Effect Of Electroacupuncture On Cognitive Control Network Of Depression State

BackgroundDepression showed a rapid growth trend in China and has become one of the main reasons for disease burden. Depression is one of the most torturing diseases that influence human health and its diagnosis is easily missed and misdiagnosed, which leads to a major loss in social and economic expenditure annually. At present, anti-depressant is used as the primary clinical treatment for depression, but there are still some problems that exist such as limitation in effect, delay, many kinds of side effects and adverse events. Recently, researches on acupuncture in the treatment of depression are increasing in number and many more foreign experts are paying attention to the acupuncture benefit for mental illness. Previously, researchers have confirmed that there are different stages of brain function changes in depression patients through a large number of MRI imaging data. Based on the previous research foundations, we intend to observe functional changes of depression patients in different stages and the changes of brain functional connectivity before and after the electro-acupuncture treatment. Our aim is to provide reliable evidences for depression treatment and to maximize the application of our research into clinical practice.Objective1 To investigate the changes in the pathogenesis of depression by observing the changes with cognitive control network (CCN) functional connectivity (FC) in depression, subthreshold depression and healthy controls.2 To verify the therapeutic effect of electro acupuncture in depression by observing the cognitive control network (CNN) functional connectivity (FC) changes post and pre treatment, and to investigate the specific brain regions relevant to electro acupuncture treatment.3 Correlation analysis in psychiatric measurements and cognitive control network (CNN) functional connectivity (FC) changes, and to observe the relevant brain region through the seven-factor of Hamilton rating of depression scale (HAMD-24) scores and cognitive control network (CNN) functional connectivity (FC) changes before and after treatment.MethodsIn this study, we recruited depression subjects from Beijing University of Chinese Medicine Dongfang Hospital and Peiking University Sixth Hospital. Subthreshold depression subjects and healthy participants were from fifteen different Beijing residence community centers.1 In epidemiological investigation, the participants which scores of CES-D (Center for Epidemiologic Studies Depression Scale) is higher than 16 were further assessed by a licensed psychiatrist using a17-item Hamilton rating of depression scale (HAMD-24) to confirm study qualifications. Participants were proceeded to acupuncture treatment when the 17- item HAMD scoring was between 7-17.2 60 depression subjects (HAMD-24 score is higher than 20) who were satisfied the diagnostic, inclusion and exclusion criteria, and have voluntarily signed the informed consent forms.3 After signed the consent forms, all 63 participants took the fMRI scans (including 15 depression subjects,23 subthreshold subjects,25 healthy controls, nine depression pre-and post-treatment subjects). Through HAMD-24 evaluation, we observe the relevant brain regions with the seven-factor of HAMD and CCN FC pre-post treatment. Observe the relativity between the level of depressed symptoms and CCN FC in subthreshold depression subjects and healthy controls by CES-D.4 We used fMRI in our research, chose the seed based analysis method as basis to analyze data and have selected ROI as the CCN-dorsolateral prefrontal cortex (DLPFC), to observe the changes in the central mechanism of the healthy control, subthreshold depression group and depression group. Through the changes in the CNN between the 3 groups in resting state, we can investigate the characteristic of the abnormal brain activity in depression and subthreshold depression group.5 Observe the correlation analysis between CCN FC changes with the seven-factor of HAMD scale changes of 9 depression patients in pre and post electro-acupuncture treatment. Explore the special brain regions related to the changes of the brain function and symptom changes after electro acupuncture treatment.Results1 The demographics of the three groups did not significantly differ in terms of age, gender and others baseline information (p>0.05).2 Compared with subthreshold depression subjects and healthy controls, subthreshold depression subjects has abnormalities in CCN FC. Decreased FC brain regions contain the left temporoparietal junction (TPJ), postcentral gyrus, medial prefrontal gyrus and dorsal anterior cingulate cortex (DLACC).3 Compared between depression subjects and subthreshold depression subjects, the depression subjects show abnormality in CCN function activity, and the brain region that shows an increase in the FC is positioned at the right precuneus.4 After the correlation analysis between subthreshold depression and healthy controls in CES-D scores, there showed a negative correlation between CNN FC and CES-D total scores. Increased FC brain regions include left TPJ and postcentral gyrus.5 Changes in the CNN FC were shown between pre-post treatments in depression patients. Decreased FC brain regions were in the left superior temporal gyrus.6 Correlation analyses between therapeutic effect of electro acupuncture in depression patients, HAMD-24 score of seven-factor reduction rate, showed that electro acupuncture intervention can cause changes in CCN FC in depression patients. There is a correlation in the electro-acupuncture intervention and anxiety/somatization factor and its change is related to the right posterior cingulated. The decrease in the CCN FC brain region is related to the right posterior cingulate and precuneus. The factor of Diurnal variation with the CCN FC correlation increased brain regions were in the left superior temporal gyrus and the right subgenus anterior cingulate cortex, dorsal anterior cingulate gyrus, parahippocampal gyrus, fusiform gyrus, left superior temporal gyrus and inferior temporal gyrus. There was no significant association between the therapeutic effect of electro-acupuncture with weight loss, cognitive impairment, retardation and sleep disturbance factors.Conclusion1 The detection rate of depression in normal people is 18.03%, and the depression and subdepression state of residents in Beijing is in bad condition.2 Electro-acupuncture treatments can improves the scores of HAMD seven factors especially in anxiety/somatization, arrest, weight, desperation and diurnal variation factors better than antidepressants.3 The working time of Electro-acupuncture treatments was significanttly earlier than antidepressants in anxiety/somatization, weight, desperation and diurnal variation factors.4 RS-fMRI as a high level of clinical evidence, can confirm the significant effects of electro-acupuncture treatment in depression.5 RS-fMRI can reflect the CCN FC difference more sensitively in depression, subthreshold depression and healthy controls.6 We found that the CCN FC changes in the depression subject are significantly associated with the changes in HAMD scores.7 Electro-acupuncture treatments has significant effects in anxiety/somatization, arrest and diurnal variation factors. The improvement in the anxiety/somatization factor is associated with the right posterior cingulate cortex of the brain region. The factor of retardation CCN FC changed were in the posterior cingulate, precuneus. Improvements in the diurnal variation factor is associated with subgenual anterior cingulate cortex, parahippocampal gyrus, fusiform gyrus, these are abnormal brain regions that shows in depression subjects.