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Nonlinear EEG analysis offers the potential for both increased diagnostic accuracy and deeper mechanistic understanding of psychopathology. EEG complexity measures have previously been shown to positively correlate with clinical depression. In this study, resting state EEG recordings were taken across multiple sessions and days with both eyes open and eyes closed conditions from a total of 306 subjects, 62 of which were in a current depressive episode, and 81 of which had a history of diagnosed depression but were not currently depressed. Three different EEG montages (mastoids, average, and Laplacian) were also computed. Higuchi fractal dimension (HFD) and sample entropy (SampEn) were calculated for each unique condition. The complexity metrics showed high internal consistency within session and high stability across days. Higher complexity was found in open-eye recordings compared to closed eyes. The predicted correlation between complexity and depression was not found. However, an unexpected sex effect was observed, in which males and females exhibited different topographic patterns of complexity., (© 2023 Society for Psychophysiological Research.)

Individuals with remitted depression are at greater risk for subsequent depression and therefore may provide a unique opportunity to understand the neurophysiological correlates underlying the risk of depression. Research has identified abnormal resting-state electroencephalography (EEG) power metrics and functional connectivity patterns associated with major depression, however little is known about these neural signatures in individuals with remitted depression. We investigate the spectral dynamics of 64-channel EEG surface power and source-estimated network connectivity during resting states in 37 individuals with depression, 56 with remitted depression, and 49 healthy adults that did not differ on age, education, and cognitive ability across theta, alpha, and beta frequencies. Average reference spectral EEG surface power analyses identified greater left and midfrontal theta in remitted depression compared to healthy adults. Using Network Based Statistics, we also demonstrate within and between network alterations in LORETA transformed EEG source-space coherence across the default mode, fronto-parietal, and salience networks where individuals with remitted depression exhibited enhanced coherence compared to those with depression, and healthy adults. This work builds upon our currently limited understanding of resting EEG connectivity in depression, and helps bridge the gap between aberrant EEG power and brain network connectivity dynamics in this disorder. Further, our unique examination of remitted depression relative to both healthy and depressed adults may be key to identifying brain-based biomarkers for those at high risk for future, or subsequent depression., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Whole-body hyperthermia (WBH) shows promise for the treatment of major depressive disorder (MDD). Because MDD is associated with increased inflammation, and anti-inflammatory agents show some promise as antidepressants, the current study sought to identify the acute and longer-term immune effects of WBH in participants with MDD and to explore whether these effects associate with the procedure's antidepressant properties. Thirty participants who met DSM-IV-TR criteria for MDD were randomized to receive a single session of WBH (n = 16) or sham treatment (n = 14). Hamilton Depression Rating Scale (HDRS) scores were assessed at baseline and 1, 2, 4, and 6 weeks post-treatment (WBH vs. sham), and plasma cytokine concentrations were assessed at baseline, immediately post-treatment, and 1 and 4 weeks post-treatment. As previously reported, WBH produced a rapid and sustained antidepressant effect. When compared to sham, WBH increased plasma interleukin (IL)-6 immediately post-treatment (time by treatment: χ 2 (3, N=108)  = 47.33, p < 0.001), while having no effect on other cytokines acutely and no impact on IL-6, or any other cytokine, at 1 or 4 weeks post treatment. In the study sample as a whole, increased IL-6 post-treatment was associated with reduced HDRS depression scores over the 6 weeks of follow-up (F (1, 102.3)  = 6.74, p = 0.01). These results suggest a hitherto unrecognized relationship between hyperthermia, the immune system, and depression, and may point to WBH as a novel modality for exploring behavioral effects of IL-6 when the cytokine is activated in isolation from the inflammatory mediators with which it frequently travels., (© 2023. The Author(s).)

