better effects than medicine treatment ; and there is no obvious difference between acupuncture therapy and electroacupuncture therapy , however , the effect works fast by electroacupuncture Objective Recent functional MRI ( fMRI ) studies show that brain activity , including the default mode network ( DMN ) , can be modulated by acupuncture . Conventional means to enhance the neurophysiological ‘ dose ’ of acupuncture , including an increased number of needles and manual needle manipulation , are expected to enhance its physiological effects . The aim of this study was to compare the effects of both methods on brain activity . Methods 58 healthy volunteers were r and omly assigned into four groups that received single needle acupuncture ( SNA , n=15 ) or transcutaneous electrical nerve stimulation ( TENS , n=13 ) as active controls , or enhanced acupuncture by way of three needle acupuncture ( TNA , n=17 ) or SNA plus manual stimulation ( SNA+MS , n=13 ) . Treatment-associated sensations were evaluated using a visual analogue scale . Central responses were recorded before , during , and after treatment at LI4 on the left h and using resting state fMRI . Results TNA and SNA+MS induced DMN-insula activity and extensive DMN activity compared to SNA , despite comparable levels of de qi sensation . The TNA and SNA+MS groups exhibited a delayed and enhanced modulation of the DMN , which was not observed followed SNA and TENS . Furthermore , TNA increased precuneus activity and increased the DMN-related activity of the cuneus and left insula , while SNA+MS increased activity in the right insula . Conclusions The results showed that conventional methods to enhance the acupuncture dose induce different DMN modulatory effects . TNA induces the most extensive DMN modulation , compared with other methods . Conventional methods of enhancing the acupuncture dose could potentially be applied as a means of modulating brain activity Objective To observe the clinical efficacy and adverse reactions of Paroxetine combined with electro-acupuncture ( EA ) in treating depression . Methods Forty-two patients with depression were r and omly assigned to the observation group ( 22 patients ) treated with EA combined with Paroxetine , and the control group ( 20 patients ) treated with Paroxetine alone , and the therapeutic course for both groups was 6 weeks . The therapeutic efficacy and adverse reactions were evaluated with scores by Hamilton depression scale ( HAMD ) and treatment emergent symptoms scale ( TESS ) , respectively . Results HAMD scores determined at the end of the 1st , 2nd , 4th , and 6th week of the treatment course were significantly lower in the observation group than those in the control group ( P<0.05 ) . The significant improvement rate evaluated at the end of the 6-week treatment was remarkably higher in the observation group than that in the control group ( 72.7 % vs 40.0 % ) . No significant difference of TESS scores was found between the two groups . Conclusion EA combined with Paroxetine has better clinical efficacy than that of Paroxetine alone , with milder adverse reaction and quicker initiation of effect Background There is relatively limited knowledge about the practitioners who provide  acupuncture treatment  within the UK , what conditions patients consult for and the treatment provided . Objectives To characterise the conditions treated and by whom , to examine characteristics of the treatment and to explore trends over time . Method A cross-sectional survey of the UK acupuncture practitioners was conducted ; 800 practitioners were selected by computer-generated r and omisation sequences from the four major UK-based professional associations . Data collected on the practitioners included demographic details , association membership , statutorily regulated status , practice setting , style of acupuncture , diagnostic methods and needle response sought . Practitioners recorded details of their 10 most recent patients , including demographic details , primary reason for consulting and lifestyle advice provided . Results 330 practitioners responded comprising doctors ( 29 % ) physiotherapists ( 29 % ) , nurses ( 15 % ) and independent acupuncturists ( 27 % ) : 62 % were women with median age of 48 years . The majority ( 68 % ) practice d in independent setting s and 42 % practice d within the National Health Service . Patients most commonly consulted for low back , neck , shoulder and knee pain , as well as headaches and migraine . Treatment for infertility by independent acupuncturists was found to have increased fivefold in 10 years . Conclusion Acupuncture provides a substantial contribution to the healthcare of the UK , with an estimated 4 million sessions provided annually . The primary complaints for which patients consult reflect the growing evidence base on acupuncture for these conditions . These data provide a basis for decision-making regarding policy and practice BACKGROUND Quality acupuncture influences the outcomes of clinical research , and issues