human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: As a widely-applied alternative therapy , acupuncture is gaining popularity in Western society . One challenge that remains , however , is incorporating it into mainstream medicine . One solution is to combine acupuncture with other conventional , mainstream treatments . In this study , we investigated the combination effect of acupuncture and the antidepressant fluoxetine , as well as its underlying mechanism using resting state functional connectivity ( rsFC ) in patients with major depressive disorders . Forty-six female depressed patients were r and omized into a verum acupuncture plus fluoxetine or a sham acupuncture plus fluoxetine group for eight weeks . Resting-state fMRI data was collected before the first and last treatments . Results showed that compared with those in the sham acupuncture treatment , verum acupuncture treatment patients showed 1 ) greater clinical improvement as indicated by Montgomery – Åsberg Depression Rating Scale ( MADRS ) and Self-Rating Depression Scale ( SDS ) scores ; 2 ) increased rsFC between the left amygdala and subgenual anterior cingulate cortex (sgACC)/preguenual anterior cingulate cortex ( pgACC ) ; 3 ) increased rsFC between the right amygdala and left parahippocampus (Para)/putamen ( Pu ) . The strength of the amygdala-sgACC/pgACC rsFC was positively associated with corresponding clinical improvement ( as indicated by a negative correlation with MADRS and SDS scores ) . Our findings demonstrate the additive effect of acupuncture to antidepressant treatment and suggest that this effect may be achieved through the limbic system , especially the amygdala and the ACC BACKGROUND Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy . In this study , we ask whether a mind-body exercise , Tai Chi Chih ( TCC ) , added to escitalopram will augment the treatment of geriatric depression design ed to achieve symptomatic remission and improvements in health functioning and cognitive performance . METHODS : One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks . Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were r and omly assigned to 10 weeks of adjunct use of either 1 ) TCC for 2 hours per week or 2 ) health education ( HE ) for 2 hours per week . All participants underwent evaluations of depression , anxiety , resilience , health-related quality of life , cognition , and inflammation at baseline and during 14-week follow-up . RESULTS Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE . Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker , C-reactive protein , compared with the control group . CONCLUSION : Complementary use of a mind-body exercise , such as TCC , may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression BACKGROUND Altered functioning of the hypothalamic-pituitary-adrenal axis ( HPA-axis ) has been associated with depression , but findings have been inconsistent . Among older depressed persons , both hyperactivity and hypo-activity of the HPA-axis were demonstrated . However , most studies were population -based studies , with single cortisol measurements , lacking insight into diurnal patterns of HPA-axis functioning . We aim to provide insight into functioning of the HPA-axis , assessed by various salivary cortisol sample s , in depressed older adults and non-depressed controls . METHODS Data were derived from the Netherl and s Study of Depression in Older Persons .  Cortisol levels  of older persons without a lifetime diagnosis of depression and /or anxiety ( n=109 ) were compared with older persons with a 6-month major depression diagnosis ( n=311 ) . ANCOVA analyses and r and om coefficient analysis on the four morning cortisol sample s were performed . A possible U-shaped association between cortisol and depression status was examined . RESULTS Depressed older persons showed higher morning cortisol levels at awakening ( T1 ) and a less dynamic awakening response compared to non-depressed older persons . Dexamethasone suppression did not differ across groups . No U-shaped association between HPA-axis activity and depression was observed . CONCLUSION We demonstrated a hypercortisolemic state and a diminished ability to respond to the stress of awakening among depressed older persons . Previously it was shown , that hypercortisolemic states may indicate a lifelong biological vulnerability for depression . Our findings exp and on previous literature by demonstrating that in older persons the HPA-axis may become less responsive to stress , culminating in a further dysregulation of the diurnal cortisol-rhythm , superimposed on - possibly lifelong - hypercortisolemic states Our previous studies have reported the therapeutic effects of 10-session Chinese Chan-based Dejian mind-body interventions ( DMBI ) in reducing the intake of antidepressants , improving depressive symptoms , and enhancing the attentional abilities of patients with depression . This study aims to explore the possible neuroelectrophysiological mechanisms underlying the previously reported treatment effects of DMBI in comparison with those of cognitive behavioral therapy ( CBT ) .  Seventy-five age- , gender- , and education-matched participants with depression were r and omly assigned to receive either CBT or DMBI or placed on a waitlist .  