Objective: To observe the effect of Tiaoqi Jieyu (regulating qi and relieving depression) acupuncture on the clinical symptoms of treatment-resistant depression (TRD), and to explore the relationship between the acupuncture pain sensitivity and symptom's improvement.
Methods: A total of 78 patients with TRD were randomly divided into an observation group (39 cases, 3 cases dropped off) and a control group (39 cases, 4 cases dropped off). The patients in the control group were treated with medications according to the treatment plan of psychiatrists (at least one medication was 5-hydroxytryptamine reuptake inhibitor). On the basis of the control group, the patients in the observation group were treated with Tiaoqi Jieyu acupuncture, and Baihui (GV 20), Yintang (GV 24+), Yanglingquan (GB 34), Taichong (LR 3), Hegu (LI 4), Neiguan (PC 6), Yinlingquan (SP 9) and Zusanli (ST 36), etc. were selected. The acupuncture was given three times a week. Both groups were treated for 8 weeks. After 8-week treatment, the response rate of Hamilton depression scale-24 (HAMD-24) score after was evaluated in the two groups. The scores of HAMD-24 and Hamilton anxiety scale (HAMA) were compared between the two groups before treatment, after 4, 8-week treatment and 12 weeks after treatment (follow-up). After the first treatment and 8-week treatment, the visual analogue scale (VAS) score in the observation group was evaluated, and the correlation between VAS score after the first treatment and HAMD-24 score before treatment, between VAS score after the first treatment and the course of disease in the observation group was analyzed, and the correlation between difference of VAS after 8-week treatment and after the first treatment and difference of HAMD-24 score before treatment and after 8-week treatment was analyzed.
Results: After 8-week treatment, the response rate of HAMD-24 score in the observation group was 52.8% (19/36), higher than 17.1% (6/35) in the control group (P<0.001). Compared before treatment, the scores of HAMD-24 and HAMA in the two groups were decreased after 4-week treatment, 8-week treatment and in follow-up (P<0.05), and those in the observation group were superior to the control group (P<0.05). After 8-week treatment, the acupuncture pain VAS score in the observation group was (5.28±2.13) points, which was higher than (3.33±1.62) points after the first treatment (P<0.001). There was a negative correlation between VAS score after the first treatment and HAMD-24 score before treatment in the observation group (r =-0.486, P=0.003); there was no correlation between acupuncture pain VAS score after the first treatment and the course of disease in the observation group (P>0.05). After 8-week treatment, there was a positive correlation between the difference of VAS score and the difference of HAMD-24 score in the observation group (r =0.514, P=0.001).
Conclusion: Tiaoqi Jieyu acupuncture could improve the depression and anxiety in patients with TRD, and the symptom's improvement is related to the recovery of acupuncture pain sensitivity.
目的：观察调气解郁法针刺对难治性抑郁症（TRD）临床症状的影响，并探讨患者针刺痛觉敏感性与症状改善的关系。方法：将78例TRD患者随机分为观察组（39例，脱落3例）和对照组（39例，脱落4例）。对照组患者根据精神科医生的治疗方案（至少有一种药物为5-羟色胺再摄取抑制剂类药物）服用药物；观察组在对照组的基础上予调气解郁法针刺治疗，穴取百会、印堂、阳陵泉、太冲、合谷、内关、阴陵泉和足三里等，每周治疗3次，两组均治疗8周。于治疗8周后评定两组患者汉密尔顿抑郁量表24项（HAMD-24）评分应答率；分别于治疗前，治疗4、8周后及治疗结束后12周（随访）比较两组患者HAMD-24、汉密尔顿焦虑量表（HAMA）评分；于第1次治疗后及治疗8周后评定观察组患者针刺疼痛视觉模拟量表（VAS）评分，并将观察组患者第1次治疗后VAS评分与治疗前HAMD-24评分、病程进行相关性分析，VAS评分差值（治疗8周后－第1次治疗后）与HAMD-24评分差值（治疗前-治疗8周后）进行相关性分析。结果：治疗8周后，观察组患者HAMD-24评分应答率为52.8%（19/36），高于对照组的17.1%（6/35，P<0.001）。与治疗前比较，两组患者治疗4、8周后及随访时HAMD-24、HAMA评分均降低（P<0.05），且观察组低于对照组（P<0.05）。治疗8周后，观察组患者针刺疼痛VAS评分为（5.28±2.13）分，高于第1次治疗后的（3.33±1.62）分（P<0.001）。观察组患者第1次治疗后VAS评分与治疗前HAMD-24评分呈负相关（r =-0.486，P=0.003）；观察组患者针刺疼痛VAS评分与病程无相关性（P>0.05）。治疗8周后，观察组患者VAS评分差值与HAMD-24评分差值呈正相关（r =0.514，P=0.001）。结论：调气解郁法针刺可以改善TRD患者抑郁及焦虑情绪，症状改善与恢复针刺痛觉敏感性有关。.
Keywords: Tiaoqi Jieyu; acupuncture; hyperalgesia; randomized controlled trial (RCT); treatment-resistant depression (TRD).