Acupuncture effects on emotional reactivity of youth with self-reported depressive symptoms

Abstract

Background: Emotional symptomatology is a hallmark of depression. Antidepressant often fail to effectively target emotional blunting, while acupuncture, by contrast, has emerged as a promising alternative. However, the exact electrophysiologic mechanisms remain unclear. This study aimed to investigate how acupuncture influences emotional reactivity in youth with self-reported depressive symptoms.

Methods: A modified oddball paradigm incorporating a negative emotional valence deviant, combined with event-related potential analysis, was used to measure emotional reactivity before and after intervention. Seventy individuals exhibiting depressive symptoms in the previous 2 weeks, were randomly assigned to either a verum or sham acupuncture group. Electroencephalogram data from 59 participants were analyzed following preprocessing and quality assessment. Occipital P1, N170, frontal N1, N2, and parietal P3 components were extracted. The Positive and Negative Affect Schedule (PANAS) was completed after each oddball session. The Massachusetts General Hospital Acupuncture Sensation Scale (MASS) was completed after each intervention session.

Results: The MASS Index was significantly higher in the verum group. However, significant increases in occipital P1, N170, frontal N1, N2, and parietal P3 amplitudes for high-negative, mild-negative, and neutral pictures were observed after the intervention in both the verum and sham groups, with no significant difference between the groups. Additionally, both groups induced PANAS changes, and positive effect changes were significantly correlated with N170 and P1 (in response to high-negative pictures) changes in the sham group.

Conclusion: Acupuncture altered emotional reactivity in youth with depressive symptoms, highlighting its potential role, albeit possibly non-specific, in depression prevention and treatment.

Keywords

depression / emotional reactivity / ERP / oddball / non-specific effect

Author contributions

W.Q. conceived the research; W.Q. and F.W.B. designed the research; W.Q., L.D.H., W.X.Y., and W.S.Z. collected the data; W.Q. and L.D.H. analyzed the data; W.Q., L.D.H., D.F., and Y.J.J. were involved in the discussion and writing of the manuscript; Y.J.J., F.W.B., and W.Q. were responsible for project supervision and funding acquisition. All authors commented on and edited the manuscript and approved the final version of the manuscript.

Conflict of interest

The authors declare no competing financial interests.

Acknowledgments

This work was supported by National Natural Science Foundation of China (81804199, 82074522, 31971018 & U23A20507), Research Fund for Zhaoyang Talents of Guangdong Provincial Hospital of Chinese Medicine (ZY2022KY14), Research Fund of Guangdong Provincial Hospital of Chinese Medicine (YN2023MS25), Key-Area Research and Development Program of Guangdong Province (2020B1111100007), Shenzhen Bao'an Research Center for Acupuncture and Moxibustion (BAZJ2018239), and Sichuan Outstanding Young Scholar Foundation (2023NSFSC1938).

Data availability

The data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

[1] Armour M, Smith C, Wang L-Q, et al. (2019) Acupuncture for depression: a systematic review and meta-analysis. JCM. 8:1140.

[2] Arroll B, Macgillivray S, Ogston S, et al. (2005) Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Ann Family Med. 3:449-56.

[3] Bahm NIG, Simon-Thomas ER, Main M, et al. (2017) Unresolved loss, a risk factor for offspring, predicts event-related potential responses to death-related imagery. Dev Psychol. 53:191-9.

[4] Bai L, Ma H, Huang YX, et al. (2005) The development of native Chinese affective picture system-A pretest in 46 college students. Chinese Mental Health Journal. 19:719-22.

[5] Brown JVE, Walton N, Meader N, et al. (2019) Pharmacy-based management for depression in adults. Cochrane Database of Systematic Reviews. 2019:CD013299.

[6] Buysse DJ, Reynolds CF, Monk TH, et al. (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 28:193-213.

[7] Bylsma LM (2021) Emotion context insensitivity in depression: toward an integrated and contextualized approach. Psychophysiology. 58:e13715.

[8] Bylsma LM, Mauss IB, Rottenberg J (2016) Is the divide a chasm?: bridging affective science with clinical practice. J Psychopathol Behav Assess. 38:42-7.

[9] Carretié L, Hinojosa JA, Martín‐Loeches M, et al. (2004) Automatic attention to emotional stimuli: neural correlates. Hum Brain Mapp. 22:290-9.

[10] Chae Y, Lee YS, Enck P (2018) How placebo needles differ from placebo pills?. Front Psychiatry. 9:243.

[11] Chae Y, Olausson H (2017) The role of touch in acupuncture treatment. Acupunct Med. 35:148-52.