Eyes-closed resting EEG data were obtained individually before and after 10 weeks . After intervention , the DMBI group demonstrated significantly enhanced frontal alpha asymmetry ( an index of positive mood ) and intra- and interhemispheric theta coherence in frontoposterior and posterior brain regions ( an index of attention ) . In contrast , neither the CBT nor the waitlist group showed significant changes in EEG activity patterns . Furthermore , the asymmetry and coherence indices of the DMBI group were correlated with self-reported depression severity levels and performance on an attention test , respectively . The present findings provide support for the effects of a Chinese Chan-based mind-body intervention in fostering human brain states that can facilitate positive mood and an attentive mind Opinion statementLate-life  depression ( LLD ) is a public health concern with deleterious effects on overall health , cognition , quality of life , and mortality . Although LLD is relatively common , it is not a normal part of aging and is often under-recognized in older adults . However , psychotherapy is an effective treatment for LLD that aligns with many patients ’ preferences and can improve health and functioning . This review synthesized the current literature on evidence -based psychotherapies for the treatment of depression in older adults . Findings suggest that active , skills-based psychotherapies ( cognitive behavioral therapy [ CBT ] and problem-solving therapy [ PST ] ) may be more effective for LLD than non-directive , supportive counseling . PST may be particularly relevant for off setting skill deficit associated with LLD , such as in instances of cognitive impairment ( especially executive dysfunction ) and disability . Emerging treatments also consider context ual factors to improve treatment delivery , such as personalized care , access , and poverty .  Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults . Although these strategies hold promise , further investigation via r and omized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD . Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence -based psychosocial interventions for LLD Electroacupuncture ( EA ) stimulation has been found to influence the brain ( norepinephrine metabolism in experimental animals ) . Preliminary clinical research has shown that EA treatment is as effective as amitriptyline for patients with depression . In this study , two consecutive clinical studies on the treatment of depression with EA are conducted . The first study was double blind placebo controlled , in which 29 depressed in patients were recruited . Patients were r and omly divided into three groups : EA + placebo ; amitriptyline ; and EA + amitriptyline . They received EA and /or amitriptyline treatment for 6 weeks . The Hamilton Rating Scale for Depression , Clinical Global Impression and ASBERG scales for the side effect of antidepressants were used to evaluate the therapeutic efficacy and side effects . Based on the results and research protocol of the first study , a multi-centered collaborative study was conducted , in which 241 in patients with depression were recruited . Patients were r and omly divided into two treatment groups : the EA + placebo and the amitriptyline groups . The results from both studies showed that the therapeutic efficacy of EA was equal to that of amitriptyline for depressive disorders ( P > 0.05 ) . Electro-acupuncture had a better therapeutic effect for anxiety somatization and cognitive process disturbance of depressed patients than amitriptyline ( P < 0.05 ) . Moreover , the side effects of EA were much less than that of amitriptyline ( P < 0.001 ) . The article suggested that EA treatment was an effective therapeutic method for depressive disorders . Particularly , it was a treatment of choice for depressed patients who were unable to comply with the classic tricyclic antidepressants because of their anticholinergic side effects . The possible mechanism of EA treatment is discussed BACKGROUND The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago . The lifetime prevalence rates of DSM-III major depressive disorder ( females 2.44 % and males 1.29 % ) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong . METHODS Each of 5004 adults r and omly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode ( MDE ) , sociodemography , help-seeking , and other  epidemiological data . RESULTS Twelve-month prevalence of MDE was 8.4 % . The female-to-male ratio was low but typical of surveys in Chinese communities . Female sex and unemployment were associated with increased risk . 32.5 % of respondents with MDE reported frequent thoughts of suicide . Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low . LIMITATIONS Response rate was low though cooperation rate was moderately high . Detailed demography , comorbidity , and clinical re appraisal interviews were not covered . CONCLUSIONS Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people . Although longitudinal studies are needed to confirm a genuine increase in prevalence , depression is likely to be more common in Hong Kong than previously suggested . High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment BACKGROUND Electroacupuncture ( EA ) has been used to treat Major Depressive Disorder ( MDD ) . However , its efficacy is inconclusive and the mechanism is still unclear . Thus , the objective of this study is to investigate the therapeutic effect of EA on GTP-binding-protein ( G protein ) in platelet membrane using fluoxetine as a comparison . METHODS A r and omized controlled trial ( RCT ) was performed on 90 MDD patients , who were divided into three groups treated with fluoxetine , EA and sham EA respectively . Antibodies were utilized to quantify the levels of G protein alpha subtypes in the platelet membrane before and after 6-week anti-depressive treatment .  