Systematic Evaluation And Meta-analysis Of Electroacupuncture For Post-stroke Depression

BackgroundPost stroke depression(PSD)is the common encountered complication of stroke,which have different kinds of mental symptoms and physical symptoms.The typical clinical symptoms are depressing emotion,activity decrease,disorders of thinking content and sluggish ideation.The occurrence of PSD has a serious impact on patients' health recovery and their quality of life,those who gravely ill may have the tendency to suicide.There have foreign study shows that the incidence of PSD in acute stage is highly to 40%.And there is another study carry through a 3-year follow-up,which reveal the fact,the highest incidence of PSD is 41%-54%at the time of three month,while at six month is 43%,at 1 year is 36%,at 2 year is 24%and at the time of the year the incidence of PSD is still about 18%.Timely and correctly diagnosed by clinical doctors can greatly decrease the death rate and disability rate of PSD patients and increase their life quality,PSD can be treated by many kinds of therapies such as western drug therapy,traditional Chinese medicine treatment,integrative Chinese and western medicine treatment and other non-drug therapy.In which,western drug therapy is the common way to cure PSD.The common antidepressant drugs are monoamine oxidase inhibitor,tricyclic and the fourth ring category antidepressant,and some new kinds of antidepressant such as:Selective Serotonin Reuptake Inhibitors(SSRIs),serotonin-norepinephrine reuptake inhibitors(SNRIs),and Noradrenergic and specific serotonergic antidepressants(NaSSA).Although western drugs have effects,but still have side effect.After a long-term usage,the resistance to drugs will occur,and cost a lot.These disadvantages limit their widely use in clinical.Chinese medicine as a traditional medicine of our country,plays an important roles on the treatment of PSD,and especially electro acupuncture is used in clinical as a significant treatment.PSD according to traditional Chinese medicine(TCM)belongs to "yu zheng"(melancholia),the pathogenic mechanism is disorder of qi and blood and blocking of meridians after stroke,thus leads to depression caused by absent of brain's spirit.Electro acupuncture can dredge the channel,awaken consciousness and open orifice,have great effects on improvement of depressive condition and recovery of neurological function.ObjectiveThis review aimed to assess the effectiveness and safety of electro acupuncture(EA)for PSD by systematically analyzed the randomized controlled trials(RCTs)related to EA for PSD.Besides,this review aimed to provide scientific basis for the future clinical treatment and research.MethodsSearch databases from the internet:China National Knowledge Infrastructure(CNKI),Wan-Fang Database,Chinese Scientific Journal Database(VIP database),Chinese Biomedical Literature Database(CMB),PubMed,EMBASE,Cochrane Central Register of Controlled Trails.RCTs related to EA for PSD in English or Chinese without restrictions on the publication status were included.The outcome of included trials must have at least one of those:the changing of HAMD scores,the changing of SDS scores,the changing of CSS scores,the changing of NIHSS scores and the advise events during the treatment.Results17 RCTs including 1522 patients with PSD were included.According to methodology,only 5 trials were evaluated as having low risk of bias,the others all evaluated as having high risk of bias.All trials were based on disease diagnosis;during the acupuncture all the trials asked to sense the "qi" movements,2 of the trials used continuous wave of EA,4 trials not mentioned,and the others used dilatational wave;1 trials used EA versus placebo,9 trials applied EA compared to western drugs,9 trials applied EA combined with western drugs compared to western drugs.For the outcomes,all trials used HAMD scores as their main outcome.Meta-analysis showed that EA decreased more scores of HAMD than placebo(WMD=-7.35,95%Cl-8.48 to-6.22,p<0.00001);EA decreased as many scores of HAMD as western drugs(MD=-0.82,95%CI-2.14 to 0.49,p=0.22);EA plus western drugs are better than western drugs in reducing HAMD scores(WMD=-2.50,95%Cl-2.93 to-2,06,p<0.00001).37 clinical trials in which patients received EA or EA combined with other therapy,all unmentioned serve advise effects.ConclusionsBased on the available literatures,EA may have a great effect on decreasing patients' depressive condition,the effect is not less than western drugs;EA also can promoting the recovery of neurological function and improving patients' life quality,and it is safe.But there are stills need more well-designed trials to provide strong evidence for the effectiveness and safety of EA.