| ObjectiveBy way of a research study of modern literatures on the use of acupuncture in the treatment for post stroke depression (including Integrative Medicine), I aimed to achieve the following goals:(1.) To analyze the characteristics of the literatures under review and to summarize the pathological changes and transmission rules so as to provide a guide for clinical practice and pave way for further research.(2.) To systematically evaluate the differences of efficacy and safety of the commonly used acupuncture therapy and antidepressant drug treatments for post stroke depression.MethodologyPart One:Having devised the criteria for literature inclusion, exclusion, search strategies, retrieve standard, search tools, and retrieval time etc., I conducted a metrological analysis on the full text of the literatures in relation to its time of publication, research area, source of publication, and diagnostic standard.Part two:Based on the research study of Part One and in accordance with the formulated inclusion and exclusion criteria, I selected electronic copies of literatures on needle acupuncture, electro-acupuncture, and acupuncture&medicine (referring to antidepressants), integrative treatment, and combined therapy with antidepressants treatment for post stroke depression. The RevMan5.1application software of Cochrance for Meta analysis was deployed to analyze randomized controlled clinical trials (RCT). ResultsPart One:The inclusion of254literatures of acupuncture treatment of post stroke depression (including Integrative Medicine) denoted an overall trend of an annual increase. Both Guangzhou and Tianjin took the lead. The diagnosis of stroke based on the criteria set forth in "The Various Types of Cerebral Vascular Diseases" whereas the diagnosis of depression employed the standards set forth in the third edition of "Chinese Classification of Psychiatric Diseases and Diagnosis Standard". Needle acupuncture and integrative treatment were applied in the treatment group. As for the controlled group, antidepressants like fluoxetine were administered. The efficacy evaluation indicators mainly based on the improvement of the signs and symptoms of depression by using the score value of Hamilton Depression Scale (HAMD) only.Part Two:A systematic reviews of the needle acupuncture versus antidepressants for post stroke depression:(1.)14RCTs with1429patients and6high-quality literatures with402patients were reviewed.(2.) Meta-analysis showed that needle acupuncture treatment for PSD was far more effective than antidepressants at the end of6weeks with the following significant differences in terms of statistical studies:OR=3.03; and95%CI;(1.32,6.94).(3.) HAMD scores were reported in all the6high-quality literatures:1recorded the SDS (depression self rating scale) rating;2recorded the Barthel index;1recorded the SSS (Scandinavia stroke scale) rating;1recorded the FIM (function independence evaluation);1recorded the MESSS (improved Edinburgh10in Scandinavia neural function defect rating scale) score and a deduction rate;1recorded NIHSS (the U.S. national institutes of health neural function defect scale) rating;1recorded TCM symptoms scale;1recorded the MMSE (simple mental status scale) score;1recorded SF-36(survival quality rating scale) score; and4recorded adverse reactions. No Meta-analysis for reasons of:different index number of literatures, different scale versions, and different antidepressants.Part Three:A systematic reviews of electro-acupuncture therapy and antidepressant treatment for post stroke depression:(1.) A total of13RCTs with1062patients and5high-quality literatureswith549patients were reviewed.(2.) Meta-analysis showed that the EA improve stroke patients with depression far more effective than fluoxetine. The differences were statistically significant:OR=1.94,95%CI (1.12,3.36).(3.) Four high-quality literature were recorded in the HAMD score,1recorded SDS score,2recorded the Barthel Index,1recorded CGI score,1recorded MESSS scores and reduced rate,4recorded adverse reactions. As there were limited number of literatures under review and different kinds of antidepressants used, no Meta-analysis was conducted.Part Four:The systematic reviews of acupuncture combined with antidepressants versus antidepressants for post stroke depression showed:(1.) A total of29RCTs with2349patients and3high-quality literatures with184patients were under review.(2.) Meta-analysis showed that patients suffered from PSD treated with electro-acupuncture together with fluoxetine improved much better than those merely treated with fluoxetine. The differences were statically significant:WMD=-2.50,95%C I (-3.40,-1.60)].(3.)1high-quality literature showed HAMD reduction rate,2reported SDS scores,1reported CSS (China Stroke Clinical Neurologic Impairment Rating Scale) score,1reported the FIM score,1reported the scores of the WHOQOL-BREF (World Health Organization Quality of Life Scale Score Table), and2reported adverse reactions. As there were limited number of literatures under review and different kinds of antidepressants used, no Meta-analysis was conducted.Conclusion(1.) Acupuncture for the treatment of post stroke depression gradually arouses widespread concern. It becomes an area for growing research and remains a hot topic for research publication. This research aims to serve as a guide for clinical use and to summarize the characteristics of diagnostic standard and treatment methodology for DSP patients.(2.) This research preliminarily evinces that acupuncture therapy and combined acupuncture with antidepressants are more effective than the use of antidepressants alone. On the other hand, there exist a few problems and limitations in the clinical research aspects because the types of antidepressants keep developing day by day... |
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