associated with effective administration of acupuncture in r and omized controlled trials need to be addressed when appraising studies . OBJECTIVE The study objective was to achieve consensus on domains and items for inclusion in a rating scale to assess quality acupuncture administered in clinical research . STUDY DESIGN AND SUBJECTS An active group of Australian acupuncture research ers initially identified a pool of items assessing quality . The Delphi consensus process was then used to select and reduce the number of items , and an additional expert panel of 42 research ers were invited to participate . Participants initially ranked items along a five-point scale for the first Delphi round , and indicated an agree or disagree response during the second round . For an item to be retained into the second round , an item had to attain greater than 80 % agreement that the item described a dimension of quality acupuncture and related study design . RESULTS Thirty-two ( 32 ) experts agreed to participate in the study . After two rounds of the Delphi process , consensus was reached on 14 domains and 26 items relating to quality acupuncture . Domains , items , and minimum st and ards related to study design ; rationale of the intervention ; criteria relating to needling stimulation either manual or electrostimulation ; duration and frequency of treatment ; and practitioner training . CONCLUSIONS Items for inclusion in an instrument to assess quality  acupuncture in clinical research were identified . Further development of the instrument including relative weighting of items and reliability testing is under way Introduction Depression and pain frequently occur together and impact on outcomes of existing treatment for depression . Additional treatment options are required . This study aim ed to explore patients ’ experiences of depression , the processes of change within acupuncture and counselling , and the elements that contributed to longer-term change . Methods In a sub study nested within a r and omised controlled trial of acupuncture or counselling compared with usual care alone for depression , semistructured interviews of 52 purposively sample d participants were conducted and analysed using thematic analysis . Results Differences were reported by participants regarding their experience of depression with comorbid pain compared with depression alone . Along with physical symptoms often related to fatigue and sleep , participants with depression and comorbid pain generally had fewer internal and external re sources available to manage their depression effectively . Those who had physical symptoms and were receiving acupuncture commonly reported that these were addressed as part of the treatment . For those receiving counselling , there was less emphasis on physical symptoms and more on help with gaining an underst and ing of themselves and their situation . Over the course of treatment , most participants in both groups reported receiving support to cope with depression and pain independently of treatment , with a focus on relevant lifestyle and behaviour changes . The establishment of a therapeutic relationship and their active engagement as participants were identified as important components of treatment . Conclusions Participants with and without comorbid pain received acupuncture or counselling for depression , and reported specific identifiable treatment effects . The therapeutic relationship and participants ’ active engagement in recovery may play distinct roles in driving long-term change . Patients who present with depression and physical symptoms of care may wish to consider a short course of acupuncture to relieve symptoms prior to a referral for counselling if needed . Trial registration number IS RCT N63787732 BACKGROUND Comparisons of structured diagnostic interviews with clinical assessment s in general population sample s show marked discrepancies . In order to vali date the CIS-R , a fully structured diagnostic interview used for the National Survey of Psychiatric Morbidity in Great Britain , it was compared with SCAN , a st and ard , semi-structured , clinical assessment . METHODS A r and om sample of 1882 Leicestershire addresses from the Postcode Address File yielded 1157 eligible adults : of these 860 completed the CIS-R ; 387 adults scores > or = 8 on the CIS-R and 205 of these completed a SCAN reference examination .  