Efficacy and safety of acupuncture for depression: A systematic review and meta-analysis

This systematic review and network meta-analysis examined the efficacy and safety of acupuncture for the treatment of depression, analyzing 22 randomized controlled trials with 2,391 participants. The study followed PRISMA guidelines and included searches across five databases through October 2021. The investigators examined different acupuncture modalities: manual acupuncture (MA), electroacupuncture (EA), and laser acupuncture, both as monotherapy and in combination with antidepressants. Study quality was assessed using the Cochrane Risk of Bias tool, version 2.

The included studies were conducted predominantly in China (13 studies), Australia (3), the United States (3), the United Kingdom (2), and Germany (1). Participants had a clinical diagnosis of depression and a mean age of 18 years or older. The number of sessions ranged from 8 to 56, with treatment durations from 3 weeks to 3 months. The most frequently used acupuncture points were Baihui (GV-20), Shenting (GV-24), and Yintang (EX-HN3).

The network meta-analysis showed that electroacupuncture combined with antidepressants achieved superior outcomes compared with the waiting list (standardized mean difference = -8.86; 95% CI: -14.78 to -2.93). Treatment ranking demonstrated that EA + antidepressant had the highest probability of efficacy (82.94%), followed by MA + antidepressant (64.70%) and MA alone (52.32%). In direct comparisons, both EA and MA combined with antidepressants proved superior to antidepressants alone. However, when compared with sham acupuncture, the acupuncture modalities did not demonstrate significant benefits, possibly owing to the physiologic effects of sham acupuncture itself.

Eighteen of the 22 studies reported adverse events, which were predominantly mild and included headache, dizziness, fatigue, and nausea. All adverse events resolved without the need for additional intervention. Publication-bias analysis using the Egger test showed no significant differences (p = 0.8977). Study limitations include substantial heterogeneity among treatment regimens, lack of standardization of acupuncture modalities, and the inclusion of only English-language publications.

In addition, only 12 studies reported post-treatment follow-up, limiting the assessment of sustained benefit. The findings suggest that acupuncture, particularly as adjuvant therapy to conventional antidepressants, represents a safe and effective therapeutic option for the management of depression. This evidence supports current clinical guidelines that recommend acupuncture as a complementary therapy for major depressive disorder.