Group mean

表六、Beck Depression Inventory scores：mean change from baseline to endpoint comparison P.S. 以 ANCOVA 方式分析兩組在第八週時的 mean change from baseline to endpoint 的差異,將 BDI

baseline score 當共變數,得到 F(1,26)=5.367, p=0.029

表七、針刺對憂鬱症患者 Pittsburgh Sleep Quality Index 之效應

PSQI baseline,mean, SE 29.20 ,3.14 33.07 ,2.23 P=0.32

at wk1, mean, SE

27.13 ,2.89 33.80 ,1.92 P=0.07

表八、Pittsburgh Sleep Quality Index：mean change from baseline to endpoint comparison baseline score 當共變數,得到 F(1,26)=4.043, p=0.055; 再以 ANCONA 方式分析兩組的 mean change

from baseline to endpoint at week 7 的差異,將 PSS baseline score 當共變數,得到 F(1,26)=8.653, p=0.007

表九、Responder analysis according HAMD-17 reduction and CGI-I

假針刺組針刺組

No or low improvement

(CGI-I>=3 or HAMD reduction <50%)

N=12 ( 80% )

N=9 ( 60% )

Medium or high improvement

(CGI=1,2 or HAMD reduction >=50%

N=3 ( 20% )

N=6 ( 40% )

χ²=1.429, df=1, p=0.427

表十、針刺對 Quality of life (SF-36)之效應

針刺組 (n=15)

假針刺組 (n=15)

P-value

Physical functioning 59.0 ± 8.0 54.0 ± 7.7 0.657

Role physical 23.3 ± 9.6 18.3 ± 8.9 0.706

Bodily pain 41.9 ± 7.1 38.7 ± 5.0 0.711

General health perceptions 33.7 ± 4.7 27.5 ± 4.3 0.333

Vitality 33.0 ± 4.6 23.7 ± 4.7 0.168

Social functioning 36.7 ± 6.8 33.3 ± 4.3 0.684

Role emotional 24.4 ± 10.0 11.1 ± 7.7 0.301

Mental health 32.0 ± 4.1 29.6 ± 4.4 0.694

Physical Component Score 38.3 ± 2.9 36.6 ± 2.7 0.668 Mental Component Score 28.5 ± 2.2 25.5 ± 1.9 0.317

Mean ± SE

表十一、Summary of Repeated-measure ANOVA for each component of SF-36

ANOVA

SF-36 Group factor Time factor Interaction Physical functioning F(1,28)=0.156

P=0.696

F(2,56)=0.061 P=0.941

F(2,56)=0.046 P=0.955 Role physical F(1,28)=0.419

P=0.523

F(2,56)=0.71 P=0.496

F(2,56)=0.783 P=0.462 Bodily pain F(1,28)=4.002

P=0.055 Vitality F(1,28)=8.606

P=0.007

F(2,56)=3.639 P=0.033

F(2,56)=2.442 P=0.096 Social functioning F(1,28)=2.183

P=0.151

F(2,56)=2.072 P=0.135

F(2,56)=1.600 P=0.211 Role emotional F(1,28)=1.309

P=0.262

F(2,56)=3.944 P=0.031

F(2,56)=0.000 P=1.0

Mental health F(1,28)=8.199 P=0.008

表十二、針刺對 Secondary outcomes 之效應: 2-month mean changes from baseline to endpoint comparison

針刺組 (n=15)

假針刺組 (n=15)

p-value

Bodily pain 20.4 ± 4.3 0.7 ± 3.8 .016

General health perceptions 13.2 ± 5.1 2.5 ± 5.5 .044

Vitality 16.3 ± 5.3 1.7 ± 5.5 .003

Mental health 14.4 ± 6.4 -4.0 ± 6.4 .002

Mental Component Score 6.34 ± 2.0 -0.9 ± 2.4 .002

Mean ± SE

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附錄

英文摘要

Background: Depression is one of the most common mental health disorder.

Up to 60% of patients do not gain full remission following a standard antidepressant treatment. Many patients only achieve partial response (e.g., 25%-49% reduction in symptoms) or continue to experience residual

symptoms. This is of significant concern, as patients with residual symptoms have reduced functioning and a worse prognosis than those who achieve remission. There is still a need to improve the treatment of depression. A wide range of different augmentation and combination strategies are available, but most of them have dissatisfied adverse effects. There is a preference for patients with depression to seek other therapy, particularly use of complementary therapies. Acupuncture is a popular complementary and alternative medicine intervention suggested in the treatment of depression, but its efficacy is uncertain. We conducted a randomized single-blind placebo-controlled study to investigate the efficacy of acupuncture

additionally applied to standard antidepressant therapy in major depression.

Methods: We randomly included 30 inpatients with a major depressive episode in two different treatment groups: verum acupuncture and sham acupuncture group. Both groups were pharmacologically treated with one kind of freely selected standard antidepressant therapy. The verum group received acupuncture at specific points considered effective in the treatment of depression in addition to standard antidepressant therapy. Needle

sensation of De Qi was required. The placebo sham group was treated in addition to standard antidepressant therapy with acupuncture at the same acupoints, inserted superficially, and needle sensation of De Qi was

prohibited. Acupuncture was applied twice a week over a period of 8 weeks.

Primary outcome measures were 17-item Hamilton Rating Scale for Depression (HAMD-17), Beck Depression Inventory(BDI), and Clinical Global Impressions-Improvement (CGI-I). Secondary outcome measures were Pittsburgh Sleep Quality Index (PSS) and health status of SF-36. All

these scales were rated by an independent rater blind to verum/placebo conditions weekly over 8 weeks. Results: 3 of 15 pateints in placebo sham group and none of 15 pateints in verum group terminated before the

completion of 8-week intervention. At the end of treatment period, verum acupuncture improved slightly more than placebo acupuncture not only in HAMD-17( p=0.043), BDI( p=0.029) and CGI-I( p=0.007) scores, but also in the following five components of SF-36: bodily pain( p=0.016), general health perceptions( p=0.044), vitality (p=0.003), mental health (p=0.002), and mental component scores (p=0.002). Conclusion: Acupuncture additionally applied to conventional standard antidepressant therapy has extra clinical benefits. It is worth further clinical trails of larger scale and stricter methodology because acupuncture augmentation causes less adverse effects and is more acceptable.

Keyword: acupuncture, major depression

謝辭

兩年的時間匆匆，往返於高雄和台中兩地，感謝研究所教授過所有課程的老師們，感謝我的指導教授謝慶良教授，總是一直不斷的鞭策我追上研究進度和給予我最適時且畫龍點睛的指導，感謝李采娟教授協助 SF-36 量表的數值轉化，也要感謝慈惠醫院提供我在職進修的機會，尤其是院長文榮光教授和副院長吳景寬醫師的支持，和院內同仁張義宗醫師、張志華醫師、劉育林醫師的協助轉介個案，以及個案管理師曾于君、

陳月香、張淑萍、謝金梅護理師的協助整理資料，當然更要感謝我的愛人陳雅雯的大力支持，在民國九十六年九月七日，適逢長子鍾念澄出

在文檔中針刺治療運用在憂鬱症患者的臨床效益; The Benefit from Whole Body Acupuncture in Major Depression (頁 55-76)