A preliminary study on the role of combining Chinese and Western medicine to improve adherence to depression treatment?
Depression is a chronic recurrent mental disorder characterized by persistent low mood, and many patients need to take antidepressants for a long time or even for life to maintain treatment. Adherence to medication is an effective way to prevent relapse. From the viewpoint of all antidepressants for depression, there is a latency period of 1 to 3 weeks for the onset of effect. Therefore, in the outpatient clinic, it is more important to improve the adherence to treatment for depressed patients in the “acute” stage. The author has achieved some experience in the treatment of depression by combining Chinese and Western medicine, which is reported as follows.
1. Subjects and methods
1.1 The subjects were outpatients from December 2005 to March 2006, diagnosed in accordance with the diagnostic criteria of the Chinese Classification of Mental Disorders scheme CCMD-III mood disorders (depressive episodes). 17-item Hamilton depression scale (HAMD) scores ≥18, 14 cases received antidepressant and Chinese medicine treatment, including 5 males and 9 females, aged 20-76 years, mean age ( 35.8±12) years old, duration of illness 1 to 36 months, mean (3.2±6.3) months, 4 cases of first attack, 10 cases of recurrence and relapse. There were 7 cases taking traditional Chinese medicine with LOTRO (group A) and 7 cases taking LOTRO (group B).
1.2 Methods
1.2.1 Medication method Group A applied the self-prepared “Diversify Liver, Resolve Phlegm and Nourish Heart Soup” (Chai Hu 10g, Bai Shao 10g, Han Xia 10g, Fu Ling 15g, Qing Pi 5g, Roasted Licorice 10g, Zhu Ru 10g, Hovenia 10g, Lily 30g, Huai Mai 30g, Sour Date Palm 30g, Zhi Mu 10g, Dragon Bone 30g, Oyster 30g). The ruling, together with Lotte 20mg/d; Group B, Lotte 20mg/d, was evaluated after 6 weeks of treatment.
1.2.2 Assessment tools The HAMD scale was used to assess the efficacy before treatment and at the 1st, 2nd, 3rd and 6th weeks after treatment.
1.2.3 Efficacy criteria HAMD score ≤ 7 and HAMD reduction rate ≥ 75% were considered as cure, 50% ≤ HAMD reduction rate < 75% were considered as significant, 25% ≤ HAMD reduction rate < 50% were considered as partially effective (progress), and reduction rate < 25% were considered as ineffective.
2. Results
Table 1 Comparison of the efficacy of the two groups before and after treatment and each time period
Time Group Cure (%) Apparent effect (%) Progress (%) Invalid (%)
1 Weekend Group A 0(0.00) 1(14.28) 1(14.28) 5(71.44)
Group B 0(0.00) 1(14.28) 1(14.28) 5(71.44)
2 Weekend Group A 0(0.00) 1(14.28) 2(28.57) 4(57.14)
Group B 0(13.16) 1(14.28) 1(14.28) 5(71.44)
3 weekends Group A 1(14.28) 3(42.86) 2(28.75) 1(14.28)
Group B 1(14.28) 2(28.75) 2(28.75) 1(14.28)
Weekend 6 Group A 3(42.86) 3(42.86) 1(14.28) 0(0.00)
Group B 3(42.86) 2(28.75) 2(28.75) 0(0.00)
Table 2 Comparison of the incidence of adverse reactions
Item Group A (%) (n=7 cases) Group B (%) (n=7 cases)
Dry mouth 1(14.28) 5(71.42)
Nausea and vomiting 2(28.57) 6(85.71)
Constipation 2(28.57) 4(57.14)
General discomfort 3(42.86) 3(42.86)
Insomnia 1(14.28) 1(14.28)
2.1 Comparison of the efficacy of different medication groups before and after treatment
Table 1 shows that there were 3 cases of cure, 3 cases of significant effect, 1 case of progress and 0 cases of ineffectiveness in group A at the end of 6 weeks of treatment; 3 cases of cure, 2 cases of significant effect, 2 cases of progress and 0 cases of ineffectiveness in group B at the end of 6 weeks of treatment, respectively. The total effective rate of the two groups was equal.
2.2 Comparison of the distribution of efficacy of different medication groups in each time period of treatment
Table 1 shows that there was no difference in the cure rate and efficacy rate between groups A and B at the end of the first week; the efficacy rate and cure rate of group A were better than those of group B at the second and third weeks.
2.3 Comparison of the occurrence of adverse reactions (Table 2)
The more common adverse reactions in group A and group B were dry mouth, nausea and vomiting, constipation, general discomfort, insomnia, and even sexual dysfunction. Comparison of the two groups showed that the incidence of adverse reactions was higher in group B than in group A, especially dry mouth, nausea and vomiting, constipation and other gastrointestinal symptoms were prominent.