While depression is a leading cause of disability, prior investigations of depression have been limited by studying correlates in isolation. A data-driven approach was applied to identify out-of-sample predictors of current depression from adults (N = 217) sampled on a continuum of no depression to clinical levels. The current study used elastic net regularized regression and predictors from sociodemographic, self-report, polygenic scores, resting electroencephalography, pupillometry, actigraphy, and cognitive tasks to classify individuals into currently depressed (MDE), psychiatric control (PC), and no current psychopathology (NP) groups, as well as predicting symptom severity and lifetime MDE. Cross-validated models explained 20.6% of the out-of-fold deviance for the classification of MDEs versus PC, 33.2% of the deviance for MDE versus NP, but -0.6% of the deviance between PC and NP. Additionally, predictors accounted for 25.7% of the out-of-fold variance in anhedonia severity, 65.7% of the variance in depression severity, and 12.9% of the deviance in lifetime depression (yes/no). Self-referent processing, anhedonia, and psychosocial functioning emerged as important differentiators of MDE and PC groups. Findings highlight the advantages of using psychiatric control groups to isolate factors specific to depression., (Copyright © 2021. Published by Elsevier B.V.)

Frontal EEG alpha asymmetry provides a promising index of depression risk, yet very little is known about the neural sources of alpha asymmetry. To identify these sources, this study examined alpha asymmetry using a distributed inverse solution: exact low resolution brain electromagnetic tomography (eLORETA). Findings implicated a generator in lateral midfrontal regions that contributed to both surface asymmetry and depression risk. Participants with any lifetime history of depressive episodes were characterized by less left than right activity in the precentral gyrus and midfrontal gyrus. Anhedonia accounted for a significant portion of the relationship between alpha asymmetry and lifetime major depressive disorder. Results are suggestive of convergence between motivational and capability models of asymmetry and replicate results from experimental studies in a large resting-state data set. The capability model of frontal alpha asymmetry is contextualized in terms of motor preparedness following emotional mobilization., (© 2017 Society for Psychophysiological Research.)

Importance: Limitations of current antidepressants highlight the need to identify novel treatments for major depressive disorder. A prior open trial found that a single session of whole-body hyperthermia (WBH) reduced depressive symptoms; however, the lack of a placebo control raises the possibility that the observed antidepressant effects resulted not from hyperthermia per se, but from nonspecific aspects of the intervention., Objective: To test whether WBH has specific antidepressant effects when compared with a sham condition and to evaluate the persistence of the antidepressant effects of a single treatment., Design, Setting, and Participants: A 6-week, randomized, double-blind study conducted between February 2013 and May 2015 at a university-based medical center comparing WBH with a sham condition. All research staff conducting screening and outcome procedures were blinded to randomization status. Of 338 individuals screened, 34 were randomized, 30 received a study intervention, and 29 provided at least 1 postintervention assessment and were included in a modified intent-to-treat efficacy analysis. Participants were medically healthy, aged 18 to 65 years, met criteria for major depressive disorder, were free of psychotropic medication use, and had a baseline 17-item Hamilton Depression Rating Scale score of 16 or greater., Interventions: A single session of active WBH vs a sham condition matched for length of WBH that mimicked all aspects of WBH except intense heat., Main Outcomes and Measures: Between-group differences in postintervention Hamilton Depression Rating Scale scores., Results: The mean (SD) age was 36.7 (15.2) years in the WBH group and 41.47 (12.54) years in the sham group. Immediately following the intervention, 10 participants (71.4%) randomized to sham treatment believed they had received WBH compared with 15 (93.8%) randomized to WBH. When compared with the sham group, the active WBH group showed significantly reduced Hamilton Depression Rating Scale scores across the 6-week postintervention study period (WBH vs sham; week 1: -6.53, 95% CI, -9.90 to -3.16, P < .001; week 2: -6.35, 95% CI, -9.95 to -2.74, P = .001; week 4: -4.50, 95% CI, -8.17 to -0.84, P = .02; and week 6: -4.27, 95% CI, -7.94 to -0.61, P = .02). These outcomes remained significant after evaluating potential moderating effects of between-group differences in baseline expectancy scores. Adverse events in both groups were generally mild., Conclusions and Relevance: Whole-body hyperthermia holds promise as a safe, rapid-acting, antidepressant modality with a prolonged therapeutic benefit., Trial Registration: clinicaltrials.gov Identifier: NCT01625546.

