Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review

Anxiety and depression are among the most common and challenging psychiatric disorders to treat in modern medicine, affecting nearly 50% of people at some point in life and accounting for approximately 15% of all disabilities. These conditions are particularly prevalent in the female population, with an incidence approximately twice as high as in the male population. Anxiety affects about 15.7 million people annually in the United States, while depression affects about 121 million people worldwide. Both conditions are characterized by high relapse rates, approaching 50%, and frequently present significant side effects from conventional treatments, such as antidepressant and anxiolytic medications.

Because of these limitations, many patients, especially women, have sought complementary and alternative therapies, such as acupuncture, which has gained growing popularity in the United States as a therapeutic option for affective disorders.

The objective of this study was to perform a systematic review of the existing scientific literature on the use of acupuncture as a treatment for anxiety and depression specifically in women, in addition to presenting a new method for evaluating the quality of acupuncture studies. The researchers conducted a comprehensive search in three electronic databases — Cochrane Central Register of Controlled Trials, MEDLINE, and Ovid — using keywords such as acupuncture, anxiety, depression, mood disorder, women, and female. Only randomized controlled studies published in English were included, in which acupuncture was compared with any control procedure in women with a clinical diagnosis of anxiety or depression. Two authors extracted the data independently and developed an innovative tool called QSAT (Quality Score for Acupuncture Trials), which evaluates the quality of studies considering specific aspects of acupuncture clinical trials, such as application method and duration of treatment, in addition to general characteristics applicable to all randomized controlled studies.

The review identified six articles that met the established inclusion and exclusion criteria. Four studies investigated depression, one studied anxiety, and one evaluated both conditions. Sample sizes ranged from 33 to 246 participants, totaling 605 women, of whom 347 received acupuncture treatment. Participants' ages ranged from 18 to 71 years, with four studies including only patients younger than 45 years.

Three studies were conducted in the United States and three in other countries (Brazil, Canada, and Norway). Two studies included exclusively pregnant women, one focused on menopausal women with vasomotor symptoms, one on women undergoing in vitro fertilization, and another on women in a substance dependence recovery program. Five studies used acupuncture as the sole treatment, while one used acupuncture as adjuvant therapy with counseling and psychotherapy. All six studies demonstrated a significant difference between acupuncture and at least one control group, indicating efficacy of the treatment.

For patients and health professionals, the results present promising evidence on the use of acupuncture in the treatment of anxiety and depression in women. The most robust clinical implications were found for pregnant women with major depression, where a high-quality study with 150 participants demonstrated that depression-specific acupuncture was significantly more effective than non-specific acupuncture. Considering that antidepressant medications can pose risks to fetal development, acupuncture emerges as a safe and effective therapeutic alternative for this population. Two high-quality studies also confirmed that acupuncture did not increase maternal or infant morbidity or mortality when compared with therapeutic massage.

For menopausal women with depressive and vasomotor symptoms, a moderate-quality study showed significant reduction in depressive symptoms, independently of improvement in hot flashes. For anxiety, two studies in specific populations (women undergoing in vitro fertilization and women in substance dependence recovery) showed promising results, although more high-quality studies are needed.

The limitations of the study include the restricted number of high-quality studies available, with only six studies meeting the inclusion criteria, and the heterogeneity of the populations studied, making broad generalizations difficult. Many acupuncture studies still have important methodological deficiencies, such as lack of adequate randomization, absence of double-blinding, and use of standardized acupuncture points instead of individualized treatments. The new QSAT tool developed by the authors, although promising for specifically evaluating acupuncture studies, still requires additional validation. The authors conclude that there is high-level scientific evidence to support the use of acupuncture in the treatment of major depressive disorder during pregnancy, while for other female populations the evidence is promising but still inconclusive.

More high-quality randomized controlled studies are needed to definitively establish the efficacy of acupuncture as monotherapy or adjuvant therapy for anxiety and depression in the general female population, especially considering that this is a therapeutic option with a favorable safety profile and potential to reduce dependence on medications with significant side effects.