[12] Chang H, Shi B, Ge H, et al. (2023) Acupuncture improves the emotion domain and lipid profiles in women with polycystic ovarian syndrome: a secondary analysis of a randomized clinical trial. Front Endocrinol. 14:1237260.

[13] Chen X, Li S. (2023) Negative bias in early and late cognitive processing of coronary heart disease patients with depressive symptoms: an EPR study. BMC Psychiatry. 23:576.

[14] Clayson PE, Clawson A, Larson MJ (2012) The effects of induced state negative affect on performance monitoring processes. Soc Cognit Affect Neurosci. 7:677-88.

[15] Correia ÉM, Monteiro D, Bento T, et al. (2024) Analysis of the effect of different physical exercise protocols on depression in adults: systematic review and meta-analysis of randomized controlled trials. Sports Health: A Multidisciplinary Approach. 16:285-94.

[16] Cuijpers P, Noma H, Karyotaki E, et al. (2020) A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 19:92-107.

[17] Dai Q, Feng Z (2011) Deficient interference inhibition for negative stimuli in depression: an event-related potential study. Clin Neurophysiol. 122:52-61.

[18] Delaney HD, Maxwell SE (1981) On using analysis of covariance in repeated measures designs. Multivariate Behav Res. 16:105-23.

[19] Dell'acqua C, Palomba D, Patron E, et al. (2023) Rethinking the risk for depression using the RDoC: a psychophysiological perspective. Front Psychol. 14:1108275.

[20] Delorme A, Sejnowski T, Makeig S (2007) Enhanced detection of artifacts in EEG data using higher-order statistics and independent component analysis. Neuroimage. 34:1443-9.

[21] Delplanque S, Silvert L, Hot P, et al. (2005) Event-related P3a and P3b in response to unpredictable emotional stimuli. Biol Psychol. 68:107-20.

[22] Deng Y, Huang S, Dong D, et al. (2024) Effects of Shugan Tiaoshen intradermal needling intervention on attentional networks in subthreshold depression: a randomized controlled trial. Zhongguo Zhen Jiu = Chinese Acupuncture & Moxibustion. 44:773-8.

[23] Dichter GS, Tomarken AJ, Shelton RC, et al. (2004) Early- and late-onset startle modulation in unipolar depression. Psychophysiology. 41:433-40.

[24] Elliott R, Rubinsztein JS, Sahakian BJ, et al. (2002) The neural basis of mood-congruent processing biases in depression. Arch Gen Psychiatry. 59:597-604.

[25] Fang J, Jin Z, Wang Y, et al. (2009) The salient characteristics of the central effects of acupuncture needling: limbic-paralimbic-neocortical network modulation. Hum Brain Mapp. 30:1196-206.

[26] Field T (2019) Social touch, CT touch and massage therapy: a narrative review. Dev Rev. 51:123-45.

[27] Flint AJ, Banerjee S (2024) Pharmacological treatment of psychotic depression. Lancet Psychiatry. 11:162-4.

[28] Freeman D, Sheaves B, Waite F, et al. (2020) Sleep disturbance and psychiatric disorders. The Lancet Psychiatry. 7:628-37.

[29] Friedrich MJ (2017) Depression is the leading cause of disability around the World. J Am Med Assoc. 317:1517.

[30] Gao W, Yan X, Yuan J (2022) Neural correlations between cognitive deficits and emotion regulation strategies: understanding emotion dysregulation in depression from the perspective of cognitive control and cognitive biases. Psychoradiology. 2:86-99.

[31] Goodwin GM, Price J, De Bodinat C, et al. (2017) Emotional blunting with antidepressant treatments: a survey among depressed patients. J Affect Disord. 221:31-5.

[32] Hetrick SE, McKenzie JE, Bailey AP, et al. (2021) New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database of Systematic Reviews. 5:CD013674.

[33] Holmes AJ, Pizzagalli DA (2008) Spatiotemporal dynamics of error processing dysfunctions in major depressive disorder. Arch Gen Psychiatry. 65:179-88.

[34] Huang L, Yang Y, Ji Z., 17(2003) A study on the applicability of positive and negative emotion scale in Chinese population. Chinese Mental Health Journal:54-6.

[35] Ito TA, Larsen JT, Smith NK, et al. (1998) Negative information weighs more heavily on the brain: the negativity bias in evaluative categorizations. J Pers Soc Psychol. 75:887-900.

[36] Joormann J, Stanton CH (2016) Examining emotion regulation in depression: a review and future directions. Behav Res Ther. 86:35-49.

