| Purposes 1.Compared with escitalopram oxalate,the efficacy and side effects of transcutaneous auricular vagus nerve electrical stimulation on depressive mood,anxiety state and sleep disorder in mild to moderate depressive disorder were observed.2.The neurotransmitter levels in different brain regions of patients with mild to moderate depressive disorder were collected by SET analysis system after 8 weeks of treatment,and the mechanism of brain function of patients with mild to moderate depressive disorder was analyzed by transcutaneous auricvagus nerve electrical stimulation.Methods A total of 46 subjects with mild to moderate depressive disorder were collected from the outpatient department of psychosomatic Medicine of Guang’anmen Hospital of China Academy of Chinese Medical Sciences from December 1,2020 to December 1,2021.The random number was generated by IBM SPSS26.0 random number generator.Patients were divided into transcutaneous auricular vagus nerve electrical stimulation group(experimental group,n=23 cases)and escitalopram oxalate group(control group,n=23 cases).The treatment cycle was 8 weeks.Hamilton Depression Scale(HAMD-17),Self-rating Depression Scale(SDS),Hamilton Anxiety Scale(HAMA),and Self-rating Anxiety Scale(SAS)scores were used to evaluate depression and anxiety at 0,2,4,8 weeks after treatment and 4 weeks after follow-up,respectively.Pittsburgh Sleep Quality Index(PSQI)score was used to evaluate sleep status at 0,4,8 and 4 weeks follow-up,and the antidepressant side effect Scal(SERS)was recorded.The reduction rate of HAMD-17 before and after treatment was used as the main outcome index.IBM SPSS26.0 statistical software was used to process data.The measurement data conforming to normal distribution were statistically described by mean±standard(x±s)deviation,and the measurement data conforming to normal distribution were statistically described by median(quartile)[M(QR)].For data consistent with normal distribution and homogeneity of variance,paired sample T test was used for intra-group comparison,and two-independent sample T test was used for inter-group comparison.Non-parametric test is used for those not conforming to normality and homogeneity of variance.The count data were expressed by frequency,the effective rate was expressed by percentage,and chi-square test was used for comparison between groups.Bilateral test,α=0.05.Detection of SET was examined at the 0 and 8 weeks of treatment in 46 patients.The levels of neurotransmitters(INH,5-HT,ACH,DA,NE,EXC)in 12 brain regions of the subjects were collected and the distribution of six neurotransmitters in 12 brain regions were analyzed.Results A total of 46 patients were included in the experimental group and the control group,all of whom completed the 8-week treatment,follow-up,adverse reaction evaluation and SET function examination.1.Baseline comparison:there were no significant differences in age,sex,course of disease,HAMD-17,HAMA,SDS,SAS and PSQI between the two groups(P>0.05).2.Depression Mood Assessment Scale(1)HAMD-17:Compared with before treatment,there was a decrease in the experimental group at the 4th week of treatment(P<0.01),the 8th week(P<0.001)and after 4 weeks of follow-up(P<0.001);The control group showed a decrease at 8 weeks of treatment(P<0.05)and 4 weeks of follow-up(P<0.001).Comparison between groups showed that the experimental group wa lower than the control group at the 8th week of treatment(P<0.01)and the 4th week of follow-up(P<0.05).(2)SDS:Compared with before treatment,the experimental group and control group showed a decrease at the 2nd,4th,8th week of treatment and 4 weeks of follow-up,showing extremely significant differences(P<0.001).Comparison between groups showed that the experimental group was lower than the control group at 8 weeks of treatment(P<0.05)and 4 weeks of follow-up(P<0.001).3.The Anxiety State Scale Assessment(1)HAMA:Compared with before treatment,the experimental group showed a decrease at the 4th and 8th week of treatment and after 4 weeks of follow-up,with extremely significant statistical differences(P<0.001);The control group showed a decrease at the 4th week of treatment(P<0.01),the 8th week of treatment(P<0.01)and the 4th week of follow-up(P<0.05).Comparison between groups showed that the experimental group was lower than the control group at the 4th week(P<0.05)and the 8th week(P<0.01).(2)SAS:Compared with before treatment,the experimental group showed a decrease at the 2nd,4th and 8th week of treatment and after 4 weeks of follow-up,with extremely significant statistical difference(P<0.001);In the control group,decreases were observed at week 2(P<0.01),week 4(P<0.001),week 8(P<0.001)and after 4 weeks of follow-up(P<0.001).The experimental group was significantly lower than the control group at the 4th and 8th week of treatment(P<0.01),and the experimental group was significantly higher than the control group after 4 weeks of follow-up(P<0.01).4.Sleep evaluation scale:compared with before treatment,the experimental group showed a decrease at the 4th and 8th week of treatment and after 4 weeks of follow-up,with extremely significant statistical difference(P<0.001);The control group showed a decrease at 8 weeks of treatment(P<0.001)and 4 weeks of follow-up(P<0.01).Intra-group comparison,the experimental group was lower than the control group at the 4th week of treatment and the 4th week of follow-up,the difference was statistically significant(P<0.01).5.Comparison of neurotransmitters in different brain regions:(1)Average brain score:Compared with before treatment,INH and ACH activation decreased,5-HT,DA,NE and EXC activation increased in experimental group,with statistical differences(P<0.05);In the control group,the activation of INH and ACH decreased,and the difference was statistically significant(P<0.05),while the activation of 5-HT(P<0.001),DA(P<0.05),NE(P<0.05)and EXC(P<0.05)increased.The activation level of 5-HT in experimental group was higher than that in control group after 8 weeks of treatment.