3. Discussion
Depression patients can reach clinical cure in about 50% of patients after continuous regular antidepressant treatment. However, the antidepressants currently in use have a “characteristic” that it takes 1-3 weeks for them to take effect and improve symptoms. The structure and pharmacological receptors of different types of drugs can produce different toxic side effects, such as selective 5hydroxytryptamine reuptake inhibitors (SSRIs), which are currently used in a large number of clinical applications, have the following side effects: dry mouth, nausea and vomiting, constipation, increased behavior, insomnia, anxiety and so on. Some studies have pointed out that the side effects of antidepressants are associated with patient noncompliance, and together with many reasons such as lack of awareness of depressive disorders and slow onset of action, they are important factors for increased shedding and decreased compliance during antidepressant treatment “1”.
Although there is no name for depression in Chinese medicine, we can find many insightful discussions in classical medical texts on the symptoms of depression as described in modern psychiatry, such as “epilepsy, depression, phlegm, sleeplessness, palpitation, dizziness, and false labor”. For example, in the Su Wen? The Five Organs of Man are matched with the Five Energies to produce happiness, anger, thought, grief and fear”, and “the liver’s will is anger, the heart’s will is happiness, the spleen’s will is thought, the lung’s will is grief, and the kidney’s will is fear”. The book of “Ling Shu? It is also recorded in the book of Epilepsy that “when mania first arises, it is preceded by sorrow”, which indicates that the physicians at that time had already noticed that manic patients could have depressive manifestations during a period of time, and this may be the earliest record of the cyclic characteristics of bipolar disorder. There are many similarities between various diseases and symptoms recorded in the Treatise on Miscellaneous Diseases of Typhoid Fever and the Essentials of the Golden Horoscope and depression, such as the evidence of Xiao Chai Hu Tang: “bitter fullness in the chest and hypochondrium, silent desire not to eat and drink, distress in the heart and vomiting, or distress in the chest without vomiting, or thirst, or pain in the abdomen, or hardness under the hypochondrium, or palpitation under the heart…”; the evidence of Chai Hu plus The evidence of Chai Hu plus Dragon Bone and Oyster Soup is “fullness in the chest, annoyance and fright”. The main symptoms in the Jin Kui Yao are lily disease and dirty restlessness, which vividly depict the patient’s distressing experience of depression and anxiety with dysfunctional speech, movement and sensation. In Ming’s “Jing Yue Quan Shu? In the book of depression, it is said, “As for the depression of emotion and will, it is always from the heart, which is also sick because of depression.” It is also proposed that the three main types of depression are “anger depression, thought depression and worry depression”. In the Qing dynasty, Zhang’s medical science Volume 3? All qi door on? Depression” is proposed: “depression is mostly due to the lack of stretching of the will, and the gas is first affected by the disease, …… but more depression in women ……” and the modern study of the incidence of depression in the ratio of men to women is 1:2.
Some modern scholars conclude that: depression is due to the seven internal injuries, liver depression and qi stagnation, the first disease in the liver, and the heart and spleen, the heart and soul loss of glory, and even fire and phlegm into stasis, after a long time, from the real to the deficient, with its impact on the internal organs and the different depletion of qi and blood and yin and Yang, and the formation of heart, spleen, liver and kidney deficiency of different lesions. It is true that, as stated in “The Complete Book of Ancient and Modern Medicine? Depression is the seven emotions are not comfortable, so it becomes a depression, both depressed for a long time, change the disease many ends.” Therefore, Chinese medicine treatment for depression is mostly based on de-stressing the liver and Qi, resolving phlegm and opening up depression, nourishing the heart and spleen, and nourishing the liver and kidney. The author’s self-designed “dredging the liver, resolving phlegm and tranquilizing the heart soup”: Chai Hu, Bai Shao, Qing Pi to dredge the liver and regulate qi; the system of Han Xia, Fu Ling, Bamboo Roo, Citrus Aurantium to regulate qi and stomach, lowering rebellion and stopping vomiting; roasted licorice, Huai Mai, Lily to nourish the heart and tranquilize the mind, sweet moisten and slow down; Zhi Mu, Sour Date Palm, Dragon Bone, Oyster to clear heat and remove annoyance, sedative and tranquilize the mind, etc. plus reduction and tailoring to achieve the dredging of the liver, resolving phlegm and tranquilizing the heart The purpose is to dredge the liver, resolve phlegm, and calm the heart.
People’s spiritual and psychological activities are cultural products rooted in the country, nation, customs and geography. The theoretical understanding of TCM on “depression” has been recognized by medical practitioners, patients and their families, and the general public, both from the perspective of folk culture, local customs, and from the academic perspective. Chinese medicine treatment for depression is based on the overall regulation of the mind and body, and is characterized by the flexibility of theory and prescription. In recent years, the antidepressant pharmacodynamic studies on the formulas of Bupleurum, Huanglian, Licorice, Ginkgo biloba, Bacopa monniera, Centella asiatica, Succinic acid, Forsythia and Chai Hu plus Oyster Soup, and Semen Aconite Soup have clarified the multi-level, multi-path, and multi-target overall regulation characteristics of Chinese medicine and its compounded pharmacodynamic components from basic research. Compared with the application of antidepressants alone in the treatment of depression, TCM combined with modern medical approaches has an important impact on improving the compliance of depression treatment.
The results of this study also tentatively suggest this, but due to the small sample, statistical treatment could not be performed, and further comparative studies are needed when the sample is expanded.