Neurotic symptoms , in the previous week and month only , were enquired about . Concordance was estimated for ICD-10 neurotic and depressive disorders , F32 to F42 and for depression symptom score . RESULTS Sociodemographic characteristics closely resembled National Survey and 1991 census profiles . Concordance was poor for any ICD-10 neurotic disorder ( kappa = 0.25 ( 95 % CI , 0.1 - 0.4 ) ) and for depressive disorder ( kappa = 0.23 ( 95 % CI , 0 - 0.46 ) ) . Sensitivity to the SCAN reference classification was also poor . Specificity ranged from 0.8 to 0.9 . Rank order correlation for total depression symptoms was 0.43 ( Kendall 's tau b ; P < 0.001 ; N = 205 ) . DISCUSSION High specificity indicates that the CIS-R and SCAN agree that prevalence rates for specific disorders are low compared with estimates in some community surveys . We have revealed substantial discrepancies in case finding . Therefore , published data on service utilization design ed to estimate unmet need in population s requires re-interpretation . The value of large-scale CIS-R survey data can be enhanced considerably by the incorporation of concurrent semi-structured clinical assessment OBJECTIVE To evaluate the efficacy and safety of acupuncture for residual insomnia and other residual symptoms associated with major depressive disorder ( MDD ) . METHOD 150 participants having significant insomnia for more than 3 months and a history of MDD ( both based on DSM-IV-TR criteria ) were recruited from 4 psychiatric outpatient clinics in Hong Kong from May 2011 to August 2013 to receive 9 sessions of treatment over 3 weeks . They were r and omized to receive acupuncture , minimal acupuncture , or placebo acupuncture . Primary outcome was sleep diary-derived sleep efficiency . Secondary outcomes included other sleep diary parameters , actigraphy , anxiety and depressive symptoms , daytime functioning , and adverse events . RESULTS The mean difference in sleep diary-derived sleep efficiency at 1-week posttreatment was -1.40 ( 95 % CI , -7.08 to 4.28 ) between the acupuncture and minimal acupuncture groups and was 3.10 ( 95 % CI , -3.64 to 9.84 ) between the acupuncture and placebo acupuncture groups . A χ(2 ) test showed that acupuncture produced a significantly higher proportion of participants achieving sleep-onset latency ≤ 30 minutes  than did minimal acupuncture at 1-week posttreatment ( P = .04 ) . However , there was no significant between-group difference in most of the other outcomes . Treatment blinding was successful , as a majority of participants did not know which treatment they had received . CONCLUSIONS Acupuncture was well tolerated , but the efficacy was only mild and similar to that of minimal acupuncture and placebo acupuncture . A high proportion of patients remained clinical ly significantly affected by insomnia after treatment . The finding raises certain doubts about the value of acupuncture and underscores the difficulties in the treatment of residual insomnia in MDD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01707706 OBJECTIVES To establish the feasibility of conducting a r and omised controlled trial to evaluate the efficacy of acupuncture in the treatment of mild-to-moderate depression . Control group intervention , blinding of treatment , outcome measures and the acceptability of such a trial amongst participants were key factors to be addressed . The findings from this study will be used to determine the design of a phase III r and omised controlled trial . DESIGN Nineteen participants were recruited through general practice s in London , UK . Participants were r and omly assigned on a 2:1 basis to either 12 sessions of verum acupuncture or 12 sessions of sham acupuncture ( control ) . Sham acupuncture involved actual needling but at sites considered to be unrelated to depression . MAIN OUTCOME MEASURES The Beck 's Depression Inventory ( BDI ) and the R AND 36 Item Health Survey 1.0 ( R AND ) were completed at baseline and at the end of treatment or at treatment dropout . All participants also attended a brief qualitative interview at the end of the study . RESULTS Treatment dropout was low and there were high levels of patient enthusiasm for a study of acupuncture . Referrals from General Practitioners ( GPs ) were lower than expected . The sham control method successfully maintained participant blinding to treatment and enabled the specific ( or active ) component of an acupuncture intervention to be isolated and its efficacy assessed . The outcome measures were sensitive enough to record changes in depressive symptoms and quality of life and are appropriate for use in a larger trial . CONCLUSIONS This feasibility study has provided important information that can be used to guide the design and methodology of a full-r and omised controlled trial OBJECTIVE To study on clinical therapeutic effect and safety of electroacupuncture and Fluoxetine for treatment of mild or moderate depression with physical symptoms . METHODS Seventy-five cases were r and omly divided into a western medicine group ( group A ) , an electroacupunctue group(group B ) and an electroacupuncture plus medicine group ( group C ) , 25 cases in each group . The group A were treated by oral Fluoxetine , 20 mg each day ; the group B by electroacupuncture with Baihui ( GV 20 ) and Yintang ( EX-HN 3 ) selected as main points ; the group C by oral administration of Fluoxetine plus electroacupunctue .  