Depression carries serious psychosocial, physical, and economic consequences for cancer survivors. Study goals were to characterize patterns and predictors of depressive symptoms and major depressive episodes in recently diagnosed breast cancer patients. Consecutively recruited women (N = 460) completed a validated interview (CIDI) and questionnaire measure (CES-D) of depression within 4 months after invasive breast cancer diagnosis and at six additional assessments across 12 months. Outcomes were major depressive episodes, continuous symptom scores, and latent symptom trajectory classes. Across 12 months, 16.6 % of women met criteria for a major depressive episode. Unemployment predicted depressive episodes after other correlates were controlled. Distinct trajectory classes were apparent: an estimated 38 % of women had chronically elevated symptoms (High trajectory), 20 % recovered from elevated symptoms (Recovery), and 43 % had lower symptoms (Low and Very Low trajectories). Although 96 % of episodes occurred in the High or Recovery classes, 66 % of women in the High trajectory did not have an episode. Women in the Low (vs High) trajectory were more likely to be older, retired, more affluent, and have fewer comorbid diseases and briefer oncologic treatment. Women in the Recovery trajectory (vs High) were more likely to be married and more affluent and have fewer comorbid diseases. Assuming available therapeutic resources, assessment of both depressive symptoms and episodes over several months after diagnosis is important. Identification of patients at risk for persistently high depressive symptoms (e.g., younger, longer treatment course) opens targeted opportunities to prevent and promote rapid recovery from depression.

Objectives: Major depression is associated with reduced cardiac vagal control, most commonly indexed by heart rate variability. To examine the dynamics of this abnormality, we examined within-participant covariation over time between brain activity, cardiac vagal control, and depressive symptoms in depressed patients treated with sertraline and in healthy volunteers., Methods: Patients with depression and nondepressed control participants were enrolled in a 12-week protocol. After Week 0 assessment, patients began treatment with sertraline. Neural activity and vagal control were measured for all participants at Weeks 0, 2, 6, and 12 using functional magnetic resonance imaging and synchronized electrocardiographic recordings. At each of the four assessments, a moving window analysis was used to estimate vagal control as assessed by respiratory sinus arrhythmia (RSA) from the electrocardiographic data, which was then regressed onto functional magnetic resonance imaging activity., Results: At baseline, patients showed reduced blood oxygen level-dependent RSA covariation compared with controls within multiple a priori brain regions associated with vagal control, collectively described as the medial visceromotor network (MVN). Sertraline treatment led to a significant increase in brain-RSA covariation for patients compared with controls, despite a lack of improvement in mean RSA., Conclusions: These data suggest a partial normalization of MVN dysfunction in depression during sertraline treatment. Specifically, results indicate a partial recovery of MVN function. However, this recovery was insufficient to cause a significant change in RSA levels. These results may help to explain both improvements with and limitations of sertraline treatment of depression.

