Depression is one of the most prevalent and fastest-growing diseases in both western and eastern worlds. New-generation antidepressants appear more effective than older drugs; however, many drugs have side effects that can affect compliance and morbidity [1
]. From the point of view of TCM the main syndromes of depression are qi stagnation, and blood stasis, liver qi depression and transformation of fire due to qi stagnation [15
]. In China, there are several preclinical and clinical studies using Chinese herbal medicine, which are the basis for design of new therapeutic programmes for treatment of depression [15
]. In addition, acupuncture is also used in several evidence-based studies concerning this topic of research.
Although there are a great number of referenced publications (see Section 1
), there are only seven articles (including our first study on the topic [2
]) concerning depression, acupuncture, and HRV at the moment (January 2012). These publications should be discussed in context with the results of this study in the following [2
]: in 2001, Callahan [16
] stated that HRV has been shown to be a strong predictor of mortality and is adversely affected by problems such as anxiety and depression. Pignotti and Steinberg [17
] demonstrated that a lowering of subjective units of distress was in most cases also related to an improvement in HRV. In the third paper in 2001, Sakai et al. [18
] included HRV in a general concept of behavioural health services, and the authors reported HRV as a useful parameter. In 2003, Agelink et al. [19
] also undertook a study to evaluate the effects of needle acupuncture on cardiac autonomic nervous system function in patients with minor depression or anxiety disorders. In contrast to our 33 patients, the 36 patients from that group were randomly distributed into a verum acupuncture group and a placebo group. Similar to our investigations, 5-minute intervals of ECG were analyzed and the acupuncture group also showed a significant decrease of the mean resting heart rate, 5 and 15 minutes after needle application (cf. ). In the study by Agelink et al. [19
], this effect was only significant in verum acupuncture in patients with minor depression or anxiety. Therefore, a relative increase of cardiovagal modulation of heart rate and physiological regulatory effects due to acupuncture stimulation could be detected in the present study, which confirms the results of other authors [19
], although the acupuncture schemes were different (He.7 Shenmen and PC7 Neiguan [19
] versus PC5 Jianshi [2
] and GV20 Baihui (this study)).
In a further publication, Yun et al. [20
] described in 2005 the dynamic range of biologic functions. They stated that reduced variation of physical exertion, environmental stressors, and thermal gradients that characterize modern life styles may reduce the autonomic dynamic range resulting in lowered HRV and a myriad of systemic dysfunctions. Acupuncture may operate through increasing autonomic variability.
As already mentioned in the previous part (part 1) of this study [4
], a systematic clinical review on acupuncture and HRV was published by Lee et al. in 2010 [21
], which searched the literature using 14 data bases. Twelve RCTs met all inclusion criteria. Five RCTs found significant differences in HRV between patients treated with acupuncture and those treated with sham acupuncture (controls). The majority of the other RCTs showed inconsistent results [21
]. The authors stated that more rigorous research appears to be warranted. The number, size, and quality of the RCTs that are available are too low to draw firm conclusions [21
]. Another review article concerning the topic of HRV and acupuncture was published by our research group already in 2007 [12
]. In this paper, it could be demonstrated that in special syndromes like fatigue and stress one can counteract the aging process using different preventive methods like acupuncture [12
]. This was demonstrated in recent investigations concerning patients with burn-out syndrome as performed in a further teleacupuncture study between Beijing and Graz [5
The following conclusions can be drawn from the present clinical teleacupuncture study in patients with depression.
- The stimulation at the acupoint Baihui (GV20) significantly decreased HR in depression patients.
- Total HRV increased significantly during and after acupuncture stimulation at Baihui.
- We have shown that teleacupuncture at the acupoint Baihui in patients with depression shows similar effects in neurovegetative parameters like acupoint stimulation of Jianshi (PC5). In both studies ( and present study) the same technique in different patients but with the same disease was used.