HAMD depression scale was used for assessment of clinical therapeutic effect and TESS adverse reaction scale was used for adverse reactions . RESULTS The clinical effective rate was 78.3 % in the group A , 82.6 % in the group B and 91.7 % in the group C , with significant differences between group C and A , group C and B ( P < 0.05 ) . Groups B and C had significant therapeutic effects in improvement of physical symptoms , and the adverse reaction of Fluoxetine in the group C was less than that in the group A. CONCLUSION Electroacupuncture can significantly improve physical symptoms and relieve adverse reactions of Fluoxetine . Electroacupuncture combined with Fluoxetine has a better therapeutic effect on depression with mild or moderate physical symptoms , with less adverse reactions OBJECTIVE To observe the clinical therapeutic effect of acupuncture on depressive neurosis . METHODS With a multi-center r and omized controlled study , 440 cases were r and omly divided into an acupuncture group , a prozac group , a non-acupoint needling group . In the acupuncture group , Hegu ( LI 4 ) and Taichong ( LR 3 ) were selected , and the Prozac group were treated with administration of 20 mg/d and the non-acupoint needling group were treated with needling the points deviating from the acupoints . The therapeutic effect was evaluated by HAMD score reduction rate , and Asberg 's anti-depressant side-effect rating scale ( SERS ) and severe adverse reaction were used for safety evaluation , and the data were analyzed with ITT . RESULTS The total effective rate was 86 . 4 % in the acupuncture group , which was better than 59.1 % in the non-acupoint needling group and 72.7 % in the prozac group ; HAMD score in the acupuncture group was similar to that in the Prozac group , which was better than that in the non-acupoint needling group ; the SERS scores in the acupuncture group and the non-acupoint needling group were significantly lower than that in the Prozac group , with no severe side-effects found for acupuncture . CONCLUSION Acupuncture is an effective and safe therapy for depressive neurosis ; therapeutic effect of acupuncture on depressive neurosis possibly is better than or similar to that of Prozac , but with less side-effects Major depressive disorder ( MDD ) is a chronic disease that adversely affects mood and cognition . In this study , we r and omly divided the rats into  control group ( C ) , model group ( M ) , fluoxetine group ( F ) , and acupuncture group ( A ) , used open-field test to ascertain whether acupuncture affects chronic restraint stress ( CRS ) induced depression-like behaviors of rats , and explored the antidepressant mechanism of acupuncture at the molecular level of transcriptome in the frontal cortex of CRS rats by RNA-sequencing ( RNA-seq ) . According to differentially expressed genes ( DEG ) analysis , we identified 134 , 46 , and 89 response genes differentially expressed in C versus M , F versus M , and A versus M , respectively . Through Gene Ontology ( GO ) term enrichment analysis and Kyoto Encyclopedia of Genes and Genomes ( KEGG ) pathway enrichment analysis , we identified the gene sets involved in extracellular space , inflammatory response , Toll-like receptor signaling pathway , chemokine signaling pathway , and TNF signaling pathway . In this study , RNA-seq technology was used to investigate the frontal cortex genome-wide transcriptomes in depression rats under CRS , which suggested that the antidepressant effect of acupuncture is effective and has a multitarget characteristic , which may be related to amino acid metabolism and inflammatory pathways , especially the Toll-like receptor signaling pathway , TNF signaling pathway , and NF-kappa B signaling pathway STUDY OBJECTIVES To evaluate the efficacy and safety of electroacupuncture as an additional treatment for residual insomnia associated with major depressive disorder ( MDD ) . DESIGN R and omized , placebo-controlled . SETTING A psychiatric outpatient clinic . PARTICIPANTS 78 Chinese patients with DSM-IV-diagnosed MDD , insomnia complaint , a Hamilton Rating Scale for Depression ( HDRS(17 ) ) score ≤ 18 , and fixed antidepressant dosage . INTERVENTION Electroacupuncture , minimal acupuncture ( superficial needling at non-acupuncture points ) , or noninvasive placebo acupuncture 3 sessions weekly for 3 weeks . MEASUREMENTS AND RESULTS Insomnia Severity Index ( ISI ) , Pittsburgh Sleep Quality Index ( PSQI ) , HDRS(17 ) , 1 week sleep diaries , and 3 day actigraphy were administered at baseline , 1 week post-treatment , and 4 week post-treatment . There was significant group by time interaction in ISI , PSQI , and sleep diary-derived sleep efficiency ( mixed-effects models , P = 0.04 , P = 0.03 , and P = 0.01 , respectively ) . Post hoc pairwise comparisons revealed that electroacupuncture and minimal acupuncture were more efficacious than placebo acupuncture  in ISI and PSQI at 1 week and 4 week post-treatment . Minimal acupuncture result ed in greater improvement in sleep diary-derived sleep efficiency  than placebo acupuncture at 1 week post-treatment . There was no significant between-group difference in actigraphy measures , depressive symptoms , daily functioning , and hypnotic consumption , and no difference