ACUPUNCTURE TREATMENT OF DEPRESSION DURING PREGNANCY

因为几乎没有医学上可以接受的治疗方法 不幸的是，怀孕期间抑郁的常见情况，我们的长期- 评估针灸疗效和疗效的学期目标 妊娠期抑郁症的治疗。作为第一步，这一试点 研究的重点是获得足够的数据来完善试点设计 随后的随机临床试验。妊娠期抑郁 有显著的有害影响，包括低出生体重，早产 分娩，并持续抑郁到产后。针灸 为抑郁症提供替代疗法(Allen、Schnyer和 HITT，1998)，一种医学上可以接受的，可能成为一种 怀孕期间理想的治疗选择。我们的主要目标是 确定急性(短期)针灸治疗是否有效 因为怀孕期间的抑郁症足够严重，足以保证 大规模临床试验。我们建议测试一下 针灸专为治疗抑郁症而设计，而不是 通过与针灸设计的比较，对怀孕期间的症状进行研究 解决不属于抑郁症状的有效症状 图片，从而控制对药物有效性的信念 治疗。我们还建议将特定的针灸与产前进行比较 按摩，从而控制注意力、身体接触、放松 从日常压力中得到喘息。75人参加会议 西方诊断重度抑郁症的标准将被随机分配到 接受三种治疗中的一种，每种治疗包括12种治疗 授课时间超过8周。因为抑郁的风险 在分娩后高，参与者谁全部或部分 急性期结束时的响应将继续收到相同的响应， 但频率较低，治疗到产后8周，并将 术后随访6个月以上。具体目标是：a)评估 针刺治疗大脑血管疾病的疗效(及疗效大小) 急性期末期妊娠期间的抑郁，与 两个控制条件：b)评价疗效(和效果 大小)的急性期/延续期特效针刺相结合治疗 产后抑郁的发生率与 两种控制条件；以及，c)评估临床意义 评估针灸治疗重度抑郁症的价值 治疗条件对婴儿结局的不同影响 措施。通过专注于这些目标，我们将能够实现 遵循本PAS规定的目标：完善干预措施 战略，细化控制战略(包括成功的我们的双- 盲目战略)，测试招聘程序的充分性 建立有效性的衡量标准。另外，通过计算， 流失率和效果规模我们将确定 最终将需要的参与者将是对 针刺治疗抑郁症的疗效及疗效观察 在怀孕期间。

Because few medically acceptable treatments are available for the unfortunately common condition of depression during pregnancy, our long- term goal to assess the efficacy and effectiveness of acupuncture treatment of depression during pregnancy. As a first step, this pilot study focuses on obtaining sufficient data to refine the pilot design of a subsequent Randomized Clinical Trial. Depression during pregnancy has significant deleterious effects including low birth weight, preterm delivery, and continued depression into postpartum. Acupuncture provides an alternative treatment for depression (Allen, Schnyer, and Hitt, 1998), one that is medically acceptable and that could become an ideal treatment option during pregnancy. Our primary objective is to determine if the efficacy of acute (short term) acupuncture treatment for depression during pregnancy is substantial enough to warrant a large-scale clinical trial. We propose to test the efficacy of acupuncture designed specifically to address depressive that are not symptomatology during pregnancy by comparing it to acupuncture designed to address valid symptoms that are not part of the depressive symptom picture, thus controlling for the belief in the efficacy of the treatment. We also propose to compare specific acupuncture to prenatal massage, thus controlling for attention, physical contact, relaxation and respite from daily stress. Seventy five participants meeting western diagnostic criteria for Major Depression will be randomized to receive one of the three treatments, each consisting of 12 treatment sessions delivered over 8 weeks. Because the risk for depression following delivery is high, participants who have full or partial response at the end of acute phase will continue to receive the same, but less frequent, treatment until 8 weeks post partum, and will be followed up for 6 more months. The specific aims are: a) to evaluate the efficacy (and effect size) of acupuncture treatment for major depression during pregnancy at the end of the acute phase, relative to the two control conditions; b) to evaluate the efficacy (and effect size) of the combined acute/continuation specific acupuncture on the incidence of depression during the post partum period, relative to the two control conditions; and, c) to evaluate the clinical significance of acupuncture treatment for major depression by assessing the differential impact of the treatment conditions on infant outcomes measures. By focusing on these aims we will be able to meet the following stated objectives of this PAS: refine the intervention strategy, refine the control strategy (including success of our double- blind strategy), test the adequacy of recruitment procedures, and establish measures of effectiveness. In addition, by computing attrition rates and effect sizes we will determine the number of participants that will ultimately be needed in a definitive study of the efficacy and effectiveness of acupuncture in the treatment of depression during pregnancy.