The use of acupuncture for the treatment of depression

ISRCTN ISRCTN88008690
DOI https://doi.org/10.1186/ISRCTN88008690
Secondary identifying numbers N/A
Submission date
10/12/2007
Registration date
04/03/2008
Last edited
16/05/2012
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Mental and Behavioural Disorders
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Dr Zhang-Jin Zhang
Scientific

School of Chinese Medicine
The University of Hong Kong
10 Sassoon Road
Pokfulam
-
Hong Kong

Study information

Study designA single-centre, single-blind, randomised, sham controlled study.
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Scientific titleA single-blind, randomised, sham controlled study of electroacupuncture in accelerating the onset of antidepressant action of selective serotonin reuptake inhibitors via serotonergic mechanisms
Study objectivesDepression is a worldwide mental health problem, with a lifetime prevalence of about 20%. The currently available antidepressant treatments, represented by selective serotonin reuptake inhibitors (SSRIs), are incomplete and unsatisfactory. The most apparent is the delay in the onset of action of SSRIs, which has hampered the use of this class of drugs.

Hypothesis:
Electroacupuncture acceleration of the response to SSRIs is achieved through its potentiation of serotonin (5-HT) release by inhibiting autoreceptor (5-HT1A/1B) activities, uptake, and turnover.
Ethics approval(s)Ethics approval received from the Medical Ethical Committee of the First Teaching Hospital, Hebei Medical University on the 19th June 2006 (ref: 66).
Health condition(s) or problem(s) studiedDepression
InterventionThis is a six-week, single-blind, randomised, sham controlled study. A total of 66 untreated patients with MDD will be recruited. Under single-blind condition, patients will be randomly assigned to paroxetine (PRX) combined with active or sham electroacupuncture (EA) for six weeks. PRX dose is initiated at 10 mg/day and escalated to maximum 40 mg/day within one week. EA intervention is conducted by electrically stimulating two acupoints: Yin-Tang (EX-HN3) and Bai-Hui (DU-20) for 45 minutes daily.

Both groups of the patients will receive orally administered PRX for six weeks. The dose is initiated at 10 mg/day and escalated to maximum 40 mg/day within one week. The choice of PRX, but not other SSRIs, is because the slow onset of PRX action has been well demonstrated in our preliminary and previous studies. Treatments with the dose range defined have been reported to yield optimal clinical outcomes in Chinese depressed patients. Concomitant use of other psychoactive medications is not allowed. If significantly clinical conditions have to require such medications, patients will be asked to withdraw from the study. Patients who have poor compliance with medication schedules (below 80%) will also be removed from the study.

Meanwhile, active or sham EA intervention is conducted daily for six weeks. For active EA, a pair of stainless steel needles of 0.25 mm diameter are inserted at a depth of 10 - 20 mm obliquely into Bai-Hui (Du-20) and Yin-Tang (EX-HN3), through which electric stimulation with continuous waves with 2 Hz at 6 voltages are delivered. The intensities of stimulation are adjusted to a level at which patients feel most comfortable. To ensure the active procedure as identical as the sham procedure, the inserted needles are affixed with adhesive tapes. For the sham treatment, the needles are inserted into two non-traditionally defined points at 1 - 1.5 cm around the acupoints used for active EA, but immediately taken out and put back into plastic needle guiding tubes. The needles contained in the tubes are then affixed on the point skins with adhesive tapes and stimulated electrically as described above. Our initial practice and other studies have demonstrated that this novel sham acupuncture procedure enables well-controlled blinding for patients.
Intervention typeDrug
Pharmaceutical study type(s)
PhaseNot Specified
Drug / device / biological / vaccine name(s)Paroxetine
Primary outcome measure1. Efficacy, measured using the HAMD-17, CGI-S, and Sheehan disability scale (SDS)
2. Adverse events, assessed using the treatment emergent symptom scale (TESS)

Assessments will be conducted at baseline and at day 3, 7, 10, 14, 21, 28, 35, and 42.
Secondary outcome measures1. Clinical response, defined as less than 50% reduction from baseline on HAMD-17
2. Remission, defined as a score 7 points or less on the HAMD-17

Assessments will be conducted at baseline and at day 3, 7, 10, 14, 21, 28, 35, and 42.
Overall study start date01/09/2006
Completion date31/12/2010

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants66
Key inclusion criteria1. Either gender aged 25 - 65 years
2. Have first-episode major depressive disorder (MDD) diagnosed from the diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV)
3. Scores on the 17-item Hamilton depression rating scale (HAMD) and clinical global impression of severity (CGI-S) are at least 20 and 4 points, respectively
4. Have not yet received any psychoactive medications
Key exclusion criteria1. Unstable medical conditions
2. Have suicidal attempts or aggressive behaviour
3. Previously experienced manic, hypomanic, or mixed episode
4. Immediate family members were or are diagnosed for bipolar or psychotic disorders
5. Treatment with investigational drugs in past six months
6. Alcoholism or drug abuse in past one year
7. Have needle phobia
Date of first enrolment01/09/2006
Date of final enrolment31/12/2010

Locations

Countries of recruitment

  • China
  • Hong Kong

Study participating centre

School of Chinese Medicine
Pokfulam
-
Hong Kong

Sponsor information

The Health and Health Services Research Fund (HHSRF), Food and Health Bureau of Hong Kong
Hospital/treatment centre

18/F, Murray Building, Garden Road, Central, Hong Kong
Hong Kong
050031
China

ROR logo "ROR" https://ror.org/03qh32912

Funders

Funder type

Hospital/treatment centre

The First Teaching Hospital (China) - Intramural Research Fund

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/08/2012 Yes No