in any measures between electroacupuncture and minimal acupuncture . CONCLUSION Compared with placebo acupuncture , electroacupuncture and minimal acupuncture result ed in greater improvement in subjective sleep measures at 1 week and 4 week post-treatment . No significant difference was found between electroacupuncture and minimal acupuncture , suggesting that the observed differences could be due to nonspecific effects of needling , regardless of whether it is done according to traditional Chinese medicine theory Objective To assess the effectiveness of acupuncture combined with selective serotonin reuptake inhibitors ( SSRIs ) for patients with depression in hospital using a pragmatic r and omised controlled trial . Methods 76 patients with depression were r and omly divided into two groups ( r and omisation ratio 2:1 for treatment and control groups ( CGs ) , respectively ) and 71 patients completed the study . The 45 patients in the treatment group ( TG ) underwent acupuncture and received an SSRI and the 26 patients in the CG received an SSRI only . The 17-item Hamilton Depression Rating Scale ( HDRS-17 ) was used to quantitatively assess patients after 1 , 2 , 4 and 6 weeks of treatment . Results The mean ( SD ) baseline total HDRS scores were 22.2 ( 0.60 ) and 22.1 ( 0.33 ) in the TG and CG , respectively . After the first week of treatment the HDRS score for the TG was reduced to 15.6 ( 0.81 ) , significantly different from the score of 18.3 ( 0.55 ) for the CG , p<0.05 . This significant difference was maintained to the end of the 6-week treatment period , when HDRS scores had fallen to 6.3 ( 0.49 ) and 8.2 ( 0.35 ) for the TG and CG , respectively . Conclusions Acupuncture combined with an SSRI showed a statistically significant benefit for patients with depression in hospital over the 6-week period compared with SSRIs alone . This reduction in symptoms started in the first week and continued throughout the 6 weeks of treatment 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 BACKGROUND Over 50 % of patients with major depressive disorder ( MDD ) either do not tolerate or do not respond to antidepressant medications . Several preliminary studies have shown the benefits of acupuncture in the treatment of depression . We sought to determine whether a 2-point electroacupuncture protocol ( verum acupuncture ) would be beneficial for MDD , in comparison to needling at nonchannel scalp points with sham electrostimulation ( control acupuncture ) . METHOD Fifty-three subjects aged 18 - 80 years , recruited via advertisement or referral , were included in the primary analysis of our r and omized controlled trial , which was conducted from March 2004 through May 2007 at UPMC Shadyside , Center for Complementary Medicine , in Pittsburgh , Pennsylvania . Inclusion criteria were mild or moderate MDD ( according to the Structured Clinical Interview for DSM-IV Axis I Disorders ) and a score of 14 or higher on the Hamilton Depression Rating Scale ( HDRS ) . Exclusion criteria included severe MDD , seizure disorder or risk for seizure disorder , psychosis , bipolar disorder , chronic MDD , treatment-resistent MDD , and history of substance abuse in the prior 6 months . Patients were r and omized to receive twelve 30-minute sessions of verum versus control acupuncture over 6 to 8 weeks . The HDRS was the primary outcome measure . The UKU Side Effect Rating Scale was used to assess for adverse effects . RESULTS Twenty-eight subjects were r and omized to verum electroacupuncture and 25 to control acupuncture . The 2 groups did not differ with regard to gender , age , or baseline severity of depression . Both groups improved , with mean ( SD ) absolute HDRS score decreases of -6.6 ( 5.9 ) in the verum group and -7.6 ( 6.6 ) in the control group , corresponding to 37.5 % and 41.3 % relative decreases from baseline . There were no serious adverse events associated with either intervention , and endorsement of adverse effects was similar in the 2 groups . CONCLUSIONS We were unable to demonstrate a specific effect of electroacupuncture . Electroacupuncture and control acupuncture were equally well tolerated , and both result ed in similar absolute and relative improvement in depressive symptoms as measured by the HDRS . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00071110 OBJECTIVE To observe clinical therapeutic effect of needling method for regulating mental activities and soothing liver on melancholia . METHODS One hundred and ten cases of depression were selected according to the diagnostic criteria of depression in mood disturbance ( emotional and mental disturbance ) and r and omly divided into a regulating mental activities and soothing liver needling group ( n=50 ) , a traditional acupuncture group ( n=30 ) and a prozac treatment group ( n=30 ) . Their therapeutic effects were evaluated by Hamilton depression scale , Self-rating depression scale ( SDS ) , psychiatric self-rating scale ( SCL-90 ) . RESULTS In the regulating mental activities and soothing liver needling