Objective: We tested the hypothesis that reduced rostral anterior cingulate cortex (rACC)-subcortical functional connectivity in depressed subjects might account for depression-related autonomic dysregulation., Methods: Ten healthy and ten depressed subjects categorized their immediate subjective emotional responses to picture sets while undergoing functional magnetic resonance imaging and electrocardiography. Using an rACC cluster commonly activated in both groups by emotion categorization as a seed region, we then performed voxel-wise functional connectivity analyses to examine rACC connectivity across the brain in depressed and control subjects., Results: rACC had significantly stronger connectivity with a region of the inferior pons in controls than in depressed subjects. Within-subjects differences in rACC-pons connectivity also significantly correlated with measures of both heart rate variability and depression severity., Conclusions: These findings support the hypothesis that autonomic dysregulation in depression may be associated with a functional disconnection between rACC and autonomic brainstem nuclei., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Regions of the medial visceromotor network (MVN) participate in concurrently regulating shifts in both affective state and cardiac vagal control in the attentional background, and this regulatory ability may be impaired in depression. We examined whether the relationship between changes in BOLD within MVN regions and changes in cardiac vagal control (VC) during affective state shifting changed with depression treatment. Ten depressed and ten control subjects performed an emotional counting Stroop task designed to trigger affective change in the attentional background while undergoing functional magnetic resonance imaging and concurrent electrocardiography (ECG) on four occasions: week 0 (pre-treatment) and weeks 2, 6 and 12 of treatment on sertraline. We measured the absolute value of change between adjacent emotional and neutral conditions in both VC and the BOLD signal in specific regions of the MVN. Over time consistent increases were observed in BOLD-VC magnitude correlations in depressed subjects in subgenual ACC and left DLPFC, which strongly correlated with depressive symptom improvement. Symptom improvement over time was also associated with decreases in the magnitude of both BOLD shifts and VC shifts within-subjects. This suggests that as depressive symptoms improve on sertraline, subgenual ACC and DLPFC may more efficiently regulate visceral states during affective state shifting., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The capability model of frontal electroencephalographic (EEG) asymmetry suggests that brain activity during emotional challenge will be a more powerful indicator of predispositions toward psychopathology than activity observed at rest. EEG data were assessed during a resting baseline and a facial emotion task, wherein individuals with (n = 143) and without (n = 163) lifetime major depressive disorder (MDD) made approach (angry and happy) and withdrawal (afraid and sad) facial expressions. EEG asymmetry during emotional challenge was a more powerful indicator of MDD status than resting asymmetry for average, Cz, and linked mastoid references, results in support of the capability model. However, current-source-density (CSD) transformed asymmetry was indicative of lifetime MDD status under resting and task-elicited conditions. Findings suggest that CSD-transformed data may be more robust indicators of trait frontal EEG asymmetry., (Copyright © 2014 Society for Psychophysiological Research.)

Background: Premenstrual dysphoric disorder (PMDD) is a chronic condition that significantly affects a woman's well-being on a monthly basis. Although co-occurrence of PMDD and major depressive disorder (MDD) is common, most studies examine whether women with PMDD are at risk for depression and investigations of PMDD in depressed women are scant. Therefore, the present study examined rates of PMDD in young depressed women., Methods: PMDD was assessed using a structured clinical interview (SCID-PMDD) in a sample of 164 young women with (n=85) and without (n=79) any history of depression., Results: Rates of PMDD were elevated among women with MDD in this sample. This result held true regardless of participants' MDD status (current, lifetime or past history-only symptoms of MDD) and regardless of whether all or most DSM-IV-TR PMDD criteria were met., Limitations: Sample size in the present study was relatively small, and daily diary data were not available to confirm a PMDD diagnosis., Conclusions: The current study highlights the need for clinicians to assess for PMDD in young female patients with major depression. Depressed women experiencing the added physical and psychological burden of PMDD may have a more severe disease course, and future studies will need to identify appropriate treatments for this subset of depressed women., (Published by Elsevier B.V.)

