The Neuroscience of Nonpharmacological Traditional Chinese Therapy (NTCT) for Major Depressive Disorder: A Systematic Review and Meta-Analysis

Table 1

Characteristics of included studies.

Source	Study design	No. of participants	Intervention group	Treatment duration	Control group	Treatment duration	Depression diagnostic criteria	Assessment
Song et al., 2007	CCT	120	N=30; Acupuncture + Fluoxetine	Acupuncture 45min/; Weekday, 6w	Con1 (n=30): fluoxetine; Con2 (n=30): Sham acupuncture + placebo; Con3 (n=30): No intervention (health control)	Con1: daily, 6w; Con2: daily, 6w	DSM-IV	HAMD; G protein in platelets; Gαs 45; Gαi; Gαq
Tsang et al, 2013	RCT	38	N=21,; Eight Section Broads	Eight Section Broads; 45min/ session, 3 times/w, 12w	Con (n=17): Newspaper reading	45min/ session, 3 times/w, 12w	DSM-IV	GDS; HRSD; 5-HT; Cortisol; (salivary)
Lian et al, 2017	CCT	96	N=48; Acupuncture + Chinese herbs	Acupuncture: 4-5 times/w + Chinese herbs daily, 6w	Con (n=48): Western medicine	daily, 6w	CCMD-3	HAMD; 5-HT
Lavretsky et al, 2011	RCT	73	N=36; Tai chi + Escitalopram	Tai chi 2hrs/weekly + 10mg/daily, intensity gradually increased, 10w	Con (n=37): Health education + Escitalopram	2 hrs/weekly + 10mg/daily, intensity gradually increased, 10w	DSM-IV	HRSD; CRP
Chan et al, 2013	RCT	50	N=17; DMBI+ medication,	DMBI; 90min/session, weekly, 10 sessions	Con1 (n=17): CBT+ medication,; Con2(n=16): Medication	Con1: 90min/session, weekly, 10 sessions; Con2: daily	DSM-IV	PDS via BDI-II; EEG (frontal α asymmetry); Hemispheric θ coherence (inter/intra)
Song et al, 2009	CCT	125	N=31; Electro-acupuncture + placebo capsules	Acupuncture 45min/session, 3 times/w +; 20mg/daily, 6 w	Con1(n=32): Fluoxetine + sham electro-acupuncture; Con2 (n=32): sham electro-acupuncture + placebo capsules; Con3 (n=30): No intervention (health control)	Con1: 20mg/daily +Acupuncture 45min/session, 3 times/w, 6w; Con2: Acupuncture 3 times/w + 20mg/daily, 6w	DSM-IV	HRSD; IL-lß; TNF-a; IFN-λ; IL-4; IL-10
Vazquez et al, 2011	RCT	42	N=23; Electro-acupuncture with low frequency (4Hz)	Acupuncture; 30min/session, twice/w, 6 w	Con (n=19): Sham electro-acupuncture with low frequency (4Hz); Non-therapeutic point	30min/session, twice/w, 6 w	DSM-IV	CRS; SCL-90; Cortisol; (salivary)
Wang et al, 2016	RCT	36	N=18; Acupuncture + fluoxetine	Acupuncture; 20min/session for first 3 days, 3 days/session for the rest of 8w, +20mg/daily, 8 w	Con (n=18): Sham acupuncture + fluoxetine; The same acupoints (no needle inserted)	20min/session for first 3 days, 3 days/session for the rest of 8 weeks, +20mg/daily, 8w	ICD-10	MADRS; SDS; fMRI; rsFC
Wang et al, 2017	RCT	36	N=18; Acupuncture + fluoxetine	Acupuncture 20min/session for first 3 days, 3 days/session for the rest of 8w, +20mg/daily, 8 w	Con (n=18): Sham acupuncture + fluoxetine; The same acupoints (no needle inserted)	20min/session for first 3 days, 3 days/session for the rest of 8w, +20mg/daily, 8w	ICD-10	MADRS; SDS; fMRI; rsFC
Liu et al, 2015	RCT	120	N=60; Acupuncture + medication	Acupuncture 30min/session, alternate day, + 20-50mg, 1-2 times/daily, intensity gradually increased, 6w	Con (n=60): Medication	20-50mg, 1-2 times/daily, intensity gradually increased, 6w	ICD-10	MADRS; 5-HT; IL-lß; IL -6; IL-4; IL-10
Zhu et al, 2018	RCT	65	N=33; Acupuncture + SSRIs	Acupuncture 30min/session, 5 times/w + daily SSRIs, 6w	Con (n=32): Western medicine	daily, 6w	CCMD-3	HAMD; HRV; SDNN; HF; LF
Zhu et al, 2017	RCT	61	N=30; Acupuncture +SSRIs	Acupuncture 30min/session, 5 times/w + daily SSRIs, 6w	Con (n=31): Western medicine	daily, 6w	CCMD-3	HAMD; IL-6; TNF-α

Abbreviations. Con: control group; SSRI: selective serotonin reuptake inhibitors; HAMD: Hamilton depression rating scale; GDS: geriatric depression scale; HRSD: Hamilton rating scale for depression; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th version; CCMD: Chinese Classification of Mental Disorders; ICD-10: the International Classification of Diseases, 10th revision; CRP: C reactive protein; 5-HT: serotonin; MADRS: Montgomery-Asberg depression rating scale; SDS: self-rating depression scale; IL: interleukin; TNF-α: tumor necrosis factor-α; IFN-λ: interferon-λ; rsFC: resting-state functional connectivity; fMRI: functional magnetic resonance imaging; DMBI: Dejian mind-body intervention; CBT: cognitive behavioral therapy; PDS: percentage of subjects reducing depressive syndrome; CRS: the Carroll rating scale; SCL-90: psychiatric symptom checklist; HRV: heart rate variability; SDNN: standard deviation of normal to normal R-R intervals; HF: high frequency; LF: low frequency.