| Depression is a mental illness mainly featured with symptom of continue depressive mood resulted from a variety of reasons. Clinical manifestations are depression, mental retardation, decreased interest, decreased mental activity, which are accompanied by anxiety, loss of appetite, sexual dysfunction, sleep disorders and other symptoms. In 2001, the "World Health Report" published by the World Health Organization (WHO) pointed out that the global incidence of depression is about 11%, which has become the world's fourth largest disease and is expected to be second only ischemic heart disease in 2020; 2005 Psychiatry Asia Pacific Summit pointed out that there were more and more Asians were suffering from depression, the direct and indirect economic loss resulted from depression in the region is estimated as over 100 billion U.S. dollars; In 1998, a study on disease burden in China from WHO reported that depression ranked second in the disease burden of 15-44 year-olds, accounting for 8.6%, which has become one of the main burdens of disease in our country, ranking before cardiovascular disease and cancer. The disease has seriously affected the life and health of patients and brought a huge burden to the society and the family. Thus, actively looking for effective interventions is of great clinical and social significance.Modern medicine mainly use antidepressant for long-term treatment of depression, there are many problems. We should fully use the advantages of effectiveness, safety, simplicity, and non-toxic side effects of acupuncture treatment of depression, in particular, for those who can not tolerate the western medicine or to those the effect of western medicine treatment is not obvious, acupuncture has good prospects and value of promotionPurpose:1. Through systematic review of previous literature, we can find evidence based medicine of acupuncture treatment for depression.2. From the clinical aspects, we explore the effectiveness of acupuncture group of soothing the liver qi and regulating the spirit in the treatment of depression, and the role of improving patients'quality of lifeContents and methods:1. Literature Evaluation:(1) Trend analysis of the publication amount of the literature of acupuncture treatment for depressionTo make "acupuncture and moxibustion" or "acupuncture" and "depression" as the search words, searched the relevant literature on the treatment of depression published in the official academic journals from January 1989 to December 2010 in the Chinese Biomedical Literature Database (CBM), Chinese web publishing academic literature pool (CAJD), China Academic Journal (CNKI), China Biomedical database (VIP), Articles on the Chinese Medical Association, use the method of bibliometric analysis to do the trend analysis of acupuncture treatment for depression(2) systematic review of literatureTo do the quality assessment and meta analysis of domestic and international RCT literature on acupuncture treatment of depression published from January 1999 to December 2010, and to objectively assess the clinical efficacy, research problems and directions for improvement. To make "acupuncture and moxibustion" or "acupuncture" and "depression" as the Chinese search words, searched the relevant literature on the treatment of depression published in the official academic journals from January 1989 to December 2010 in the Chinese Biomedical Literature Database (CBM), Chinese web publishing academic literature pool (CAJD), China Academic Journal (CNKI), China Biomedical database (VIP), Articles on the Chinese Medical Association. English key words are "Depression" or "Depressive Disorder" and "Acupuncture", English databases are PubMed database, Embase medicine database, Cochrane Central Register Database Collaboration, JSTOR Archive Library of Western, LISTA with Full Text Library Information and scientific and technical databases, Ovid platform medical electronic journals. Finally choose the literature which score is more than 3 by the standard of Jadad to do the further research.2. Clinical Research:The 163 patients who met the inclusion criteria were randomly divided into acupuncture group of soothing the liver qi and regulating the spirit, superficial acupuncture group and non-acupoint superficial acupuncture group.For acupuncture group of soothing the liver qi and regulating the spirit,we used LR3 (bilateral), LI14 (bilateral), DU20, EX-HN3. For LR3 and LI14, the needle should be inserted with the depth of 10-12mm, four points needed to be inserted up and down and the manipulation of twist and turn until the qi was attained with the method of regulating qi. Then DU20 and EX-HN3 were inserted with the depth of 4-5mm, both taking even twisting, the total needle retention time was 30 minutes. Then do the direct moxa cone moxibustion on BL15 (bilateral) and BL18 (bilateral). When the cone burned closeto its 2/3 part and the patients had a sense of warm or mild burning pain, remove the remaining moxa cone, each point done the moxibustion of 5 mins. Last, buried intradermal needle on BL15 (bilateral), BL18(bilateral). Pierce the needle within the skin with the depth of 5mm horizontally with with the direcition from the lateral, leaving the needle handle outside the skin. Then paste the handle with medical tape, after a retention of 2 days, remove the intradermal needle.For superficial