Clinical study of acupuncture combined with medication in the treatment of depression with sleep disorders

This study first explains that depression is a mood disorder with high prevalence, high recurrence and high suicide rates, presenting as a persistent depressed state accompanied by symptoms such as low mood, somatic discomfort and sleep disorders; the clinical manifestations of depression can be summarized in three aspects: low mood, reduced ability and somatic symptoms. In 61.8% of patients with depression the first symptom is a sleep disorder, while patients with depression without sleep disorders account for only about 1%, and sleep disorders are present in 31% of those with moderate to severe depression. Sleep disorders can also aggravate depression and delay recovery; therefore, improving sleep disorders necessarily promotes the remission and recovery of depression. Sleep disorders can serve as an indicator for predicting and preventing new episodes and recurrences of depression and are a key symptom in predicting and preventing depression. Research on acupuncture for depression has covered neuroendocrine aspects, neurotransmitters and their receptors, immune function and neural signal transduction pathways; in addition, some studies have addressed the balance between different transmitters and between different brain regions, and others have examined the effect of acupuncture on apoptosis and protection of hippocampal neurons. These studies found that the mechanism of action of acupuncture in depression is related to multiple mechanisms and processes. Furthermore, studies have begun to address the relationships among multiple mechanisms, such as the relationships between central neurotransmitters, comparisons of the tissue and function of different brain regions, and the relationship of the same neurotransmitter between the central nervous system and the periphery. In this study, acupuncture was added to selective serotonin reuptake inhibitors (SSRI antidepressants) for the treatment of depression with sleep disorders, which may enhance the role and status of Chinese medicine in the treatment of depression, broaden clinical treatment approaches, and provide a more definite method to improve clinical efficacy and reduce drug side effects. SSRIs still have some insurmountable shortcomings, such as delayed onset, many side effects, limited effects on somatic and psychological symptoms, the need for 3-6 weeks to take effect, and an effective rate of only about 70%. Therefore, seeking non-drug therapies for this disease has broad application prospects and social significance. In summary, acupuncture combined with antidepressants is an important path for the development of acupuncture: it combines the advantages of acupuncture and medication, broadens the range of diseases treated with acupuncture and brings acupuncture into more and newer fields. Acupuncture combined with antidepressants is increasingly widely used in clinical practice and shows clear advantages. Acupuncture can serve as a long-term method for the prevention and treatment of depression with sleep disorders and has positive effects on improving sleep disorders and preventing the recurrence of depression. OBJECTIVE: (1) Theoretical study: 1. To clarify that depression is a Western medicine disease name; although manifestations of depression may appear in the symptom complexes of several Chinese medicine disease names, at present depression cannot be directly equated with any single Chinese medicine disease name. 2. To clarify that sleep disorder refers generally to sleep disturbances, including insomnia and hypersomnia in Chinese medicine. 3. To explore the Western medicine pathogenesis of depression and sleep disorders. 4. Many literature studies show that Western drug treatment has shortcomings such as slow onset, marked side effects and poor patient compliance. 5. To analyze the marked difference between the holistic regulating action of acupuncture and the relatively single action of Western drugs. 6. To explore the advantages of acupuncture treatment of depression with sleep disorders guided by the theory that "the brain is the house of the original spirit". 7. To clarify that acupuncture at points mainly on the Governor Vessel has efficacy comparable to tricyclic drugs for these conditions, while being superior to the latter in improving symptoms such as anxiety/somatization. (2) Clinical study: To compare the clinical efficacy, in patients with depression and sleep disorders, of acupuncture at points mainly on the Governor Vessel plus moxibustion at Baihui while taking selective serotonin reuptake inhibitors (SSRI antidepressants) (treatment group) versus SSRIs alone without acupuncture (control group), in order to find an effective method for treating sleep disorders in depression; to explore the mechanism of action of acupuncture at points mainly on the Governor Vessel plus moxibustion at Baihui in patients with depression and sleep disorders, with a view to expanding the multidirectional role of acupuncture in disease prevention and treatment; and to provide a definite method for improving clinical efficacy, reducing drug side effects and improving patients' quality of life. METHODS: (1) Theoretical study: 1. Literature on Chinese medicine treatment of depression and sleep disorders was collected, analyzed and reviewed. 2. Literature on Western medicine treatment of depression and sleep disorders was collected, analyzed and reviewed. 3. Literature on integrated Chinese and Western medicine treatment of depression and sleep disorders was collected, analyzed and reviewed. 