Background: Although it has been argued that frontal electroencephalographic (EEG) asymmetry at rest may be a risk marker for major depressive disorder (MDD), it is unclear whether a pattern of relatively less left than right activity characterizes depressed individuals during emotional challenges. Examination of frontal asymmetry during emotion task manipulations could provide an assessment of the function of systems relevant for MDD, and test the limits of frontal EEG asymmetry as a marker of risk for depression., Methods: EEG data were assessed during a facial emotion task, wherein 306 individuals age 18-34 (31% male) with (n=143) and without (n=163) DSM-IV defined lifetime MDD made directed facial actions of approach (angry and happy) and withdrawal (afraid and sad) expressions., Results: Lifetime depressed individuals displayed less relative left frontal activity than never-depressed individuals during all facial expressions across four EEG reference montages, findings that were not due to emotional experience, facial expression quality, electromyographic (EMG) activity, or current depression status., Limitations: Although this was a sizable sample, only one emotion task was utilized., Conclusions: Results provide further support for frontal EEG asymmetry as a risk marker for MDD., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Relatively less right parietal activity may reflect reduced arousal and signify risk for major depressive disorder (MDD). Inconsistent findings with parietal electroencephalographic (EEG) asymmetry, however, suggest issues such as anxiety comorbidity and sex differences have yet to be resolved. Resting parietal EEG asymmetry was assessed in 306 individuals (31% male) with (n=143) and without (n=163) a DSM-IV diagnosis of lifetime MDD and no comorbid anxiety disorders. Past MDD+ women displayed relatively less right parietal activity than current MDD+ and MDD- women, replicating prior work. Recent caffeine intake, an index of arousal, moderated the relationship between depression and EEG asymmetry for women and men. Findings suggest that sex differences and arousal should be examined in studies of depression and regional brain activity., (Copyright © 2010 Society for Psychophysiological Research.)

Background: Pre-menstrual dysphoric disorder (PMDD), a dysphoric form of pre-menstrual syndrome, is included as a diagnosis for further study in the DSM-IV-TR (APA, 2000). The present study investigated whether a marker of risk for major depressive disorder (MDD), prefrontal brain asymmetry, also characterizes women with PMDD., Methods: In a sample of 25 college women with PMDD symptomatology and 25 matched controls, resting frontal electroencephalographic (EEG) activity was assessed on four occasions within a two-week span., Results: Across several frontal sites women with PMDD had relatively less left than right prefrontal brain activity, consistent with a diathesis-stress model for menstrual-related dysphoria., Conclusions: The findings suggest an overlap in the risk profile for MDD and PMDD., (Published by Elsevier B.V.)

Resting frontal electroencephalographic (EEG) asymmetry has been hypothesized as a marker of risk for major depressive disorder (MDD), but the extant literature is based predominately on female samples. Resting frontal asymmetry was assessed on 4 occasions within a 2-week period in 306 individuals aged 18-34 (31% male) with (n = 143) and without (n = 163) lifetime MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994). Lifetime MDD was linked to relatively less left frontal activity for both sexes using a current source density (CSD) reference, findings that were not accounted for solely by current MDD status or current depression severity, suggesting that CSD-referenced EEG asymmetry is a possible endophenotype for depression. In contrast, results for average and linked mastoid references were less consistent but demonstrated a link between less left frontal activity and current depression severity in women., (Copyright 2010 APA, all rights reserved)

Objective: To estimate the efficacy of acupuncture for depression during pregnancy in a randomized controlled trial., Methods: A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Junior acupuncturists, who were not told about treatment assignment, needled participants at points prescribed by senior acupuncturists. All treatments were standardized. The primary outcome was the Hamilton Rating Scale for Depression, administered by masked raters at baseline and after 4 and 8 weeks of treatment. Continuous data were analyzed using mixed effects models and by intent to treat., Results: Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity (P<.05) compared with the combined controls (Cohen's d=0.39, 95% confidence interval [CI] 0.01-0.77) or control acupuncture alone (P<.05; Cohen's d=0.46, 95% CI 0.01-0.92). They also had significantly greater response rate (63.0%) than the combined controls (44.3%; P<.05; number needed to treat, 5.3; 95% CI 2.8-75.0) and control acupuncture alone (37.5%; P<.05: number needed to treat, 3.9; 95% CI 2.2-19.8). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%)., Conclusion: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy., Clinical Trial Registration: Clinicaltrials.gov, www.clinicaltrials.gov, NCT00186654.

