Effects of electroacupuncture on anxiety and depression in unmarried patients with polycystic ovarian syndrome: secondary analysis of a pilot randomised controlled trial

Abstract

Objective:

To evaluate the efficacy of electroacupuncture (EA) for the treatment of anxiety and depression in unmarried patients with polycystic ovarian syndrome (PCOS) by secondary analysis of a randomised controlled trial.

Methods:

A prospective pilot randomised controlled trial of unmarried women with PCOS was conducted from November 2012 to March 2016. Participants were assigned to the acupuncture group (receiving EA for 16 weeks) or the control group (receiving sham acupuncture for 16 weeks), with 27 patients in each group. The pre-specified primary outcomes and all secondary outcomes, with the exception of serum levels of neurotransmitters including norepinephrine (NE), epinephrine (AD), serotonin (5-HT) and γ-aminobutyric acid (GABA), will be reported separately. Additional outcome measures selected for this secondary analysis included anxiety and depression scale scores (Zung-SAS and Zung-SDS), 36-Item Short Form (SF-36) scale scores, PCOS Quality of Life (PCOSQOL) scale scores and Chinese Quality of Life (CHQOL) scale scores.

Results:

After the16-week intervention, an increase in serum NE and reduction in 5-HT were observed in the acupuncture group (P=0.028 and P=0.023, respectively). The serum level of GABA decreased in both groups after the interventions (both P<0.001). However, there were no significant differences between the two groups in the levels of any neurotransmitters (p>0.05). After EA treatment, SAS and SDS scores were decreased in the acupuncture group (P=0.007 and P=0.027, respectively) and were lower than those of the control group (P=0.003 and P=0.004, respectively). The SF-36 domain scores for mental health, vitality, social functioning, general health and health transition, the total CHQOL scores, and the infertility problems and body hair domains of the PCOSQOL improved significantly after EA (P<0.05).

Conclusion:

EA appears to improve symptoms of anxiety/depression and quality of life in PCOS patients and may influence serum levels of NE and 5-HT. These findings should be interpreted with caution, given the secondary nature of the outcome measures reported herein.

Trial registration number:

NCT01812161; ChiCTR-TRC-12002529

Keywords

electroacupuncture polycystic ovarian syndrome anxiety depression catecholamines

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References

Norman

Dewailly

Legro

, et al. Polycystic ovary syndrome. Lancet 2007; 370: 685–697.

Teede

Hutchison

Zoungas

, et al. Insulin resistance, the metabolic syndrome, diabetes, and cardiovascular disease risk in women with PCOS. Endocrine 2006; 30: 45–54.

Regier

Rae

Narrow

, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. Br J Psychiatry Suppl 1998; 34: 24–28.

Månsson

Holte

Landin-Wilhelmsen

, et al. Women with polycystic ovary syndrome are often depressed or anxious–a case control study. Psychoneuroendocrinology 2008; 33: 1132–1138.

Hamon

Blier

. Monoamine neurocircuitry in depression and strategies for new treatments. Prog Neuropsychopharmacol Biol Psychiatry 2013; 45: 54–63.

Root

Hoffman

Good

, et al. Norepinephrine activates dopamine D4 receptors in the rat lateral habenula. J Neurosci 2015; 35: 3460–3469.

Prabhakar

Gupta

Kanade

, et al. Diabetes-associated depression: the serotonergic system as a novel multifunctional target. Indian J Pharmacol 2015; 47: 4–10.

Goda

Otsuka

Iwamoto

, et al. Serotonin levels in the dorsal raphe nuclei of both chipmunks and mice are enhanced by long photoperiod, but brain dopamine level response to photoperiod is species-specific. Neurosci Lett 2015; 593: 95–100.

Luscher

Shen

Sahir

. The GABAergic deficit hypothesis of major depressive disorder. Mol Psychiatry 2011; 16: 383–406.

10.