Thirty age and sex-matched normal individuals were used as controls . RESULT All the treatments had the same therapeutic effects in treating moderate depression . Both levels of Galphai and Galphaq in depression patients were significantly higher than those in controls and were not reduced by treatments , although the severity was considerably relieved . LIMITATIONS The duration of treatment was limited to six weeks only . CONCLUSION EA might be served as an alternative treatment for moderate depression and we further demonstrate that the abnormal levels of Galpha protein in platelet membrane might be a potential risk factor for MDD Inflammatory diseases are commonly associated with depressed mood . This association may be influenced by the production of proinflammatory cytokines . Accordingly , we assessed whether cytokine levels and mood ( measured with the profile of mood states ) could be altered by a mild , non-sickness inducing , acute inflammatory stimulus . Using a r and omised placebo-controlled , double-blind design , 30 healthy male volunteers were injected with Salmonella typhi vaccine or placebo .  Assessment s of mood , symptoms of illness and temperature were made at baseline and at 1.5 , 3 , and 6 h post-injection . Plasma concentrations of interleukin-6 ( IL-6 ) , interleukin-1 receptor antagonist ( IL-1Ra ) , and tumour necrosis factor-alpha ( TNF-alpha ) were assessed at baseline and 3 h post-injection . No significant symptoms of illness were reported in either group . Mood was more negative following injection in the vaccine than the placebo group , and the vaccine group experienced a 106 % increase in IL-6 concentration . Negative changes in mood following injection were significantly correlated with increases in IL-6 production . No changes in TNF-alpha or IL-1Ra concentration were recorded in either group . It is concluded that S. typhi vaccination may be a useful model of mild inflammatory challenge , producing a significant transient cytokine-induced decrease in mood in the absence of any febrile response . Implication s for de 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: As a widely-applied alternative therapy , acupuncture is gaining popularity in Western society . One challenge that remains , however , is incorporating it into mainstream medicine . One solution is to combine acupuncture with other conventional , mainstream treatments . In this study , we investigated the combination effect of acupuncture and the antidepressant fluoxetine , as well as its underlying mechanism using resting state functional connectivity ( rsFC ) in patients with major depressive disorders . Forty-six female depressed patients were r and omized into a verum acupuncture plus fluoxetine or a sham acupuncture plus fluoxetine group for eight weeks . Resting-state fMRI data was collected before the first and last treatments . Results showed that compared with those in the sham acupuncture treatment , verum acupuncture treatment patients showed 1 ) greater clinical improvement as indicated by Montgomery – Åsberg Depression Rating Scale ( MADRS ) and Self-Rating Depression Scale ( SDS ) scores ; 2 ) increased rsFC between the left amygdala and subgenual anterior cingulate cortex (sgACC)/preguenual anterior cingulate cortex ( pgACC ) ; 3 ) increased rsFC between the right amygdala and left parahippocampus (Para)/putamen ( Pu ) . The strength of the amygdala-sgACC/pgACC rsFC was positively associated with corresponding clinical improvement ( as indicated by a negative correlation with MADRS and SDS scores ) . Our findings demonstrate the additive effect of acupuncture to antidepressant treatment and suggest that this effect may be achieved through the limbic system , especially the amygdala and the ACC BACKGROUND Nearly two-thirds of elderly patients treated for depression fail to achieve symptomatic remission and functional recovery with first-line pharmacotherapy . In this study , we ask whether a mind-body exercise , Tai Chi Chih ( TCC ) , added to escitalopram will augment the treatment of geriatric depression design ed to achieve symptomatic remission and improvements in health functioning and cognitive performance . METHODS : One hundred twelve older adults with major depression age 60 years and older were recruited and treated with escitalopram for approximately 4 weeks . Seventy-three partial responders to escitalopram continued to receive escitalopram daily and were r and omly assigned to 10 weeks of adjunct use of either 1 ) TCC for 2 hours per week or 2 ) health education ( HE ) for 2 hours per week . All participants underwent evaluations of depression , anxiety , resilience , health-related quality of life , cognition , and inflammation at baseline and during 14-week follow-up . RESULTS Subjects in the escitalopram and TCC condition were more likely to show greater reduction of depressive symptoms and to achieve a depression remission as compared with those receiving escitalopram and HE . Subjects in the escitalopram and TCC condition also showed significantly greater improvements in 36-Item Short Form Health Survey physical functioning and cognitive tests and a decline in the inflammatory marker , C-reactive protein , compared with the control group . CONCLUSION : Complementary use of a mind-body exercise , such as TCC , may provide additional improvements of clinical outcomes in the pharmacologic treatment of geriatric depression BACKGROUND Altered functioning of the hypothalamic-pituitary-adrenal axis ( HPA-axis ) has been associated with depression , but findings have been inconsistent . Among older depressed persons , both hyperactivity and hypo-activity of the HPA-axis were demonstrated . However , most studies were population -based studies , with single cortisol measurements , lacking insight into diurnal patterns of HPA-axis functioning . We aim to provide insight into functioning of the HPA-axis , assessed by various salivary cortisol sample s , in depressed older adults and non-depressed controls . METHODS Data were derived from the Netherl and s Study of Depression in Older Persons .  