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Treating Depression With Transcutaneous Electrical Cranial-auricular Acupoint Stimulation (TECAS).

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StatusRekrytering
Sponsorer
The University of Hong Kong
Samarbetare
Guang'anmen Hospital of China Academy of Chinese Medical Sciences
Beijing First Hospital of integrated Chinese and Western Medicine
The First Hospital of Hebei Medical University
Southwest Medical University, Hospital of Traditional Chinese Medicine

Nyckelord

Abstrakt

One multi-center, randomized controlled clinical trial is designed to examine whether transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) is non-inferior to the antidepressant drug (Escitalopram) in treating mild-to-moderate depression, to evaluate the depressive subtypes who are suitable for the TECAS treatment. To achieve this objective, 470 patients with mild-to-moderate depression will be recruited and assigned to receive TECAS treatment (n =235) or Escitalopram (n =235, 10-20mg/day, q.d.) for 8 weeks. The primary outcome is the Montgomery-Åsberg Depression Rating Scale (MADRS); other outcomes include the17-item Hamilton Depression Scale (HAMD-17), the Hamilton Anxiety Rating Scale (HAMA), Pittsburgh sleep quality index (PSQI), the Short Form 36 Health Survey and TCM diagnosis of depression. In addition, the safety index will be measured throughout the whole study.

Beskrivning

Depression is a common and costly disorder with high prevalence rate and high suicide rate. Antidepressants are the first-line treatments for depression. However, approximately 50% to 60% of the patients have not achieved adequate response following antidepressant treatment.

A large body of evidence well confirms that electro-acupuncture is effective in improving depression and reducing anti-depressant treatment-caused side effects, including pain, nausea, dizziness, fatigue, anxiety and sleep disturbance.

Based on the combination of ancient and modern literature and famous traditional Chinese medicine practitioners' experience, the Evidence-based Guidelines of Clinical Practice with Acupuncture and Moxibustion-Depression (ZJ/TE003-2014) recommended Baihui (DU20) and Yintang (DU29) as main acupoints in treating patients with depression via electro-acupuncture.

Our research team have completed a series of clinical trials, including electrical stimulation on cranial and auricular acupoints for treating depression, postpartum depression, post-stroke depression, and depression with somatic pain. These studies found that cranial-auricular acupoint stimulation, as well as transcutaneous electrical stimulation, can improve depressive symptoms and accompanying symptoms in patients with depression significantly.

Unlike traditional acupuncture, transcutaneous electrical stimulation does not need needles to penetrate the skin. It places electrodes on the skin of the corresponding acupoints. In this way, traumatic pain and fear of acupuncture can be avoided. And it is more easily accepted for patients and more convenient for clinical operation. Therefore, the investigators plan to build a novel transcutaneous electrical stimulation therapy--Transcutaneous electrical cranial-auricular acupoint stimulation (TECAS).

In the proposed study, a combination of transcutaneous electrical cranial and transcutaneous electrical auricular acupoint stimulation will be employed to treat patients with mild-to-moderate depression compared with antidepressant Escitalopram, to confirm the clinical effectiveness of TECAS in mild-to-moderate depression.

Datum

Senast verifierad: 11/30/2019
Först skickat: 03/27/2019
Beräknad anmälan inlämnad: 04/07/2019
Först publicerad: 04/08/2019
Senaste uppdatering skickad: 12/11/2019
Senaste uppdatering publicerad: 12/12/2019
Faktiskt startdatum för studien: 08/25/2019
Uppskattat primärt slutdatum: 12/30/2021
Beräknat slutfört datum: 12/30/2022

Tillstånd eller sjukdom

Mild-to-moderate Depression

Intervention / behandling

Procedure: TECAS

Drug: Anti-depressants

Drug: Insomnia medication

Fas

Fas 2/Fas 3

Armgrupper

ÄrmIntervention / behandling
Experimental: TECAS
Patients will receive transcutaneous electrical cranial-auricular acupoint stimulation (TECAS) daily.
Procedure: TECAS
Location: Cranial electrical stimulation acupoints: Baihui (DU20) and Yintang (DU29). Auricular electrical stimulation zone: the distribution area of auricular branch of the vagus nerve. Two electrodes electric stimulation at a frequency of 4/20 Hz will be employed on the cranial acupoints and the auricular zone respectively. The TECAS treatment will consistent of two sessions per day (30 minutes) for 8 consecutive weeks.
Active Comparator: Anti-depressants
Each subject shall receive oral administration Escitalopram (10-20mg/day, q.d.), as prescribed by a clinical psychiatrist with respect to patients' conditions for 8 consecutive weeks.
Drug: Anti-depressants
Each subject shall receive oral administration Escitalopram (10-20mg/day, q.d.), as prescribed by clinical psychiatrist with respect to patients' conditions for 8 consecutive weeks.