Luo

Meng

Jia

, et al. Clinical research on the therapeutic effect of the electro-acupuncture treatment in patients with depression. Psychiatry Clin Neurosci 1998; 52 Suppl: S338–S340.

11.

Luo

Jia

, et al. Electro-acupuncture vs. amitriptyline in the treatment of depressive states. J Tradit Chin Med 1985; 5: 3–8.

12.

Yeung

Chung

Tso

, et al. Electroacupuncture for residual insomnia associated with major depressive disorder: a randomized controlled trial. Sleep 2011; 34: 807–815.

13.

Gronier

Letombe

Collier

, et al. [Focus on intrauterine contraception in 15 questions and answers]. Gynecol Obstet Fertil 2012; 40: 37–42.

14.

Manber

Schnyer

Allen

, et al. Acupuncture: a promising treatment for depression during pregnancy. J Affect Disord 2004; 83: 89–95.

15.

Manber

Schnyer

Lyell

, et al. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol 2010; 115: 511–520.

16.

Chung

Yeung

Zhang

, et al. Randomized non-invasive sham-controlled pilot trial of electroacupuncture for postpartum depression. J Affect Disord. 2012; 142: 115–121.

17.

Zhou

. [Therapeutic effect of acupuncture on female’s climacteric depression and its effects on DA, NE and 5-HIAA contents]. Zhongguo Zhen Jiu 2007; 27: 317–321.

18.

Liu

Pei

Zhao

, et al. Electroacupuncture pretreatment at GB20 exerts antinociceptive effects via peripheral and central serotonin mechanism in conscious migraine rats. Evid Based Complement Alternat Med 2016; 2016: 1–10.

19.

Kvorning

Akeson

. Plasma adrenaline increases in anesthetized patients given electro-acupuncture before surgery. Pain Med 2010; 11: 1126–1131.

20.

Yue

Chang

, et al. [Comparative study on effects between electroacupuncture and acupuncture for spastic paralysis after stroke]. Zhongguo Zhen Jiu 2012; 32: 582–586.

21.

Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41–47.

22.

MacPherson

Altman

Hammerschlag

, et al. STRICTA Revision Group. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med 2010; 7:e1000261.

23.

Yu Ng

, et al. Polycystic ovary syndrome is associated with negatively variable impacts on domains of health-related quality of life: evidence from a meta-analysis. Fertil Steril 2011; 96: 452–458.

24.

Deeks

Gibson-Helm

Paul

, et al. Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Hum Reprod 2011; 26: 1399–1407.

25.

Hung

Tsai

, et al. Risk of psychiatric disorders following polycystic ovary syndrome: a nationwide population-based cohort study. PLoS One 2014; 9:e97041.

26.

Scaruffi

Gambineri

Cattaneo

, et al. Personality and psychiatric disorders in women affected by polycystic ovary syndrome. Front Endocrinol 2014; 5: 1–8.

27.

Hussain

Chandel

Ganie

, et al. Prevalence of psychiatric disorders in patients with a diagnosis of polycystic ovary syndrome in Kashmir. Indian J Psychol Med 2015; 37: 66–70.

28.

Jones

Hall

Balen

, et al. Health-related quality of life measurement in women with polycystic ovary syndrome: a systematic review. Hum Reprod Update 2008; 14: 15–25.

29.

Cronin

Guyatt

Griffith

, et al. Development of a health-related quality-of-life questionnaire (PCOSQ) for women with polycystic ovary syndrome (PCOS). J Clin Endocrinol Metab 1998; 83: 1976–1987.

30.

Guyatt

Weaver

Cronin

, et al. Health-related quality of life in women with polycystic ovary syndrome, a self-administered questionnaire, was validated. J Clin Epidemiol 2004; 57: 1279–1287.

31.

Zhao

Chan

Leung

, et al. [Application of factor analysis in development and validation of a new questionnaire for quality of life]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2004; 24: 965–968.