Abdominal acupuncture added to tDCS improves post-stroke depression in randomized trial

OBJECTIVE: To explore the clinical efficacy of abdominal acupuncture in combination with transcranial direct current stimulation on post-stroke depression (PSD) and the influence on the levels of autophagy-related proteins based on the brain-gut axis theory. METHODS: A total of 126 PSD patients were randomly assigned to an observation group and a control group, with 63 patients in each one. After propensity score matching (PSM) at a ratio of 1 to 1, 45 patients from each group were selected for final analysis. The routine treatment for stroke was administered in each group. Additionally, the patients in the control group underwent transcranial direct current stimulation, while in the observation group, besides the treatment as the control group, abdominal acupuncture was delivered at Zhongwan (CV12), Xiawan (CV10), Guanyuan (CV4), etc. Intervention in each group was administered once daily, 5 times per week, for 4 weeks. Before treatment, and in 2 and 4 weeks of treatment, separately, the scores of Hamilton depression scale (HAMD), National Institutes of Health stroke scale (NIHSS), activities of daily living scale (ADL), Pittsburgh sleep quality index (PSQI), and TCM syndromes were compared between the two groups; the serum levels of brain-gut peptides such as 5-hydroxytryptamine (5-HT), gastrin (GAS), neuropeptide Y (NPY), substance P (SP), and calcitonin gene-related peptide (CGRP) were detected, as well as the serum levels of autophagy-related proteins such as microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ), Beclin1, and sequestosome 1 (SQSTM1/p62) in the two groups. After treatment completion, the clinical efficacy was observed in each group. Using linear regression, the correlations were analyzed among brain-gut peptide levels, the score of each scale and the levels of autophagy-related proteins. RESULTS: In 2 and 4 weeks of treatment, both groups exhibited the decrease in the scores of HAMD, NIHSS, PSQI and TCM syndromes, the serum levels of SP and CGRP, and the serum levels of LC3-Ⅱ and Beclin1 compared to before treatment (<0.05). In 4 weeks of treatment, these indexes were lower than those in 2 weeks of treatment (<0.05); the observation group demonstrated lower levels of the above indexes compared with the control group at the same time point (<0.05). In 2 and 4 weeks of treatment, ADL scores, the serum levels of 5-HT, GAS, NPY and p62 increased in comparison with before treatment in both groups (<0.05), and these indexes were elevated in 4 weeks of treatment when compared with those in 2 weeks of treatment (<0.05); and the indexes in the observation group were superior to those in the control group (<0.05). The total effective rate in the observation group was 91.1% (41/45), higher than that in the control group (73.3% [33/45], <0.05). The scores of HAMD, NIHSS, PSQI and TCM syndromes, and the levels of LC3-Ⅱ and Beclin1 were negatively correlated with the levels of 5-HT, GAS, and NPY (<0.01, <0.001) and positively correlated with the levels of SP and CGRP (<0.001, <0.01). ADL score and p62 level were positively correlated with the levels of 5-HT, GAS, and NPY (<0.001, <0.01), and negatively correlated with the levels of SP and CGRP (<0.01, <0.001). CONCLUSION: Abdominal acupuncture combined with transcranial direct current stimulation can effectively alleviate the depressive symptoms of PSD patients. Its effect may be related to the regulation of brain-gut peptide levels and the expression of autophagy-related proteins.