Sleep disturbances are among the most common and debilitating aspects of major depressive disorder. In a sample of unmedicated adults experiencing a current depressive episode (N participants = 99, N data points = 428), the authors examined the longitudinal dynamics of sleep disturbances and mood symptoms across a 17-week acupuncture treatment study using latent difference score structural equation modeling. Results indicated that changes in sleep and mood disturbances could be characterized as a single bivariate system where low levels of mood symptoms lead to increases in sleep disturbances, whereas high levels of sleep disturbance exert a dampening effect on mood symptoms. Movement of the bivariate system toward or away from better outcomes depended on the precise combination of sleep-mood symptoms; without knowing the state and trajectory of both variables, predicting change in either sleep or mood symptoms was limited. The results have implications for better understanding the complexity and reciprocity of sleep-mood associations, as well as the dynamic, time-based predictors of depressive treatment response.

Background and Aims: Epidemiological data on the prevalence of mood disorders demonstrate that major depressive disorder (MDD) is approximately twice as common in women as in men and that its first onset peaks during the reproductive years. We aimed to review key social, psychological, and biological factors that seem strongly implicated in the etiology of major depression and to focus on sex-specific aspects of depression, such as the role of a woman's reproductive life cycle in depressive symptomatology., Methods: A review of the literature, from 1965 to present, was conducted., Results: An integrated etiological model best explains gender and sex differences in depression. Social, psychological, and biological variables must be simultaneously taken into account. These vulnerabilities include (but are not limited to) gender-specific roles in society, life stress such as trauma, a tendency toward ruminative coping strategies, and the effects of sex hormones and genetic factors., Conclusions: To effectively treat MDD in women and to prevent the recurrence of illness in vulnerable women, clinicians must understand the sex-specific aspects of mood disorders over the longitudinal course of women's reproductive lives. A biopsychosocial approach should, therefore, be the main focus of future research and practice, to eventually result in an integrated etiological model of depression in women. Based on the prevalence of MDD in women, timely screening, diagnosis, and intervention should be public health priorities.

Background: Impaired cardiac vagal control (CVC), as indexed by respiratory sinus arrhythmia, has been investigated as a risk factor for major depressive disorder (MDD), but prior findings are mixed with respect to whether impaired CVC predicts greater global depression severity and/or a more severe course of disorder. One possible explanation for mixed findings is that CVC abnormalities in MDD are related more closely to specific depression symptoms than to the syndrome as a whole., Methods: Depression severity (both global and symptom-specific indices) and electrocardiogram measures of resting CVC were obtained from 151 diagnosed MDD participants at intake, before randomization to a novel treatment for depression (acupuncture), and again after 8 and 16 weeks., Results: Resting CVC did not predict global indices of depression in cross-sectional or longitudinal analyses. In symptom-specific analyses, resting CVC was positively related to sad mood and crying and inversely related to middle and late insomnia. Improvement in late insomnia was related to increases in CVC over time., Limitations: Relationships between CVC and MDD were studied only within the clinical range of severity. Symptom analyses were exploratory and hence did not correct for Type I error., Conclusions: Resting CVC did not exhibit concurrent or prospective relations with overall depression severity but a few specific symptoms did. Symptomatic heterogeneity across samples may account for mixed findings within the CVC-depression literature.

Previous studies suggest depression is a risk factor for all cause mortality, with depressed men at greater risk than depressed women. Diminished cardiac vagal control (CVC) in depressed patients has also been found to increase risk of cardiac mortality. Previous research found that depressed women have higher CVC than depressed men suggesting CVC might be related to the discrepancy in mortality rates between depressed men and women. This finding, however, was in the context of a study with several methodological weaknesses. The current study sought to replicate the sex difference in CVC in a sample of 137 medically healthy and clinically diagnosed depressed patients. Main effects of sex and age significantly predicted CVC such that depressed women had greater CVC and CVC decreased with age in the cross-sectional sample. The results suggest greater CVC in depressed women might confer cardioprotective functions, which may partially explain the sex difference in mortality rates in the depressed population.