Urvalskriterier

Åldrar berättigade till studier 18 Years Till 18 Years
Kön som är berättigade till studierAll
Accepterar friska volontärerJa
Kriterier

Inclusion Criteria:

1. Primary diagnosis as mild to moderate depression;

2. Aged 18-70;

3. A score of MADRS ≥12 and <30 without suicide risk;

4. Participants to give consent and to cooperate with the treatment and data collection;

Exclusion Criteria:

1. Pregnant;

2. Patients with severe diseases of heart, brain, liver, kidney or hematopoietic system, patients with acute diseases, infectious diseases and malignant tumours;

3. Patients who are unable to stop taking relevant drugs as required during the trial; (any other drug or non-drug treatment that affects depressive symptoms, including Chinese medicine, western medicine, and physical therapies et al.)

4. Patients with any history of psychosis or mania;

5. Patients with cognitive disorders or personality disorders;

6. Patients with serious suicidal ideation or behaviours.

Resultat

Primära resultatåtgärder

1. Changes in the Montgomery-Åsberg Depression Rating Scale (MADRS) [Baseline, 2 week, 4 week, 8 week, 12 week]

The severity of depressive symptoms will be assessed using the Montgomery-Åsberg Depression Rating Scale. Assessments will be conducted at baseline, 2-week and once every four weeks thereafter.

Sekundära resultatåtgärder

1. Changes in the 17-item Hamilton Depression Scale (HAMD-17) [Baseline, 2 week, 4 week, 8 week, 12 week]

The severity of depressive symptoms will be also assessed using the 17-item Hamilton Depression Scale. Assessments will be conducted at baseline, 2-week and once every four weeks thereafter.

2. Changes in the Pittsburgh sleep quality index (PSQI) [Baseline, 2 week, 4 week, 8 week, 12 week]

The sleep quality will be assessed using the Pittsburgh sleep quality index. Assessments will be conducted at baseline, 2-week and once every four weeks thereafter.

3. Changes in the Hamilton Anxiety Rating Scale (HAMA) [Baseline, 2 week, 4 week, 8 week, 12 week]

The severity of anxiety symptoms will be assessed using the 17-item Hamilton Depression Scale. Assessments will be conducted at baseline, 2-week and once every four weeks thereafter.

4. Changes in the Short Form 36 Health Survey [Baseline, 2 week, 4 week, 8 week, 12 week]

The quality of life will be assessed using the Short Form 36 Health Survey. Assessments will be conducted at baseline, 2-week and once every four weeks thereafter.

5. Changes in TCM diagnosis of depression [Baseline, 2 week, 4 week, 8 week, 12 week]

TCM diagnosis will be based on the Criteria of diagnosis and therapeutic effect of diseases and syndromes in traditional Chinese medicine(ZY/T001.8-94). Assessments will be conducted at baseline, 2-week and once every four weeks thereafter.

6. Changes in blood pressure [Baseline, 8 week]

Blood pressure will be measured before and after the 8-week treatment.

7. Changes in electrocardiogram [Baseline, 8 week]

Electrocardiogram will be measured before and after the 8-week treatment.

8. Changes in respiratory rate [Baseline, 8 week]

Respiratory rate will be measured before and after the 8-week treatment.

9. Changes in pulse rate [Baseline, 8 week]

Pulse rate will be measured before and after the 8-week treatment.

10. Changes in blood routine tests [Baseline, 8 week]

Full blood routine tests will be carried out before and after the 8-week treatment.

11. Changes in liver function tests [Baseline, 8 week]

Liver function tests will be carried out before and after the 8-week treatment.

12. Changes in kidney function tests [Baseline, 8 week]

Kidney function tests will be carried out before and after the 8-week treatment.

13. Changes in Rating Scale for Side Effects (SERS) and adverse events [Baseline,1,2,3,4,5,6,7,8 weeks]

Adverse events of TECAS treatment will be assessed and would be evaluated during the whole procedure, as well as laboratory tests (whole blood counts, renal and liver functions) if needed. Side Effects of Escitalopram will be assessed and would be evaluated during the whole procedure, as well as laboratory tests (whole blood counts, renal and liver functions) if needed. All clinical adverse events will be recorded in terms of intensity (mild, moderate, or severe), duration, outcome and relationship to the study.

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