| Objective:To verify the synergistic antidepressant effect of acupuncture for patients with major depressive disorder(MDD),and to explore its effects on patients' inflammatory cytokines in peripheral blood and their heart rate variability(HRV).Methods:Sixty one patients met the inclusion criteria were randomly divided into the trial group(n=30)and the control group(n=31).Patients of the trial group received treatment with selective serotonin reuptake inhibitors(S SRI)combined with acupuncture,while those of the control group only received SSRI treatment.The Hamilton Depression Rating Scale(HAMD,24 items version)was used to estimate the severity of depression at baseline,3-weekend and 6-weekend of treatment,respectively.Concentrations of IL-6 and TNF-? in the peripheral blood were tested and the HRV were analyzed for each participant at baseline and 6-weekend of treatment,respectively.The Asberg Rating Scale for Side Effects(SERS)was employed to evaluate the severity of side effect at the end of 6-week treatment.We compared the antidepressant effects,the concentrations of IL-6 and TNF-? and the HRV indicators between the two groups.Also,we explored the correlations among the HAMD scores,the levels of inflammatory cytokines and the values of HRV indicators.Results:1.There was no significant difference in HAMD scores between two groups at the baseline.The repeated measures analysis of variance revealed a significant interactive effect of HAMD score×group(F=4.760,P=0.010).Simple effect analysis indicated that the HAMD scores in both groups decreased significantly over time.The HAMD scores of the trial group was significant lower than those of the control group at both 3-and 6-weekend(both P<0.05).After 6-week of treatment,the reduction rate of HAMD score of the trial group was also significantly higher than that of the control group(41.3±9.9%vs.35.3±7.8%,t=2.628,P=0.011).2.There was no significant difference in concentrations of serum IL-6 and TNF-a in peripheral blood between two groups at the baseline.The serum concentrations of these inflammatory cytokines significantly decreased after 6 weeks of treatment in both groups,and the concentrations of them was lower and the reduction rate was higher in the trial group than in the control group(all P<0.05).Pearson correlation analyses indicated that the HAMD reduction rate was positively related to the reduction rate of peripheral serum TNF-a concentration in the trial group(r=0.381,P<0.05).3.At the baseline,there was no significant between-group difference in values of HRV indicators including SDNN,HF and LF(all P>O.05).At the 6-weekend of treatment,the values of SDNN and HF significantly increased in both groups and the increase rates were higher in the trial group than in the control group(all P<0.05).In addition,the LF value significantly decreased in the trial group and was much lower than that in the control group.Spearman correlation analyses indicated that the HAMD reduction rate was positively related to the increase rates of SDNN and HF,and the reduction rate of LF,in the trial group(r=0.522,0.449,0.365,respectively,all P<0.05).4.For all subjects,the reduction rate of peripheral serum TNF-a concentration was positively related to the increase rates of SDNN and the reduction rate of LF.However,when data were analyzed by groups,we only found a positive relationship of reduction rate of IL-6 concentration with the SDNN increase rate in the trial group(r=0.421,P=0.021).5.There was no serious side effect among all participants,and there was no significant between-group difference in the SERS scores(3.03±0.73 vs.2.93±0.87,t=0.483,P=0.631).Conclusion:1.Acupuncture has synergistic antidepressant effect for SSRI on the treatment of patients with MDD without increasing side effects.2.The antidepressant effect of acupuncture may be related to its anti-inflammatory effects and the moderating effect on the function of autonomic nervous system. |
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