[37] Joseph R (1992) The limbic system: emotion, laterality, and unconscious mind. Psychoanal Rev. 79:405-56.

[38] Kong J, Gollub R, Huang T, et al. (2007) Acupuncture De Qi, from qualitative history to quantitative measurement. The Journal of Alternative and Complementary Medicine. 13:1059-70.

[39] Kreibig SD (2010) Autonomic nervous system activity in emotion: a review. Biol Psychol. 84:394-421.

[40] Kroenke K, Spitzer RL, Williams JBW, et al. (2007) Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 146:317-25.

[41] Kruizinga J, Liemburg E, Burger H, et al. (2021) Pharmacological treatment for psychotic depression. Cochrane Database of Systematic Reviews. 12:CD004044.

[42] Kypriotakis G, Cinciripini PM, Versace F (2020) Modeling neuroaffective biomarkers of drug addiction: a Bayesian nonparametric approach using dirichlet process mixtures. J Neurosci Methods. 341:108753.

[43] Ledoux J (1998) Fear and the brain: where have we been, and where are we going?. Biol Psychiatry. 44:1229-38.

[44] Lee IS, Chae Y. (2021) Cognitive components of acupuncture treatment. Integrative Medicine Research. 10:100754.

[45] Lee S, Moon H, Ryu Y, et al. (2023) Sensory and emotional responses to deep pressure stimulation at myofascial trigger points: a pilot study. Front Neurosci. 17:1197302.

[46] Li J, Xu C, Cao X, et al. (2013) Abnormal activation of the occipital lobes during emotion picture processing in major depressive disorder patients. Neural Regen Res. 8:1693-701.

[47] Li P, Yokoyama M, Okamoto D, et al. (2023) Depressive states in healthy subjects lead to biased processing in frontal-parietal ERPs during emotional stimuli. Sci Rep. 13:17175.

[48] Li S, Li Z, Wu Q, et al. (2018) A multicenter, randomized, controlled trial of electroacupuncture for perimenopause women with mild-moderate depression. Biomed Res Int:5351210.

[49] Li Y, Yan X, Meng X, et al. (2024) Focus on the sex-specific neural markers in the discrimination of various degrees of depression. Psychoradiology. 4:kkae006.

[50] Li Y, Zhang B, Pan X, et al. (2022) Dopamine-mediated major depressive disorder in the neural circuit of ventral tegmental area-nucleus accumbens-medial prefrontal cortex: from biological evidence to computational models. Front Cell Neurosci. 16:923039.

[51] Liu G, Ma H-J, Hu P-P, et al. (2013) Effects of painful stimulation and acupuncture on attention networks in healthy subjects. Behav Brain Funct. 9:23.

[52] Liu H, Xu J, Shan B, et al. (2012) Determining the precise cerebral response to acupuncture: an improved FMRI study. PLoS One. 7:e49154.

[53] Liu S, Wang Z-F, Su Y-S, et al. (2020) Somatotopic organization and intensity dependence in driving distinct NPY-expressing sympathetic pathways by electroacupuncture. Neuron. 108:436-450.e7.

[54] Long Q, Yang J, Lou Y, et al. (2015) Humans' emotional habituation to pleasant stimuli: behavioral and electrophysiological evidence. Chin Sci Bull. 60:3594-605.

[55] Lou Y, Meng X, Yang J, et al. (2016) The impact of extraversion on attentional bias to pleasant stimuli: neuroticism matters. Exp Brain Res. 234:721-31.

[56] Magee KE, Mcclaine R, Laurianti V, et al. (2023) Effects of binge drinking and depression on cognitive-control processes during an emotional Go/No-Go task in emerging adults. J Psychiatr Res. 162:161-9.

[57] Massioui FE, Lesèvre N (1988) Attention impairment and psychomotor retardation in depressed patients: an event-related potential study. Electroencephalogr Clin Neurophysiol. 70:46-55.

[58] Mauss IB, Levenson RW, Mccarter L, et al. (2005) The tie that binds? Coherence among emotion experience, behavior, and physiology. Emotion. 5:175-90.

[59] Miron J-P, Jodoin VD, Lespérance P, et al. (2021) Repetitive transcranial magnetic stimulation for major depressive disorder: basic principles and future directions. Therapeutic Advances in Psychopharmacology. 11:20451253211042696.

[60] Moran EK, Mehta N, Kring AM (2012) Emotional responding in depression: distinctions in the time course of emotion. Cognition & Emotion. 26:1153-75.