acupuncture group, the points of acupuncture, moxibustion and buried intradermal needle were the same with the previous group, but LR3, LI14, DU20 and EX-HN3 would be inserted with depth of 2-3mm, and the sensation of qi was not required. When the cone burned closeto its 1/3, remove the remaining moxa cone. Intradermal needle would be buried with the depth of 1-2mm.For Superficial acupuncture group of non-acupoint acupuncture, the operation of aucuncture, moxibustion, buried intradermal needle are the same with that of superficial acupuncture group, but the acupoints would be 10mm from the radial side of LI14(bilateral),10mm from the lateral side of LR3 (bilateral),10mm from the left side of DU20,10mm from the left side of EX-HN3, for moxibustion the acupoints would be 10mm from the lateral side of BL17(bilateral),10mm from the lateral side of BL19(bilateral), for intradermal needle, the acupoints would be 10mm from the lateral side of BL15(bilateral) and BL18(bilateral), for the lateral (double), gall Yu lateral 10mm (double); buried intradermal needle selection of points outside the Xinshu 10mm (double), liver Yu lateral 10mm (double).Three groups' treatments are arranged as 2 times per week, and the time between every two treatments must be more than 48 hours, totally 12 weeks. To evaluate at 4 different time points:before the treatment, at the end of treatment, one month after the treatment, three months after the treatment with the Hamilton Depression Rating Scale (HAMD), SF-36 Quality of Life Scale, Symptom rating scale (SCL-90) and syndromes of depression. To use descriptive analysis,rank sum test and other statistical methods to compare clinical efficacy and quality of life improvements among the acupuncture group of soothing the liver qi and regulating the spirit, superficial acupuncture group and superficial acupuncture group of non-acupoint acupuncture.Results:1. Literature Evaluation(1) Trend analysis of the amount of the literature of acupuncture treatment for depressionThere are 2920 related literature of treating depression, among which there are 249 articles about acupuncture treatment during 22 years which are from 1989 to 2010, accounting for 8.53%, there are 86 RCT literature of acupuncture treating depression, which account for 34.54%, most of which (163, accounting for 65.46%) are non-randomized controlled literature.There are relatively fewer literature of clinical treatment published between 1989-1999, after 2002, research on depression is rising, but there are relatively few randomized, controlled documents, research quality is not high. (2) systematic review of literatureBy using search strategy and literature screening methods, we can retrieve 283 randomized controlled documents published in official academic journals, including 248 Chinese literature and 35 English literature. To grade with the Jadad scale score after reading the title, abstract, full text and screen out 26 high-quality randomized controlled clinical literature with score of≥3 points, in which there are 20 Chinese literature and 6 English literature.26 high-quality literature which contain 2269 patients were included into 15 trials, all using HAMD points rate reduction to calculate the efficacy rate, in which HAMD reduction rate is regarded as effective when it≥50% and <75%. Use fixed effect model, combined OR=2.25,95% CI of (1.66, 3.05), the value of combined effects of the test statistic Z=5.25, the efficacy rate difference between treatment group and control group was significant (P<0.01), we can consider that the efficacy of treatment group is better than that of control group.16 studies were included for HAMD score, heterogeneity test (P<0.01) suggested that two groups are heterogeneous, therefore a random effects model would be used. WMD=-1.92,95% CI of (-3.27,-0.58), the difference between treatment group and control group was significant (P<0.01), the efficacy of treatment group is better than that of control group.We also do the fixed effect model analysis and the results is the same with the random effects model, we can consider that the results have relatively high stability.7 were included for SDS score. Use random effect model, WMD=-8.20,95% CI is (-11.24, -5.16), the difference of SDS scores between the two groups is statistically significant (P<0.01), therefore the efficacy of the treatment group is better than the control group.4 were included for BDI score. Use random effect model, WMD=-1.15,95% CI is (-7.05,4.74), the difference of SDS score between the two groups is no significant (P>0.05), therefore the efficacy of the two groups are the same.2. Clinical Research(1) baseline informationThe difference in terms of age, height, weight, disease duration, sex, educational level, occupation, whether living habits are regular, whether western medicine was taken and whether acupuncture treatment has been among 3 groups is no significant (P>0.05), so there is comparability; in the aspects of health care, family history and whether psychological treatment was received, because theoretical number is less than 5, after using fisher precise probability method, the difference was not statistically significant (P>0.05). And, the difference of scores of HAMD scale, SF-36 Quality of Life Scale, SCL-90 symptom scale and TCM syndrome rating scale among the three groups of depressed patients before treatment was not statistically significant (P>0.05), baseline level can be considered the same among the three groups.