The Study On Clinical Effect And Mechanism Of Electric-acupuncture Therapy For Depression

BackgroundIn the fast paced modern society, people are bearing much psychological pressure. In both developed and developing countries including China, mental health problems are becoming more and more serious. Among which, the high incidence of depression should be pay more attention to. Depression is a popular and refractory disease, which seriously endangers people's physical and mental health. It has a long history of acupuncture treatment for depression, which characterized by its significant effectiveness and no side effects. Therefore, it is an urgent task for us to show its advantages and discover its mechanisms and then improve it.Object1. Find out the different effect, the onset time, the security and the prognosis of there different plans for depression, which are EA, fluoxetine and EA+ fluoxetine.2. To take the 1H‐MRS exam of the consistence of the metabolic matters in hippocampus and prefrontal lobe of the healthy volunteers and definite the matters'location. This can Provides reference basis for depression research.3. To take the quantitative analysis of the NAA, Cho, Cr of the hippocampus and prefrontal lobe of the depression patients. To explore the changes between treatment and after treatment of the depression patients. This can provides evidence for the clinical treatment.4. Use MRI and MRS methods to evaluate the three different treatment methods holistically and dynamically. To find out the relationship between these iconography indexes and the depression scales. By doing this we can combine the different type of the TCM differentiation according to the syndromes with the image methods in order to provide theoretic basis for EA to depression. Method1. 75 minor and mild depression patients were divided into three groups, which are A (fluoxetine group), B (EA group), C (fluoxetine+ EA group). There is no significant difference in those three groups in the age and sex. Use HAMD, SDS to evaluate the clinical effective rate, the onset time and the recurernce rate; while use TESS scale to evaluate the untoward effect.2. Use PROBE‐J sequence at GE EXCITE II Signa 3.OT MRI system on Single Voxel of the ROI of bilateral hippocampus and frontal lobe of 20 healthy volunteers. Compare differences of the NAA/Cho, NAA/ Cr and Cho/ Cr between men and wemen.3. Use PROBE‐J sequence at GE EXCITE II Signa 3.OT MRI system on Single Voxel of the ROI of each lateral hippocampus and frontal lobe depression patients of the three groups. Compare the differences of NAA/Cho, NAA/ Cr and Cho/ Cr between the healthy volunteers and the patients and also the patients before treatment and after treatment. In addition, compare the differences of NAA/Cho, NAA/ Cr and Cho/ Cr between the different TCM syndrome differentiation types.Result1. The control rate of C (fluoxetine+ EA group) is 29.17% and the effective rate is 91.67% which is much significantly higher than the A (fluoxetine group) with the control rate of 17.39% and the effective rate of 78.26%, B (EA group) with the control rate of 21.74%and the effective rate of 82.61%(P<0.05).2. Compared with the average before treatment, the HAMD and SDS average of the patients in the three groups significantly decreased after treatmen(tP<0.01). And the C (fluoxetine+ EA group) showed a significant difference with the A (fluoxetine group) and B (EA group) (P<0.05).This may suggest the preferable effectiveness of the C (fluoxetine+ EA group) than the other two groups.3. The significant difference(P<0.05) between before treatment and after treatment of C (fluoxetine+ EA group) started from the second week. While it happened to B (EA group) (P<0.05) from the fourth week and the A (fluoxetine group), the fifth week. This indicates that fluoxetine with EA together function most quickly and the fluoxetine only function most slowly.4. There were significant differences between before treatment and after treatment in somatization syndromes and the somnipathy factor scores of the B (EA group) and C (fluoxetine+ EA group) (P<0.01). There were significant differences between before treatment and after treatment in retarded factor scores of the B (EA group) and C (fluoxetine+ EA group)(P<0.05). This may indicate that EA is more effective in improving the somatization syndromes and he somnipathy while the fluoxetine is more effective in retarded depression.5. The side effect of the C (fluoxetine+ EA group) was much less than the A (fluoxetine group), which indicate that fluoxetine with EA together can alleviate the side effect of the fluoxetine only. The recurernce rateof the C (fluoxetine+ EA group) is significantly decreased than A (fluoxetine group) (P<0.05).6. The effective rate of Liver‐depression is significantly higher than the hepatic and renal yin deficiency type depression.(P<0.01).7. There were no significant differences between the men and women in NAA/Cho, NAA/ Cr and Cho/ Cr in each lateral hippocampus and frontal lobe.8. There were a significant decrease of the NAA/Cr in bilateral hippocampus and a significant increase of the Cho/ Cr of the bilateral frontal lobe of the depression patients in the three groups before treatment(P<0.05).The NAA/Cr in bilateral hippocampus of B (EA group) and the NAA/Cr of the right hippocampus of C (fluoxetine+ EA group) increased significantly(P<0.05),the NAA/Cr of the left hippocampus of C (fluoxetine+ EA group) increased very significantly(P<0.01). The Cho/ Cr of the bilateral frontal lobe of A(fluoxetine group) and B (EA group) decreased significantly after treatment(P<0.05). The Cho/ Cr of the bilateral frontal lobe of C (fluoxetine+ EA group) decreased very significantly after treatment(P<0.01)。9.There were significant differences in NAA/ Cr of bilateral hippocampus and Cho/ Cr of bilateral frontal lobe between Liver‐depression and Spleen‐deficiency type, Deficiency of both Heart and Spleen type and hepatic and renal yin deficiency type depression patients and healthy volunteers (P<0.05);While there were no significant differences in NAA/ Cr of bilateral hippocampus and Cho/ Cr of bilateral frontal lobe between Liver Stagnation type depression patients and healthy volunteers. The Liver Stagnation type depression patients is less than the other three groups and their course of disease is respectively shorter and patient's condition is better than the other three types. This may suggest that the different TCM syndrome differentiation type may relate to their metabolism. This result needs further study.There were significant differences in NAA/ Cr of bilateral hippocampus and Cho/ Cr of bilateral frontal lobe between Liver‐depression and Spleen‐deficiency type and Deficiency of both Heart and Spleen type depression patients and healthy volunteers after treatment(P<0.05); While there were no significant differences in NAA/ Cr of bilateral hippocampus and Cho/ Cr of bilateral frontal lobe in hepatic and renal yin deficiency type depression patients between before treatment and after treatment. This may indicate that the treatment is more effective to the Liver‐depression and Spleen‐deficiency type, Deficiency of both Heart and Spleen type and Liver Stagnation type than to hepatic and renal yin deficiency type depression patients. This may because the long course of disease and severe patient's condition. This result needs further study.Conclusion1. EA can alleviate the somatization of the depression patients and the side effects of the fluoxetine, EA with fluoxetine together is a prominent treatment for depression for its small side effect and recurernce rate.2. 1H‐MRS can reflect the spectrum of NAA, Cho and Cr accurately,so it is a valuable method to detect the biochemistry changes in brain. There is different in the density of the metabolite in frontal lobe and hippocampus of common adults, which may reflect their structural differences.3. There is difference between depression patients and common people in the density of the metabolite in frontal lobe and hippocampus, which may relate to the nosogenesis of depression. The changes of those scales and MRI index before and after those three treatment and their relation between different TCM syndrome differentiation type would provide new method to explore the treatment and evaluation of depression.