group , 34 cases were cured , 10 cases were markedly effective , 4 cases were effective and 1 cases were ineffective , with the cured rate of 69.4 % and the total effective rate of 98.0 % , which were significantly better than those in the traditional acupuncture group ( the cured rate was 48.3 % and the total effective rate was 89.7 % ) , and was not significantly different with the prozac treatment group ( the cured rate was 64.0 % and the total effective rate was 96.0 % ) . CONCLUSION The needling method for regulating mental activities and soothing liver has a better therapeutic effect on depression BACKGROUND A problem acupuncture research has to face is the concept of a control group . If , in control groups , non-acupoint needling is done , physiological acupuncture effects are implied . Therefore the effects shown in this group are often close to those shown in the acupuncture group . In other trials , control groups have received obviously different treatments , such as transcutaneous electrical nervous stimulation or TENS-laser treatment ; it is not clear if the effects of acupuncture are due only to the psychological effects of the treatment . METHODS We developed a placebo acupuncture needle , with which it should be possible to simulate an acupuncture procedure without penetrating the skin . In a cross-over experiment with 60 volunteers we tested whether needling with the placebo needle feels any different from real acupuncture . FINDINGS Of 60 volunteers , 54 felt a penetration with acupuncture  ( mean visual analogue scale [ VAS ] 13.4 ; SD 10.58 ) and 47 felt it with placebo ( VAS 8.86 ; SD 10.55 ) , 34 felt a dull pain sensation ( DEQI ) with acupuncture and 13 with placebo . None of the volunteers suspected that the needle may not have penetrated the skin . INTERPRETATION The placebo needle is sufficiently credible to be used in investigations of the effects of acupuncture OBJECTIVE To compare the differences in the efficacy on  agitated depression  among the alliance therapy of acupuncture and seroxat , the alliance therapy of electroacupuncture and seroxat and the simple application of seroxat . METHODS One hundred and two cases were r and omized into a medication group , a conventional acupuncture + medication group and an electroacupuncture + medication group , 34 cases in each one . In the medication group , seroxat was prescribed for oral administration , once per day . In the conventional acupuncture + medication group , seroxat was applied in combination with the conventional acupuncture therapy , in which , Baihui ( GV 20 ) and Yintang ( EX-HN 3 ) were taken as the main acupoints . In the electroacupuncture + medication group , seroxat was applied in combination with electroacupuncture , in which , on the basic therapeutic program as the conventional acupuncture + medication group , the electric stimulation was attached to Baihui ( GV 20 ) and Yintang ( EX-HN 3 ) . Acupuncture was applied once every two days , the treatment of 6 weeks made one session and one session treatment was required in the research . Before and after treatment , the clinical global impression ( CGI ) and the World Health Organization Quality of Life-BREF ( WHOQOL-BREF ) were adopted for the assessment in each group . RESULTS ( 1 ) CGI comparison : the severity of illness ( SI ) after treatment was all alleviated significantly for the patients in three groups as compared with that before treatment ( all P < 0.001 ) , but the difference was not significant statistically among groups ( P > 0.05 ) . The global improvement ( GI ) was different significantly among three groups ( P < 0.05 ) , in which GI in the electroacupuncture + medication group was the best , that in the conventional acupuncture + medication group was taken second place . The total improvement rates were 100.0 % ( 29/29 ) , 96.9 % ( 31/32 ) and 93.5 % ( 29/31 ) separately . The difference in the efficacy index ( EI ) was not significant statistically among three groups ( P > 0.05 ) . Concerning to the adverse events , there were 1 case ( mild insomnia ) in the medication group , 1 case ( moderate anorexia ) in the conventional acupuncture + medication group and 2 cases ( mild insomnia and dry mouth ) in the electroacupuncture + medication group . ( 2 ) WHOQOL-BREF comparison : compared with those before treatment , all the indices in the  electroacupuncture + medication group were increased significantly after treatment ( all P < 0.01 ) ; except the indices in the physiological field , all the other indices were improved in the conventional acupuncture + medication group after treatment ( P < 0.01 , P < 0.05 ) ; the scores only in the physiological field and social field were higher significantly than those before treatment in the medication group ( P < 0.01 , P < 0.05 ) . After treatment , the statistically significant difference was displayed only in the psychological field among three groups ( P < 0.05 ) , in which , the improvement in the electroacupuncture + medication group was the best , that in