Use of Chinese Herbal Medicines Is Related to a Reduction in Depression Risk Among Patients With Insomnia: A Matched Cohort Study

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Abstract

Objective: Subjects with insomnia have a higher risk of depression, thus possibly making them live with serious health conditions. To date, information regarding the effect of Chinese herbal medicines (CHMs), a commonly used complementary and alternative medicine, on depression risk among people with insomnia is still unknown. This study aimed to investigate the effect of CHMs on the risk of depression among individuals with insomnia.

Methods: This cohort study used a national health insurance database to identify 68,573 subjects newly diagnosed with insomnia, aged 20–70 years, who received treatment between 1998 and 2010. Using propensity score matching, we randomly selected 26,743 CHMs users and 26,743 non-CHMs users from this sample. All enrollees were followed to the end of 2012 to identify any treatment for depression as the end point. Cox proportional hazards regression was used to compute the adjusted hazard ratio of depression associated with CHMs use.

Results: After utilizing the propensity score matching, we randomly selected 26,743 CHMs users and 26,743 non-CHMs users from this sample. During follow up, 3,328 CHMs users and 6,988 non-CHMs users developed depression at incidence rates of 17.24 and 37.97 per 1,000 person-years, respectively. CHMs users had a lower depression risk than the non-CHMs users (adjusted hazard ratio = 0.44; 95% Confidence Interval, 0.42–0.46). The greatest effect was observed for those taking CHMs for more than 2 years. Gegen, Huangqin, Dan-Shen, Beimu, Dahuang, Shegan, Shu-jing-huo-xue-tang, Ge-gen-tang, Shao-yao-gan-cao-tang and Píng wèi sǎn were significantly associated with a lower risk of depression.

Conclusions: Findings from this study demonstrated that adding CHMs to conventional treatment significantly reduces depression risk among patients with insomnia.

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Most cited references 41

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Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

R Deyo (1992)

Administrative databases are increasingly used for studying outcomes of medical care. Valid inferences from such data require the ability to account for disease severity and comorbid conditions. We adapted a clinical comorbidity index, designed for use with medical records, for research relying on International Classification of Diseases (ICD-9-CM) diagnosis and procedure codes. The association of this adapted index with health outcomes and resource use was then examined with a sample of Medicare beneficiaries who underwent lumbar spine surgery in 1985 (n = 27,111). The index was associated in the expected direction with postoperative complications, mortality, blood transfusion, discharge to nursing home, length of hospital stay, and hospital charges. These associations were observed whether the index incorporated data from multiple hospitalizations over a year's time, or just from the index surgical admission. They also persisted after controlling for patient age. We conclude that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.

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A meta-analysis of cytokines in major depression.

Yekta Dowlati, Nathan Herrmann, Walter Swardfager … (2010)

Major depression occurs in 4.4% to 20% of the general population. Studies suggest that major depression is accompanied by immune dysregulation and activation of the inflammatory response system (IRS). Our objective was to quantitatively summarize the data on concentrations of specific cytokines in patients diagnosed with a major depressive episode and controls. We performed a meta-analysis of studies measuring cytokine concentration in patients with major depression, with a database search of the English literature (to August 2009) and a manual search of references. Twenty-four studies involving unstimulated measurements of cytokines in patients meeting DSM criteria for major depression were included in the meta-analysis; 13 for tumor necrosis factor (TNF)-alpha, 9 for interleukin (IL)-1beta, 16 for IL-6, 5 for IL-4, 5 for IL-2, 4 for IL-8, 6 for IL-10, and 4 for interferon (IFN)-gamma. There were significantly higher concentrations of TNF-alpha (p < .00001), weighted mean difference (WMD) (95% confidence interval) 3.97 pg/mL (2.24 to 5.71), in depressed subjects compared with control subjects (438 depressed/350 nondepressed). Also, IL-6 concentrations were significantly higher (p < .00001) in depressed subjects compared with control subjects (492 depressed/400 nondepressed) with an overall WMD of 1.78 pg/mL (1.23 to 2.33). There were no significant differences among depressed and nondepressed subjects for the other cytokines studied. This meta-analysis reports significantly higher concentrations of the proinflammatory cytokines TNF-alpha and IL-6 in depressed subjects compared with control subjects. While both positive and negative results have been reported in individual studies, this meta-analytic result strengthens evidence that depression is accompanied by activation of the IRS. Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

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Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies.

Chiara Baglioni, Gemma Battagliese, Bernd Feige … (2011)

In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98-3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86-2.38). The main limit is that included studies did not always consider the role of other intervening variables. Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care. Copyright © 2011 Elsevier B.V. All rights reserved.

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Author and article information

Contributors

How-Ran Guo: URI : http://loop.frontiersin.org/people/110643/overview

Tzung-Yi Tsai: URI : http://loop.frontiersin.org/people/892263/overview

Journal

Journal ID (nlm-ta): Front Neurol

Journal ID (iso-abbrev): Front Neurol

Journal ID (publisher-id): Front. Neurol.

Title: Frontiers in Neurology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-2295

Publication date (Electronic): 20 January 2021

Publication date Collection: 2020

Volume: 11

Electronic Location Identifier: 583485

Affiliations

[1] ¹Department of Chinese Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation , Chiayi, Taiwan

[2] ²Department of Traditional Medicine, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan

[3] ³Rehabilitation Counseling Program, Portland State University , Portland, OR, United States

[4] ⁴Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital , Tainan, Taiwan

[5] ⁵Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University , Tainan, Taiwan

[6] ⁶Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University , Tainan, Taiwan

[7] ⁷Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation , Chiayi, Taiwan

[8] ⁸School of Medicine, Tzu Chi University , Hualien, Taiwan

[9] ⁹Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation , Chiayi, Taiwan

[10] ¹⁰School of Post-Baccalaureate Chinese Medicine, Tzu Chi University , Hualien, Taiwan

[11] ¹¹Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation , Chiayi, Taiwan

[12] ¹²Department of Nursing, Tzu Chi University of Science and Technology , Hualien, Taiwan

Author notes

Edited by: Lino Nobili, University of Genoa, Italy

Reviewed by: Arturo Garay, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Argentina; Jupi Li, China Medical University, Taiwan

*Correspondence: Chia-Chou Yeh yehcc0530@ 123456gmail.com

Tzung-Yi Tsai dm732024@ 123456tzuchi.com.tw

How-Ran Guo hrguo@ 123456ncku.edu.tw

This article was submitted to Sleep Disorders, a section of the journal Frontiers in Neurology

†These authors have contributed equally to this work

Article

DOI: 10.3389/fneur.2020.583485

PMC ID: 7854552

PubMed ID: 33551951

SO-VID: 603bc58a-ae12-4b84-8537-22fb2cbc34a6

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 19 July 2020

Date accepted : 10 December 2020

Page count

Figures: 2, Tables: 4, Equations: 0, References: 42, Pages: 9, Words: 5925

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Use of Chinese Herbal Medicines Is Related to a Reduction in Depression Risk Among Patients With Insomnia: A Matched Cohort Study

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Abstract

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Most cited references 41

Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

A meta-analysis of cytokines in major depression.

Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies.

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Cited by 7

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