[61] Morris BH, Bylsma LM, Rottenberg J (2009) Does emotion predict the course of major depressive disorder? A review of prospective studies. British J Clinic Psychol. 48:255-73.

[62] Nagy E, Potts GF, Loveland KA (2003) Sex-related ERP differences in deviance detection. Int J Psychophysiol. 48:285-92.

[63] Nan C, Wang G, Wang H, et al. (2018) The P300 component decreases in a bimodal oddball task in individuals with depression: an event-related potentials study. Clin Neurophysiol. 129:2525-33.

[64] NICE. (2022) Depression in Adults: Treatment and Management. London: National Institute for Health and Care Excellence.

[65] Ning B, Wang Z, He J, et al. (2024) The rapid antidepressant effect of acupuncture on two animal models of depression by inhibiting M1-Ach receptors regulates synaptic plasticity in the prefrontal cortex. Brain Res. 1822:148609.

[66] Park J, White A, Lee H, et al. (1999) Development of a new sham needle. Acupunct Med. 17:110-2.

[67] Pearson NJ (2006) Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Arch Intern Med. 166:1775-82.

[68] Peng DH, Jiang KD, Fang YR, et al. (2011) Decreased regional homogeneity in major depression as revealed by resting-state functional magnetic resonance imaging. Chin Med J (Engl). 124:369-73.

[69] Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, et al. (2023) Nonpharmacologic and pharmacologic treatments of adults in the acute phase of major depressive disorder: a living clinical guideline from the American College of Physicians. Ann Intern Med. 176:239-52.

[70] Quinn ME, Stange JP, Jenkins LM, et al. (2018) Cognitive control and network disruption in remitted depression: a correlate of childhood adversity. Soc Cognit Affect Neurosci. 13:1081-90.

[71] Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1:385-401.

[72] Ravindran AV, Balneaves LG, Faulkner G, et al. (2016) Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: section 5. Complementary and Alternative Medicine Treatments. Can J Psychiatry. 61:576-87.

[73] Ren S, Wang Y, Yue F, et al. (2018) The paraventricular thalamus is a critical thalamic area for wakefulness. Science. 362:429-34.

[74] Rock PL, Roiser JP, Riedel WJ, et al. (2014) Cognitive impairment in depression: a systematic review and meta-analysis. Psychol. Med. 44:2029-40.

[75] Rottenberg J (2017) Emotions in depression: what do we really know?. Annu. Rev. Clin. Psychol. 13:241-63.

[76] Rottenberg J, Gross JJ, Gotlib IH (2005) Emotion context insensitivity in major depressive disorder. J Abnorm Psychol. 114:627-39.

[77] Rush AJ, Trivedi M, Fava M (2003) Depression, IV: STAR*D treatment trial for depression. AJP. 160:237.

[78] Schettino A, Keil A, Porcu E, et al. (2016) Shedding light on emotional perception: interaction of brightness and semantic content in extrastriate visual cortex. Neuroimage. 133:341-53.

[79] Shao R, Liu H-L, Huang C-M, et al. (2020) Loneliness and depression dissociated on parietal-centered networks in cognitive and resting states. Psychol. Med. 50:2691-701.

[80] Smith CA, Armour M, Lee MS, et al. (2018) Acupuncture for depression. Cochrane Database of Systematic Reviews. 3:CD004046.

[81] Smith NK, Cacioppo JT, Larsen JT, et al. (2003) May I have your attention, please: electrocortical responses to positive and negative stimuli. Neuropsychologia. 41:171-83.

[82] Snyder HR (2013) Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: a meta-analysis and review. Psychol Bull. 139:81-132.

[83] Starr LR, Hershenberg R, Shaw ZA, et al. (2020) The perils of murky emotions: emotion differentiation moderates the prospective relationship between naturalistic stress exposure and adolescent depression. Emotion. 20:927-38.

[84] Takakura N, Takayama M, Kawase A, et al. (2013) Double-blind acupuncture needle: a potential tool to investigate the nature of pain and pleasure. ISRN Pain. 2013:1.

[85] Tang Y, Li Y, Wang N, et al. (2011) The altered cortical connectivity during spatial search for facial expressions in major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 35:1891-900.

[86] Thomas SJ, Johnstone SJ, Gonsalvez CJ (2007) Event-related potentials during an emotional Stroop task. Int J Psychophysiol. 63:221-31.

[87] Vilgis V, Silk TJ, Vance A (2015) Executive function and attention in children and adolescents with depressive disorders: a systematic review. Eur Child Adolesc Psychiatry. 24:365-84.