the conventional acupuncture + medication group was taken second place and that in the medication group was the worst . CONCLUSION Either the alliance therapy of acupuncture and medication or the simple oral administration of seroxat improves the overall efficacy and the quality of life in the patients with agitated depression . The efficacy of the alliance therapy of acupuncture and medication is superior to the simple oral administration of seroxat and the efficacy of electroacupuncture is superior to the conventional acupuncture therapy Objective Depression is a major public health problem . There is some evidence supporting the effectiveness of needle acupuncture in its treatment . Laser stimulation , regarded here as a modality of acupuncture , is non-invasive and therefore free of infection risk ; and it is acceptable to patients with needle phobia . The technique is relatively easily learned by community-based general practitioners . It is also amenable to sham control and therefore double-blinding in clinical trials . A double-blind r and omised controlled trial was conducted to test the efficacy of low level laser acupuncture in mild to moderate depression . Methods Thirty patients with depression were r and omised to receive either active or inactive laser treatment . The laser unit could be switched to one of two setting s. One switch position delivered active laser acupuncture and the other was inactive ( sham ) . In the active mode , 0.5J was delivered to each of six to eight individually tailored acupuncture sites per visit . All patients were treated twice weekly for four weeks then weekly for a further four weeks . The patients and the acupuncturist were both blinded to conditions . Outcome was assessed using the Beck Depression Inventory at baseline , weeks four and eight during treatment , and at 4 and 12 weeks following the treatment . Results At the end of the treatment period , Beck Depression Inventory scores fell from baseline by 16.1 points in the intervention group and by 6.8 points in the sham control group ( P<0.001 ) . The difference showed only a trend four weeks later , but was again significant after 12 weeks ( P=0.007 ) . Laser acupuncture was well tolerated with transient fatigue as the most common adverse effect . Conclusion Laser acupuncture may be worth further investigation as a treatment for mild to moderate depression in primary care 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 INTRODUCTION Trials of acupuncture for the treatment of depression have produced mixed results . We examined the effectiveness of laser acupuncture compared with placebo acupuncture for the treatment of major depression . METHODS A r and omised , double blinded , placebo controlled trial was conducted in Sydney , Australia . Participants aged 18 - 50 years with DSM-IV major depressive disorder were eligible to join the study . Forty-seven participants were r and omised to receive laser acupuncture or placebo laser at acupoints LR14 , CV14 , LR8 , HT7 and KI3 . The intervention was administered twice a week for 4 weeks and once a week for another four weeks , for a total of 12 sessions . The primary outcome assessed the change in severity of depression using the Hamilton-Depression Rating Scale ( HAM-D ) , and secondary outcomes assessed the change in severity of depression using the Quick Inventory for Depression-Self Reporting ( QID-SR ) , the Quick Inventory for Depression-Clinician ( QIDS-CL ) , with outcomes assessed at eight weeks . The treatment response ( greater than 50 % improvement in HAM-D ) and remission ( HAM-D<8 ) were analysed . RESULTS At eight weeks participants showed greater improvement in the active laser group on the primary and clinician-rated secondary outcome measures ( HAM-D ( mean 9.28 ( SD 6.55 ) vs. mean 14.14 ( SD 4.78 p<0.001 ) ; QIDS-CL ( mean 8.12 ( SD 6.61 versus 12.68 ( mean SD 3.77 ) ) p<0.001 ) . The self-report QIDS-SR scores improved in both groups but did not differ significantly between the groups . In the active laser group , QIDS-SR scores remained significantly lower than baseline at 3 months follow-up . Response rates ( active laser , placebo laser ) on ITT ( intention to treat ) analyses were 72.0 % and 18.2 % ( p<0.001 ) , respectively . Remission rates on ITT analyses ( active laser , placebo laser ) were 56.0 % and 4.5 % ( p<0.001 ) . Transient fatigue was the only adverse effect reported . LIMITATIONS There was no follow-up for the placebo group at one and 3 months . CONCLUSION Laser acupuncture showed a clinical ly and statistically significant benefit with reducing symptoms of depression on objective measures
Background : Depression is commonly treated with anti-depressant medication and /or psychological interventions .
Patients with depression are common users of complementary therapies , such as acupuncture , either as a replacement for , or adjunct to , their conventional treatments .
This systematic review and meta- analysis examined the effectiveness of acupuncture in major depressive disorder .