Cortisol levels  of older persons without a lifetime diagnosis of depression and /or anxiety ( n=109 ) were compared with older persons with a 6-month major depression diagnosis ( n=311 ) . ANCOVA analyses and r and om coefficient analysis on the four morning cortisol sample s were performed . A possible U-shaped association between cortisol and depression status was examined . RESULTS Depressed older persons showed higher morning cortisol levels at awakening ( T1 ) and a less dynamic awakening response compared to non-depressed older persons . Dexamethasone suppression did not differ across groups . No U-shaped association between HPA-axis activity and depression was observed . CONCLUSION We demonstrated a hypercortisolemic state and a diminished ability to respond to the stress of awakening among depressed older persons . Previously it was shown , that hypercortisolemic states may indicate a lifelong biological vulnerability for depression . Our findings exp and on previous literature by demonstrating that in older persons the HPA-axis may become less responsive to stress , culminating in a further dysregulation of the diurnal cortisol-rhythm , superimposed on - possibly lifelong - hypercortisolemic states Our previous studies have reported the therapeutic effects of 10-session Chinese Chan-based Dejian mind-body interventions ( DMBI ) in reducing the intake of antidepressants , improving depressive symptoms , and enhancing the attentional abilities of patients with depression . This study aims to explore the possible neuroelectrophysiological mechanisms underlying the previously reported treatment effects of DMBI in comparison with those of cognitive behavioral therapy ( CBT ) .  Seventy-five age- , gender- , and education-matched participants with depression were r and omly assigned to receive either CBT or DMBI or placed on a waitlist .  Eyes-closed resting EEG data were obtained individually before and after 10 weeks . After intervention , the DMBI group demonstrated significantly enhanced frontal alpha asymmetry ( an index of positive mood ) and intra- and interhemispheric theta coherence in frontoposterior and posterior brain regions ( an index of attention ) . In contrast , neither the CBT nor the waitlist group showed significant changes in EEG activity patterns . Furthermore , the asymmetry and coherence indices of the DMBI group were correlated with self-reported depression severity levels and performance on an attention test , respectively . The present findings provide support for the effects of a Chinese Chan-based mind-body intervention in fostering human brain states that can facilitate positive mood and an attentive mind Opinion statementLate-life  depression ( LLD ) is a public health concern with deleterious effects on overall health , cognition , quality of life , and mortality . Although LLD is relatively common , it is not a normal part of aging and is often under-recognized in older adults . However , psychotherapy is an effective treatment for LLD that aligns with many patients ’ preferences and can improve health and functioning . This review synthesized the current literature on evidence -based psychotherapies for the treatment of depression in older adults . Findings suggest that active , skills-based psychotherapies ( cognitive behavioral therapy [ CBT ] and problem-solving therapy [ PST ] ) may be more effective for LLD than non-directive , supportive counseling . PST may be particularly relevant for off setting skill deficit associated with LLD , such as in instances of cognitive impairment ( especially executive dysfunction ) and disability . Emerging treatments also consider context ual factors to improve treatment delivery , such as personalized care , access , and poverty .  Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults . Although these strategies hold promise , further investigation via r and omized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD . Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence -based psychosocial interventions for LLD Electroacupuncture ( EA ) stimulation has been found to influence the brain ( norepinephrine metabolism in experimental animals ) . Preliminary clinical research has shown that EA treatment is as effective as amitriptyline for patients with depression . In this study , two consecutive clinical studies on the treatment of depression with EA are conducted . The first study was double blind placebo controlled , in which 29 depressed in patients were recruited . Patients were r and omly divided into three groups : EA + placebo ; amitriptyline ; and EA + amitriptyline . They received EA and /or amitriptyline treatment for 6 weeks . The Hamilton Rating Scale for Depression , Clinical Global Impression and ASBERG scales for the side effect of antidepressants were