[88] Wang L, Xian J, Sun M, et al. (2022) Acupuncture for emotional symptoms in patients with functional gastrointestinal disorders: a systematic review and meta-analysis. PLoS One. 17:e0263166.

[89] Wang Q, Wei X, Dang R, et al. (2022) An eye tracking and event-related potentials study with visual stimuli for adolescents emotional issues. Front Psychiatry. 13:933793.

[90] Watson D, Clark LA, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: the PANAS Scales. J Pers Soc Psychol. 54:1063-70.

[91] Wen X, Wu Q, Liu J, et al. (2018) Randomized single-blind multicenter trial comparing the effects of standard and augmented acupuncture protocols on sleep quality and depressive symptoms in patients with depression. Psychology, Health & Medicine. 23:375-90.

[92] Wong KKL, Xu J, Chen C, et al. (2023) Functional magnetic resonance imaging providing the brain effect mechanism of acupuncture and moxibustion treatment for depression. Front. Neurol. 14:1151421.

[93] World Health Organization. (2017) Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization.

[94] Wu Q, Wang S, Lin D, et al. (2024) Theory and practice of the lingnan liver-soothing and spirit-regulating acupuncture technique for depressive disorders. Journal of Sichuan Normal University (Natural Science). 47:753-61.

[95] Xiao Y, Dong S, Pan C, et al. (2024) Effectiveness of non-invasive brain stimulation on depressive symptoms targeting prefrontal cortex in functional magnetic resonance imaging studies: a combined systematic review and meta-analysis. Psychoradiology. 4:kkae025.

[96] Yang Y, Liu X, Liu Z-Z, et al. (2023) Life stress, insomnia, and anxiety/depressive symptoms in adolescents: a three-wave longitudinal study. J Affect Disord. 322:91-8.

[97] Yoo S-S, Kerr CE, Park M, et al. (2007) Neural activities in human somatosensory cortical areas evoked by acupuncture stimulation. Complement Ther Med. 15:247-54.

[98] Yu DTW, Jones AYM, Pang MYC (2012) Development and validation of the chinese version of the massachusetts general hospital acupuncture sensation scale: an exploratory and methodological study. Acupunct Med. 30:214-21.

[99] Yuan J, Ding N, Liu Y, et al. (2015) Unconscious emotion regulation: nonconscious reappraisal decreases emotion-related physiological reactivity during frustration. Cognition and Emotion. 29:1042-53.

[100] Yuan J, Li H, Long Q, et al. (2021) Gender role, but not sex, shapes humans’ susceptibility to emotion. Neurosci Bull. 37:201-16.

[101] Yuan J, Luo Y, Yan JH, et al. (2009) Neural correlates of the females’ susceptibility to negative emotions: an insight into gender-related prevalence of affective disturbances. Hum Brain Mapp. 30:3676-86.

[102] Yuan J, Zhang J, Zhou X, et al. (2012) Neural mechanisms underlying the higher levels of subjective well-being in extraverts: pleasant bias and unpleasant resistance. Cogn Affect Behav Neurosci. 12:175-92.

[103] Yuan J, Zhang Q, Chen A, et al. (2007) Are we sensitive to valence differences in emotionally negative stimuli? Electrophysiological evidence from an ERP study. Neuropsychologia. 45:2764-71.

[104] Zhang J, Wu X, Nie D, et al. (2021) Magnetic resonance imaging studies on acupuncture therapy in depression: a systematic review. Front Psychiatry. 12:670739.

[105] Zhang T, Zhang J, Huang J, et al. (2021) Neural activation via acupuncture in patients with major depressive disorder: a functional near-infrared spectroscopy study. Front Psychiatry. 12:669533.

[106] Zhang Y, Liang J, Qin W, et al. (2009) Comparison of visual cortical activations induced by electro-acupuncture at vision and nonvision-related acupoints. Neurosci Lett. 458:6-10.

[107] Zhao F-Y, Zheng Z, Fu Q-Q, et al. (2023) Acupuncture for comorbid depression and insomnia in perimenopause: a feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial. Front. Public Health. 11:1120567.

[108] Zhao J, Liu C, Zhang F, et al. (2022) A paraventricular thalamus to central amygdala neural circuit modulates acute stress-induced heightened wakefulness. Cell Rep. 41:111824.

[109] Zucker NA, Tsodikov A, Mist SD, et al. (2017) Evoked pressure pain sensitivity is associated with differential analgesic response to verum and sham acupuncture in fibromyalgia. Pain Med. 18:1582-92.