Acupuncture treatment for depression-A systematic review and meta-analysis

Aim of the study: To assess the beneficial effects of acupuncture in patients with depression and to evaluate the report quality of acupuncture treatment for depression in randomized controlled trials and systematic reviews. Introduction: Acupuncture has a long history of treating illnesses which we today in a biomedical context would understand and recognize as depression. Also in contemporary China and in the West patients are trying acupuncture as a treatment for depression. Randomized controlled trials have been conducted to investigate its efficacy. Materials and methods: The following electronic databases were searched: the Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO and PUBMED. These searches ended in January 2009. In addition new searches were completed in Asian databases in February 2010. Standard guidelines were followed when the methodological quality of the RCTs were assessed, including CONSORT and the criteria in the Cochrane Handbook. Systematic reviews were evaluated using the PRISMA checklist. Results: Four systematic reviews and 26 RCTs on acupuncture for treatment of depression were identified and included in this review. The methodological quality of the trial reports was generally low in terms of generation of the allocation sequence, allocation concealment, blinding and intention to treat. A significant beneficial effect was found for acupuncture in improvement of depression compared to pooled control measured by Hamilton Rating Scale for Depression(WMD-3.10, 95% CI-4.91 to-1.99, P = 0.0008). Subgroup analysis suggested that electro-acupuncture (WMD-0.68, 95% CI-1.49 to 0.13, P=0.10) and TCM acupuncture (WMD 0.79, 95% CI-0.93 to 2.52, P=0.37), were not statistically different from medication. Acupuncture was regarded as generally safe in the clinical trials included in this review. Conclusions: Current evidence from this meta-analysis of randomized trials shows that acupuncture is effective in reducing severity of depression and that TCM-and electro acupuncture may have similar effect as current usual care. More rigorous trials are needed and long-term effects should be investigated if acupuncture is to be recommended for clinical use. (C) 2011 Elsevier GmbH. All rights reserved.