N20 Transcutaneous Electrical Acupuncture-point Stimulation for Depressive symptoms in Inflammatory Bowel Disease: a feasibility study
Authors: Norton C , Huang C , Czuber-Dochan W 
Published: January 2025

Abstract

Background
Depressive symptoms are common in individuals with Inflammatory Bowel Disease (IBD) and are associated with a worse disease course1. Transcutaneous Electrical Acupuncture-point Stimulation (TEAS) is a portable, non-invasive intervention and has shown promise in other inflammatory conditions2–4, but remains untested in IBD. We developed an APP to deliver a remote, real-time protocol for home-based self-administration of TEAS and evaluated its acceptability and feasibility, as well as preliminary estimates of clinical outcomes.

Methods
We conducted a randomised feasibility study to assess the feasibility and effects of TEAS in IBD patients with depressive symptoms. Participants were recruited through Crohn's & Colitis UK and were eligible if they scored ≥8 on the PHQ-9 depression scale. They were randomly assigned using an online randomisation system to two groups. Both groups were trained remotely online on how to use the device, download the APP controlling the delivery of the intervention to their mobile phone, locate acupoints, and to self-administer the intervention. Group A self-administered a 30-minute daily intervention for 21 days starting in week 1, while Group B began the same treatment in week 6. Outcome measures (recruitment, retention, acceptability, depression, fatigue, pain and quality of life) were assessed at baseline, 4 weeks, and 9 weeks.

Results
Figure 1 shows the Consort diagram. Of 109 expressions of interest, 57 people were assessed for eligibility; 36 were randomised (63% recruitment rate). All 18 participants allocated to Group A started the intervention, with 15 (83%) completing more than 18 sessions. In Group B, 12 participants (67%) started, and 9 (75%) of these completed the 21-day protocol. Questionnaire completion rates were 89% at baseline, 83% at 4 weeks, and 67% at 9 weeks. The intervention was well-received, with 80% of 26 respondents willing to recommend it to others. Preliminary efficacy analysis suggested reductions in depressive symptoms and improvements in quality of life, both immediately post-intervention and after 4 weeks, though findings are limited by the feasibility design.

Conclusion
The TEAS intervention and the research protocol were feasible and acceptable to patients and there is a suggestion of clinical benefit. Two thirds of participants completed the follow up questionnaires and the majority completed at least 18 sessions of TEAS. A full-scale randomised controlled trial testing the effectiveness of TEAS for IBD-related depression is now warranted to evaluate the effectiveness for depression in IBD patients.

References
1.Dubinsky MC, Dotan I, Rubin DT, et al. Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review. Expert Rev Gastroenterol Hepatol. 2021;15(9):985-997. doi:10.1080/17474124.2021.1911644
2.Xuan J lei, Zhu Y wei, Xu W hui, et al. Integrative effects of transcutaneous electrical acustimulation on abdominal pain, gastrointestinal motility, and inflammation in patients with early-stage acute pancreatitis. Neurogastroenterology & Motility. 2022;34(4):e14249. doi:10.1111/NMO.14249
3.Hu P, Sun K, Li H, et al. Transcutaneous Electrical Acustimulation Improved the Quality of Life in Patients With Diarrhea-Irritable Bowel Syndrome. Neuromodulation. Published online 2021. doi:10.1016/J.NEUROM.2021.10.009
4.Liu S, Wang Z, Su Y, et al. A neuroanatomical basis for electroacupuncture to drive the vagal–adrenal axis. Nature 2021 598:7882. 2021;598(7882):641-645. doi:10.1038/s41586-021-04001-4