used to evaluate the therapeutic efficacy and side effects . Based on the results and research protocol of the first study , a multi-centered collaborative study was conducted , in which 241 in patients with depression were recruited . Patients were r and omly divided into two treatment groups : the EA + placebo and the amitriptyline groups . The results from both studies showed that the therapeutic efficacy of EA was equal to that of amitriptyline for depressive disorders ( P > 0.05 ) . Electro-acupuncture had a better therapeutic effect for anxiety somatization and cognitive process disturbance of depressed patients than amitriptyline ( P < 0.05 ) . Moreover , the side effects of EA were much less than that of amitriptyline ( P < 0.001 ) . The article suggested that EA treatment was an effective therapeutic method for depressive disorders . Particularly , it was a treatment of choice for depressed patients who were unable to comply with the classic tricyclic antidepressants because of their anticholinergic side effects . The possible mechanism of EA treatment is discussed BACKGROUND The most recent large-scale community mental health survey of depression among adults in Hong Kong was conducted over two decades ago . The lifetime prevalence rates of DSM-III major depressive disorder ( females 2.44 % and males 1.29 % ) in that study do not tally with several indices of worsened social health and clinical prevalence studies of depression in contemporary Hong Kong . METHODS Each of 5004 adults r and omly drawn from the general population completed a telephone interview that generated the DSM-IV-based diagnosis of major depressive episode ( MDE ) , sociodemography , help-seeking , and other  epidemiological data . RESULTS Twelve-month prevalence of MDE was 8.4 % . The female-to-male ratio was low but typical of surveys in Chinese communities . Female sex and unemployment were associated with increased risk . 32.5 % of respondents with MDE reported frequent thoughts of suicide . Recognition of the need for treatment of depression was high but actual treatment rate and preference for mental health specialists were low . LIMITATIONS Response rate was low though cooperation rate was moderately high . Detailed demography , comorbidity , and clinical re appraisal interviews were not covered . CONCLUSIONS Resolving issues of stigma and mode of symptom elicitation may lead to more valid prevalence estimates of depression among Chinese people . Although longitudinal studies are needed to confirm a genuine increase in prevalence , depression is likely to be more common in Hong Kong than previously suggested . High recognition of the need for treatment but low rate of actual treatment calls for policy and programs that improve access to treatment BACKGROUND Electroacupuncture ( EA ) has been used to treat Major Depressive Disorder ( MDD ) . However , its efficacy is inconclusive and the mechanism is still unclear . Thus , the objective of this study is to investigate the therapeutic effect of EA on GTP-binding-protein ( G protein ) in platelet membrane using fluoxetine as a comparison . METHODS A r and omized controlled trial ( RCT ) was performed on 90 MDD patients , who were divided into three groups treated with fluoxetine , EA and sham EA respectively . Antibodies were utilized to quantify the levels of G protein alpha subtypes in the platelet membrane before and after 6-week anti-depressive treatment .  Thirty age and sex-matched normal individuals were used as controls . RESULT All the treatments had the same therapeutic effects in treating moderate depression . Both levels of Galphai and Galphaq in depression patients were significantly higher than those in controls and were not reduced by treatments , although the severity was considerably relieved . LIMITATIONS The duration of treatment was limited to six weeks only . CONCLUSION EA might be served as an alternative treatment for moderate depression and we further demonstrate that the abnormal levels of Galpha protein in platelet membrane might be a potential risk factor for MDD Inflammatory diseases are commonly associated with depressed mood . This association may be influenced by the production of proinflammatory cytokines . Accordingly , we assessed whether cytokine levels and mood ( measured with the profile of mood states ) could be altered by a mild , non-sickness inducing , acute inflammatory stimulus . Using a r and omised placebo-controlled , double-blind design , 30 healthy male volunteers were injected with Salmonella typhi vaccine or placebo .  Assessment s of mood , symptoms of illness and temperature were made at baseline and at 1.5 , 3 , and 6 h post-injection . Plasma concentrations of interleukin-6 ( IL-6 ) , interleukin-1 receptor antagonist ( IL-1Ra ) , and tumour necrosis factor-alpha ( TNF-alpha ) were assessed at baseline and 3 h post-injection . No significant symptoms of illness were reported in either group . Mood was more negative following injection in the vaccine than the placebo group , and the vaccine group experienced a 106 % increase in IL-6 concentration . Negative changes in mood following injection were significantly correlated with increases in IL-6 production . No changes in TNF-alpha or IL-1Ra concentration were recorded in either group . It is concluded that S. typhi vaccination may be a useful model of mild inflammatory challenge , producing a significant transient cytokine-induced decrease in mood in the absence of any febrile response . Implication s for de 
    Output:
    