Review
The effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis

https://doi.org/10.1016/j.jad.2009.07.005Get rights and content

Abstract

Background

Although acupuncture has been used as an alternative treatment for depressive disorders, its effectiveness and safety are not well defined. The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of acupuncture as monotherapy and as an additional therapy in treating various depressive conditions, particularly major depressive disorder (MDD) and post-stroke depression (PSD).

Methods

Following systematic review, meta-analysis was conducted on high-quality randomized controlled trials (RCTs).

Results

Of 207 clinical studies of acupuncture for various depression retrieved, 113 (54.6%) were on MDD and 76 (36.7%) on PSD. Twenty RCTs of MDD (n = 1998) and 15 of PSD (n = 1680) identified for high-quality protocol (Jadad score ≥ 3) were included for meta-analysis. The efficacy of acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, but not different from sham acupuncture. No sufficient evidence favored the expectation that acupuncture combined with antidepressants could yield better outcomes than antidepressants alone in treating MDD. Acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants.

Conclusions

Acupuncture therapy is safe and effective in treating MDD and PSD, and could be considered an alternative option for the two disorders. The efficacy in other forms of depression remains to be further determined.

Introduction

Although the development of various classes of antidepressant drugs, represented by selective serotonin reuptake inhibitors (SSRIs), has considerably improved the prognosis and the tolerability in the treatment of depressive disorders, the currently available antidepressant therapy is unsatisfactory (Arroll et al., 2005). There remains a large portion of depressed patients who cannot obtain full responses and experienced recurrent episodes. Furthermore, undesirable side effects and delay in the onset of the therapeutic action also have hampered the clinical use of antidepressant medications (Arroll et al., 2005). In order to overcome these shortcomings, strenuous attempts have been made to search for alternative strategies that could improve the outcomes of antidepressant treatments (van der Watt et al., 2008).

As an ancient therapeutic modality, acupuncture therapy has become a widely recognized alternative therapy in today clinical practice. As a result, numerous clinical studies aimed at evaluating the efficacy and safety of acupuncture in patients with depressive disorders have been reported over the past decades, especially for major depressive disorder (MDD) and post-stroke depression (PSD) (He and Shen, 2007, Leo and Ligot, 2007, Mukaino et al., 2005, Smith and Hay, 2005, Wang et al., 2008). Nonetheless, great discrepancies are present in the results reported and prior meta-analyses failed to yield significant conclusions, largely due to the incompleteness of data collection and lack of detailed subgroup analyses of different diagnoses of depressive disorders (Leo and Ligot, 2007, Mukaino et al., 2005, Smith and Hay, 2005, Wang et al., 2008).

In the present study, systematic review and meta-analysis performed to evaluate the effectiveness and safety of acupuncture therapy for depression were based on standardized classification of depressive disorders and the definition of high-quality randomized, controlled trials (RCTs) of MDD and PSD. The present study also included several newer trials which were not included in previous meta-analyses.

Section snippets

Search strategy

All case and controlled studies of acupuncture therapy in patients with various depressive disorders were searched. Since most relevant studies were published in English and Chinese bibliographies, the searches were mainly conducted in the following two language databases: PubMed (1950–), MEDLINE (1950–), Cochrane Central Register of Controlled Trials (CENTRAL), China Journals Full-text Database (1915–), China Master and Doctor Theses Full-text Database (1999–), and China Proceedings of

Classification of studies and depressive conditions

A total of 207 studies were retrieved (Table 1). Sixty-one (29.5%) were case studies and 93 (44.9%) were rated for poor-quality RCTs (Jadad score ≤ 2). The remaining 53 (25.6%) were identified for relatively high-quality RCTs (Jadad score ≥ 3). Although the studies covered six depressive conditions: MDD, PSD, postmenstrual depression (PMD), peri-natal depression (PND, including postpartum depression and depression during pregnancy), comorbid depression (CMD), and post-traumatic depression (PTD),

Discussion

The present study represents a systematic investigation reviewing clinical studies of acupuncture therapy in various depressive disorders and determining treatment effects in MDD and PSD with meta-analysis. Unlike previous meta-analyses, in which subgroup analyses for different treatment regimes and different diagnoses of depressive disorders were in general not conducted and poorly-designed RCTs were often included (Leo and Ligot, 2007, Mukaino et al., 2005, Smith and Hay, 2005), the present

Role of funding source

No any fund agencies listed herein have roles in the design, conduct and data analysis of this work.

Conflict of interest

All authors declare that they have no any conflict of interest in this study.

Acknowledgements

The present study was supported by the Hospital Authority of Hong Kong. The authors thank Mr. Steven E. Zhang for grammatically reading the manuscript.

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