4. Based on the above, the importance of acupuncture combined with medication in the treatment of depression with sleep disorders is explained. (2) Clinical study: From September 2006 to December 2008, 60 outpatients of KONG'S TCM Singapore & Singapore Yuguo TCM Clinic Pte Ltd (all diagnosed with depression by a psychiatrist) were randomly divided into 2 groups, with 30 cases each in the treatment group and the control group. Disease condition, age and other baseline characteristics were comparable between the 2 groups. Both groups routinely took selective serotonin reuptake inhibitors (SSRI antidepressants). The treatment group, while taking SSRI antidepressants, received acupuncture at Yintang, Shenting, Dazhui, Fengchi (bilateral), Shenmen (bilateral) and Sanyinjiao (bilateral) and moxibustion at Baihui, combined with syndrome-differentiated point selection and symptom-based modifications, twice a week, with a follow-up visit every 2 weeks of treatment; 10 weeks of treatment constituted one course. The control group took only SSRI antidepressants without acupuncture, with a follow-up visit every 2 weeks, and the observation period was 10 weeks. Changes in the Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), Asberg Side Effect Rating Scale (SERS) and Clinical Global Impression (CGI) were compared between the treatment and control groups before treatment and at the end of weeks 2 and 10 of treatment. RESULTS: (1) Theoretical study: 1. Acupuncture at Governor Vessel points can markedly increase the activity of 5-HT neurons in the raphe nuclei and increase 5-HT content in the substantia nigra, hypothalamus and other areas; it can also improve cerebral blood circulation, enhance the antioxidant capacity of brain tissue and improve memory function. 2. Moxibustion at Baihui regulates yin and yang, refreshes the brain and opens the orifices, and calms the heart and spirit. Moxibustion at this point can improve the blood supply and vascular elasticity of brain tissue and can regulate the autonomic nervous system through cerebral cortical reflexes, thereby treating nervous system diseases; moxibustion at Baihui can inhibit abnormal excitation of the brain and restore balance and coordination to disordered brain function. (2) Clinical study: After 10 weeks of treatment, HAMD scores in the treatment group showed a highly significant difference before versus after treatment (P<0.01); the control group showed a difference before versus after treatment (P<0.05), indicating that both treatments were effective in improving HAMD scores in patients with depression, with statistical significance. During treatment (week 2), there was a difference between the two treatments in improving HAMD scores (P<0.05); at the end of treatment (week 10), there was no difference between the two treatments in improving HAMD scores (P>0.05), suggesting that although the two treatments ultimately did not differ in improving HAMD scores, the effect in the acupuncture treatment group was faster than in the drug group. After 10 weeks of treatment, PSQI scores in the acupuncture treatment group showed a highly significant difference before versus after treatment (P<0.01); the drug control group showed no difference before versus after treatment (P>0.05), indicating that acupuncture was effective in improving PSQI scores in patients with depression, with statistical significance. During treatment (week 2), there was a difference between the two treatments in improving PSQI scores (P<0.05), suggesting that the acupuncture treatment group was superior to the drug group. After 10 weeks of treatment, SDS scores showed no difference before versus after treatment in either group (P>0.05), indicating that neither method produced a statistically significant improvement in SDS scores in patients with depression. During treatment (week 2), there was a difference between the two treatments in improving SDS scores (P<0.05); at the end of treatment (week 10), there was no difference between the two treatments in improving SDS scores (P>0.05), suggesting that although the two treatments ultimately did not differ in improving SDS scores, the effect in the treatment group was faster than in the control group. After 10 weeks of treatment, SERS scores showed no difference before versus after treatment in either group (P>0.05), indicating that neither method produced a statistically significant improvement in SERS scores in patients with depression. During treatment (week 2), there was a highly significant difference between the two treatments in improving SERS scores (P<0.01); at the end of treatment (week 10), there was also a highly significant difference between the two treatments in improving SERS scores (P<0.01), suggesting that the treatment group was superior to the control group in improving Asberg side effects in depression. There was no difference between the two groups in severity of illness (SI) (P>0.05); after 10 weeks of treatment, the treatment group was superior to the control group in global improvement (GI), with statistical significance (P<0.05); there was no difference between the two groups in the efficacy index (EI) (P>0.05). This suggests that acupuncture combined with SSRIs has definite efficacy for depression with sleep difficulties. CONCLUSIONS: (1) Theoretical study: 1. The advantage of acupuncture combined with antidepressants lies mainly in better improvement of somatic symptoms such as anxiety and sleep disorders. 2. Acupuncture combined with antidepressants can compensate for the slow onset of antidepressants and reduce the adverse reactions of Western drugs; clinical practice has shown complementary advantages of rapid onset and high efficacy. 3. The action of acupuncture is based on stimulating the patient's own endogenous regulatory mechanisms; it acts without the aid of drugs and therefore has no side effects on the human body. 4. The literature shows that the marked-effect and cure rate of acupuncture alone for depression is 76.67%, whereas acupuncture combined with antidepressants can more markedly increase the marked-effect rate and the total effective rate. 5. Acupuncture can enhance the function of the brain monoaminergic nervous system and increase 5-HT, NE and DA levels in specific brain regions, thereby improving the clinical symptoms of patients with depression. (2) Clinical study: 1. Acupuncture combined with SSRIs has definite efficacy for depression, and acupuncture can be used as an adjunctive therapy to SSRIs in the treatment of depression with sleep disorders. 2. Acupuncture combined with medication for depression with sleep disorders can effectively improve clinical efficacy; its advantages are mainly rapid onset and a clearly greater improvement of the somatic symptoms and sleep disorders accompanying depression than with SSRIs alone. 3. Acupuncture combined with medication for depression with sleep disorders can reduce the various symptoms caused by drug side effects.