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

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. (C) 2009 Elsevier B.V. All rights reserved.