Objective: To assess the efficacy of acupuncture as an intervention for major depressive disorder (MDD)., Method: Acupuncture was examined in 151 patients with MDD (DSM-IV) who were randomly assigned to 1 of 3 groups in a double-blind randomized controlled trial. The specific intervention involved Traditional Chinese Medicine (TCM)-style acupuncture with manual stimulation for depression; the control conditions consisted of (1) a nonspecific intervention using a comparable number of legitimate acupuncture points not specifically targeted to depressive symptoms and (2) a waitlist condition, which involved waiting without intervention for 8 weeks. After 8 weeks, all patients received the depression-specific acupuncture. Each 8-week intervention regimen consisted of 12 acupuncture sessions delivered in an acupuncturist's office in the community. The primary outcome measure was the 17-item Hamilton Rating Scale for Depression. The study was conducted from February 1998 to April 2002., Results: Twenty patients terminated treatment before the completion of the 8-week intervention (13%) but not differentially by study group. Random regression models of the intent-to-treat sample revealed that although patients receiving acupuncture improved more than those awaiting intervention, no evidence of differential efficacy of the depression-specific over nonspecific intervention was found. Response rates in acupuncture-treated patients were relatively low after 8 weeks (22% and 39% for specific and nonspecific intervention groups, respectively), with the response rate after the entire 16-week trial reaching 50%., Conclusion: Although TCM manual acupuncture is a well-tolerated intervention, results fail to support its efficacy as a monotherapy for MDD. It can't be ruled out that factors unique to the implementation of acupuncture in this research study may have limited the efficacy of interventions compared to those provided in naturalistic settings., Clinical Trials Registration: ClinicalTrials.gov identifier NCT00010517.

Background: Few medically acceptable treatments for depression during pregnancy are available. The aim of this randomized controlled pilot study was to determine whether acupuncture holds promise as a treatment for depression during pregnancy., Methods: Sixty-one pregnant women with major depressive disorder and a 17-item Hamilton Rating Scale for Depression (HRSD17) score >or=14 were randomly assigned to one of three treatments, delivered over 8 weeks: an active acupuncture (SPEC, N=20), an active control acupuncture (NSPEC, N=21), and massage (MSSG, N=20). Acupuncture treatments were standardized, but individually tailored, and were provided in a double-blind fashion. Responders to acute phase treatment (HRSD17 score<14 and >or=50% reduction from baseline) continued the treatment they were initially randomized to until 10 weeks postpartum., Results: Response rates at the end of the acute phase were statistically significantly higher for SPEC (69%) than for MSSG (32%), with an intermediate NSPEC response rate (47%). The SPEC group also exhibited a significantly higher average rate of reduction in BDI scores from baseline to the end of the first month of treatment than the MSSG group. Responders to the acute phase of all treatments combined had significantly lower depression scores at 10 weeks postpartum than nonresponders., Limitations: Generalizability is limited by the small sample and its relative homogeneity., Conclusion: Acupuncture holds promise for the treatment of depression during pregnancy.

Increased vagal tone has been associated with treatment success using pharmacological agents and cognitive-behavioral treatment in major depression, but not using electroconvulsive therapy. The present study investigated whether increases in vagal tone would be associated with favorable treatment response with nonpharmacological treatment. At baseline and following treatment, 16 subjects were administered the Hamilton Rating Scale for Depression (HRSD) followed by electrocardiographic recording. Those with little change in vagal tone from before to after treatment showed minimal reduction in HRSD score (-4.8); those with larger vagal tone change showed a large decrease in HRSD score (-14.8). Changes in vagal tone are thus related to favorable treatment response in depression, and do not represent anticholinergic pharmacological effects. Future work manipulating vagal tone might prove informative in teasing apart the causal role of vagal tone and depression.