(2)Frontal regions:Compared with before treatment,activation levels of INH and ACH decreased in the left frontal area of the experimental group and the control group,while activation levels of DA,NE,EXC and 5-HT increased,with extremely significant differences(P<0.001).The activation levels of INH,5-HT,ACH,DA,NE and EXC in the right frontal region of the test group and the control group were significantly increased(P<0.001).There was no significant difference between the left and right frontal regions.(3)Central region:Compared with before treatment,activation levels of INH,5-HT,ACH,DA and EXC showed an upward trend in the left central region of the experimental group and the control group,while activation levels of NE showed a downward trend,but there was no statistical significance(P>0.05).INH(P<0.05),5-HT(P<0.001),ACH(P<0.001),DA(P<0.001),EXC(P<0.001)increased in the right central region of experimental group.The activation levels of INH(P<0.01),5-HT(P<0.001),ACH(P<0.001),DA(P<0.001),NE(P<0.001)and EXC(P<0.001)were also increased in the control group.There was no significant difference between the left and right central regions.(4)Parietal region:Compared with before treatment,activation levels of INH,5-HT,ACH,DA and EXC in the left parietal region of the experimental group and the control group increased,while activation levels of NE decreased,with extremely significant statistical differences(P<0.001).The activation levels of NE(P<0.05),INH(P<0.05),DA(P<0.05)and EXC(P<0.001)in the left parietal area of the experimental group were higher than those in the control group,while the activation levels of 5-HT(P<0.001)were lower than those in the control group.There was no significant difference in the activation level of ACH between the two groups.Compared with before treatment,activation levels of INH,DA,NE and EXC in the right parietal region of the experimental group and the control group increased,with extremely significant differences(P<0.001),while activation levels of 5-HT and ACH decreased,with extremely significant differences(P<0.001).The activation level of DA in control group was higher than that in experimental group(P<0.05).(5)Occipital region:Compared with before treatment,the activation levels of INH,5-HT,DA and EXC in the left occipital region of the experimental group and the control group decreased,while the activation levels of ACH and NE increased,with extremely significant differences(P<0.001).The activation levels of INH(P<0.001),5-HT(P<0.001),DA(P<0.05)and EXC(P<0.001)in the right occipital area of the test group and the control group showed a downward trend,while the activation level of ACH increased(P<0.001),while there was no significant difference in the activation level of NE.There was no significant difference between the left and right occipital areas.(6)Temporal region:Compared with before treatment,the activation levels of INH,ACH,DA and NE in the anterior temporal region of the experimental group and the control group showed an upward trend,with significant differences(P<0.001),while the activation levels of 5-HT and EXC decreased,with extremely significant statistical differences(P<0.001).The activation levels of INH and 5-HT in the right anterior temporal region in the control group were higher than those in the experimental group.Compared with before treatment,the activation levels of INH,DA and NE in the left middle temporal region of experimental group showed an increasing trend with extremely significant differences(P<0.001),while the activation levels of 5-HT(P<0.001),ACH(P<0.05)and EXC(P<0.001)showed a decreasing trend.The activation levels of INH,ACH,DA and NE in the left middle temporal region increased in the control group,with extremely significant differences(P<0.001).The activation level of 5-HT(P<0.05)in the control group was lower than that in the experimental group,and the activation level of DA(P<0.001)was higher than that in the experimental group.The activation level of ACH(P<0.001)in the left middle temporal region showed an opposite trend in the two groups.Compared with before treatment,the activation levels of INH,ACH,DA and NE in the right middle temporal region of the experimental group and the control group showed an increasing trend,with extremely significant differences(P<0.001),while the activation levels of 5-HT and EXC were decreased,with extremely significant statistical differences(P<0.001).The activation levels of INH(P<0.05)and DA(P<0.001)in control group were lower than those in experimental group,and the activation levels of NE(P<0.01)were higher than those in experimental group.5.Efficacy and adverse reactions:The total reaction rate of the experimental group was 47.83%and the clinical cure rate was 65.22%,while the total reaction rate of the control group was 39.13%and the clinical cure rate was 56.52%,showing no statistical difference.There were no adverse reactions in the experiment,and 7 cases in the control group had adverse reactions in the second week of treatment.At week4,3 patients had adverse reactions;At week8,2 patients had adverse reactions.Adverse reactions include physical fatigue,headache,palpitations,constipation and sweating.No adverse events occurred in the two groups.Conclusions1.The overall efficacy of transcutaneous auricular vagal nerve electrical stimulation and escitalopram oxalate in the treatment of mild to moderate depressive disorder is similar,and the improvement of sleep disorders and anxiety associated with mild to moderate depressive disorder by transcutaneous auricular vagal nerve electrical stimulation is superior to escitalopram oxalate.2.Compared with escitalopram oxalate,transcutaneous auricular vagus nerve electrical stimulation is safer.3.Transcutaneous auricular vagus nerve electrical stimulation may play an anti-depressive and ameliorative role in concomitant symptoms by regulating the levels of six neurotransmitters in various brain regions,especially increasing the average level of 5-HT,parietal and middle temporal DA,and adjusting the balance of ACH and NE,EXC and INH. |
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