Article type
Year
Abstract
Background: depression is a highly prevalent mental disorder, and is the leading cause of years lived with disability counts for nearly three decades. Acupuncture is widely used in China and some other part of the world to help patients with depression.
Objectives: to evaluate effects and safety of acupuncture for depression.
Methods: we performed a systematic review and network meta-analysis on randomized controlled trials in adults with unipolar depression identified from PubMed, the Cochrane Library, Embase, PsycINFO, China National Knowledge Infrastructure, VIP database, SinoMed, Wanfang database, ClinicalTrials.gov and Chinese Clinical Trials Registry. Studies had to include at least two of the following treatments: acupuncture, selective serotonin reuptake inhibitors (SSRIs), psychotherapy, acupuncture plus SSRIs, acupuncture plus psychotherapy, or SSRIs plus psychotherapy, and we did not include studies without any combination to acupuncture. Primary outcome was efficacy (we calculated a Cohen’s d effect size (ES) according to the results of clinician-administered scales and patient self-rating scales), secondary outcomes include safety (ES of safety scales) and attrition (study discontinuations for any cause) of the treatment.
Results: we screened 8976 potential studies. We included 183 trials (comprising 15,835 participants) published between 1996 and 2017. Compared with SSRIs, in terms of efficacy (181 RCTs), acupuncture plus psychotherapy, SSRIs plus psychotherapy, acupuncture plus SSRIs and acupuncture alone were more effective, with ES −1.22 (95% credible interval (CrI) −1.69 to −0.73), −0.92 (−1.68 to −0.16), −0.86 (−1.03 to −0.68) and −0.32 (−0.47 to −0.16) respectively (Figure 1, Figure 2). In terms of safety (31 RCTs), acupuncture (ES −3.57, 95% CrI −5.43 to −1.74) and acupuncture plus SSRIs (ES −1.68, 95% CrI −3.06 to −0.29) were associated with fewer adverse events than SSRIs. In terms of attrition (53 RCTs), acupuncture (odds ratio 0.57, 95% CrI 0.35 to 0.87) was associated with fewer dropouts than SSRIs; by contrast, other treatments showed no difference with SSRIs. The certainty of evidence (based on CINeMA GRADE) for the relative treatment effects of efficacy and safety were varied; it was low or very low for most comparisons involving SSRIs and acupuncture.
Conclusions: the rank of effect of treatments from high to low is: acupuncture plus psychotherapy (94.4%), SSRIs plus psychotherapy (72.5%), acupuncture plus SSRIs (69.7%), acupuncture (31.4%), psychotherapy (29.1%), and SSRIs (2.9%). The combination therapies showed better effects. Acupuncture and acupuncture plus SSRIs showed fewer adverse events than SSRIs alone. Acupuncture groups had lower dropout rates than SSRI groups.
Patient or healthcare consumer involvement: no patient or public was involved in the design or planning of this study. It was not evaluated whether the studies included in the review had any patient involvement.
Objectives: to evaluate effects and safety of acupuncture for depression.
Methods: we performed a systematic review and network meta-analysis on randomized controlled trials in adults with unipolar depression identified from PubMed, the Cochrane Library, Embase, PsycINFO, China National Knowledge Infrastructure, VIP database, SinoMed, Wanfang database, ClinicalTrials.gov and Chinese Clinical Trials Registry. Studies had to include at least two of the following treatments: acupuncture, selective serotonin reuptake inhibitors (SSRIs), psychotherapy, acupuncture plus SSRIs, acupuncture plus psychotherapy, or SSRIs plus psychotherapy, and we did not include studies without any combination to acupuncture. Primary outcome was efficacy (we calculated a Cohen’s d effect size (ES) according to the results of clinician-administered scales and patient self-rating scales), secondary outcomes include safety (ES of safety scales) and attrition (study discontinuations for any cause) of the treatment.
Results: we screened 8976 potential studies. We included 183 trials (comprising 15,835 participants) published between 1996 and 2017. Compared with SSRIs, in terms of efficacy (181 RCTs), acupuncture plus psychotherapy, SSRIs plus psychotherapy, acupuncture plus SSRIs and acupuncture alone were more effective, with ES −1.22 (95% credible interval (CrI) −1.69 to −0.73), −0.92 (−1.68 to −0.16), −0.86 (−1.03 to −0.68) and −0.32 (−0.47 to −0.16) respectively (Figure 1, Figure 2). In terms of safety (31 RCTs), acupuncture (ES −3.57, 95% CrI −5.43 to −1.74) and acupuncture plus SSRIs (ES −1.68, 95% CrI −3.06 to −0.29) were associated with fewer adverse events than SSRIs. In terms of attrition (53 RCTs), acupuncture (odds ratio 0.57, 95% CrI 0.35 to 0.87) was associated with fewer dropouts than SSRIs; by contrast, other treatments showed no difference with SSRIs. The certainty of evidence (based on CINeMA GRADE) for the relative treatment effects of efficacy and safety were varied; it was low or very low for most comparisons involving SSRIs and acupuncture.
Conclusions: the rank of effect of treatments from high to low is: acupuncture plus psychotherapy (94.4%), SSRIs plus psychotherapy (72.5%), acupuncture plus SSRIs (69.7%), acupuncture (31.4%), psychotherapy (29.1%), and SSRIs (2.9%). The combination therapies showed better effects. Acupuncture and acupuncture plus SSRIs showed fewer adverse events than SSRIs alone. Acupuncture groups had lower dropout rates than SSRI groups.
Patient or healthcare consumer involvement: no patient or public was involved in the design or planning of this study. It was not evaluated whether the studies included in the review had any patient involvement.