Stimulated by Ma et al 2024.[1]
This image came up when I searched for Yancheng on Unsplash. Just to the right of centre, between the two central pillars you can just see a fluid level – I guess that is the Yellow Sea.
EA – electroacupuncture
key to acronyms
PSD – post stroke depression
RCT – randomised controlled trial
SR – systematic review
HAMD-17 – Hamilton depression scale (the first 17 items)
SDS – Zung self-rating depression scale
MBI – modified Barthel index
This is a relatively large, single centre, sham controlled and comparative RCT from a group in Yancheng, which is 2 days walk northeast of Nanjing. Nanjing translates as south capital, so that makes Beijing the north capital. Nanjing is on the Yangtze River about 300km inland of Shanghai. The first and last authors on the paper include an affiliation with Nanjing University of Chinese Medicine, but the study was based at a rehabilitation hospital in Yancheng. The author list includes someone called Lu Lu, who was first author on an SR in the same journal in 2022 on a similar topic – cardiovascular disease complicated by depression.[2]
Patients with PSD were included if they had a HAMD-17 score of 8-24, which corresponds with mild to moderate depression. 150 patients were randomized to EA or sham EA plus escitalopram (10mg to 20mg). EA was applied from GV20 to Yintang and from LI4 to LR3 (ipsilateral) at 2/15Hz for 30 minutes daily for 5 day per week for 6 weeks. I assume ipsilateral refers to the hemiplegia associated with the stroke.
Sham EA involved superficial off point needle insertion and mock EA stimulation for the same number of sessions (30 over 6 weeks).
The primary outcome was the HAMD-17. Secondary outcomes were the SDS and MBI. In addition, serum levels of the following cytokines were measured at baseline and following the 6-week course of treatment: IL-1β, IL-6, IL-10, TNF-α, and INF-γ.
Both groups started with a mean HAMD-17 score of just over 18 and this reduced significantly at 6 weeks and then further at 10 weeks. At the latter time point, the EA group was significant more improved than the escitalopram group (mean HAMD-17: 10.47 vs 12.10 respectively). Similar changes were seen on the SDS. Whilst the difference between groups may not have been clinically significant,[3] the statistical significance in favour of EA means we can claim that EA is at least as good as escitalopram in PSD.
The cytokine levels changed significantly within groups but not between groups, demonstrating a reduction in proinflammatory markers and an increase in IL-10, which is anti-inflammatory.
The results of this trial do seem to be a first in that the most recent SR on the topic did not manage to show a statistically significant benefit of acupuncture/EA over antidepressants when pooling HAMD-17 outcomes from 5 of the 17 trials included in the SR.[4]
References
1 Ma F, Cao G, Lu L, et al. Electroacupuncture versus Escitalopram for mild to moderate Post-Stroke Depression: A randomized non-inferiority trial. Front Psychiatry. 2024;15:1332107.
2 Lu L, He W, Guan D, et al. Acupuncture in treating cardiovascular disease complicated with depression: A systematic review and meta-analysis. Front Psychiatry. 2022;13:1051324.
3 Rush AJ, South C, Jain S, et al. Clinically Significant Changes in the 17- and 6-Item Hamilton Rating Scales for Depression: A STAR*D Report. Neuropsychiatr Dis Treat. 2021;17:2333–45.
4 Liu R, Zhang K, Tong Q-Y, et al. Acupuncture for post-stroke depression: a systematic review and meta-analysis. BMC Complement Med Ther. 2021;21:109.
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