(2) Total effective rateCompare the total effective rate of the treatment group and superficial acupuncture group with that of non-acupoint superficial acupuncture group at 3 time points:after treatment,1 month after treatment,3 months after treatment, the difference was significant (P<0.01). At the time points of after treatment and 1 month after treatment, compare the efficacy rate of treatment group (93.62%) with that of the superficial acupuncture group (89.58%), the difference was not statistically significant (P> 0.05), prompting the effect of two groups are the same after treatment and 1 month after treatment; 3 months after treatment, compare the efficacy rate of treatment group (87.23%) with that of superficial acupuncture group (79.17%), the difference was statistically significant (P<0.01).(3) HAMD scaleCompare the HAMD scores at each time point of the 3 groups with that of before the treatment, we found that the previous ones were higher than that of before treatment, the differences were statistically significant (P<0.05), prompted the three groups had improvement after treatment. We can see from the analysis of the HAMD score at each time point that the difference between the treatment group and superficial acupuncture group was not significant (P>0.05); The differences between treatment group and superficial non-acupoint acupuncture group were statistically significant, the differences between superficial acupuncture group and superficial non-acupoint acupuncture group were statistically significant (P<0.05).In the evaluation of the the HAMD scale, the efficacy of the acupuncture group of soothing the liver qi and regulating the spirit and the superficial acupuncture group are better than the superficial acupuncture group of non-acupoint, and the efficacy of the acupuncture group of soothing the liver qi and regulating the spirit is the best.(4) SF-36 scaleCompare the scores of the treatment group and superficial acupuncture group with that of non-acupoint superficial acupuncture group at 3 time points:after treatment,1 month after treatment,3 months after treatment, eight dimensions of quality of life in the SF-36 scale scores are all higher that that of before the treatment, the difference was significant (P<0.05). Compare the scores of the treatment group with that of superficial acupuncture group and non-acupoint superficial acupuncture group at 3 different time points, which are after the treatment, after 1 month after the treatment,3 months after treatment, the difference was significant (P<0.0125); compare the 8 dimension scores of superficial acupuncture group with that of non-acupoint superficial acupuncture group after the treatment, the differences were statistically significant (P<0.0125); Compare the SF-36 scores of superficial acupuncture group with that of non-acupoint superficial acupuncture group 1 month after treatment and 3 months after treatment, difference was not statistically significance, (Z=1.51, P=0.13), the differences other dimension scores were statistically significant (P<0.0125).In the evaluation of the the SF-36 scale, the efficacy of the acupuncture group of soothing the liver qi and regulating the spirit are better than the superficial acupuncture group and the superficial acupuncture group of non-acupoint in 8 aspects of the SF-36 scale.(5) SCL-90 scaleIn the evaluation of the the SCL-90 scale, the efficacy of the acupuncture group of soothing the liver qi and regulating the spirit are better than the superficial acupuncture group of non-acupoint in 8 aspects of the SCL-90 scale, and they are better than the superficial acupuncture group in 3 aspects of the SCL-90 scale.(6) Syndrome Rating ScaleIn the evaluation of the Syndrome Rating Scale, the efficacy of the acupuncture group of soothing the liver qi and regulating the spirit and the superficial acupuncture group are better than the superficial acupuncture group of non-acupoint, and the efficacy of the acupuncture group of soothing the liver qi and regulating the spirit is the best.Conclusions:1.The literature review found that the majority of literature report of acupuncture treatment of depression had low quality. Therefore we advocate the adoption of internationally recognized standards of CONSORT statement and STRICTA to do the standardized report of RCT research of acupuncture. After doing the systematic reviews of the 26 high-quality literature, we consider that the efficacy of acupuncture treatment for depression may be better than or equal to drugs and with fewer adverse reactions. 2. The acupuncture method of soothing liver qi and regulating the spirit is an academic idea with "treat with the liver qi, regulating qi first"as a core, combine the acupuncture, direct moxibustion with moxa cone and buried intradermal needle, this study shows that the treatment group can effectively improve the score of HAMD scale and SF-36 scale. In terms of short and long term efficacy and extent of the role, the treatment group is better than superficial acupuncture group and non-acupoint superficial acupuncture group, it is effective and safe in improving depression and quality of life of patients which has a good application and promotion prospects.
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