Post-stroke depression (PSD) affects between 30% and 50% of stroke survivors and is associated with higher mortality, worse functional recovery, and significant reduction in quality of life. Despite its prevalence, pharmacologic management of PSD remains limited by drug intolerance, interactions with anticoagulants, and low therapeutic adherence in this population. A Bayesian network meta-analysis published in BMC Psychiatry in May 2023 gathered 62 randomized clinical trials and 5,308 participants to systematically compare the different therapeutic approaches available.
The study — conducted by Wai Lam Ching and colleagues from Hong Kong Baptist University — compared eight intervention categories: acupuncture (AC) alone, AC combined with repetitive transcranial magnetic stimulation (rTMS), traditional Chinese medicine (TCM) alone, TCM with Western medication, Western medication alone, acupuncture with moxibustion, cognitive therapy, and usual care. The primary endpoint was the severity of depressive symptoms assessed by the Hamilton Depression Rating Scale (HAMD), the reference standard for assessing depression in hospital settings.
STUDY DATA
Results: Bayesian ranking favors combinations with acupuncture
The Bayesian analysis indicated that acupuncture — alone or in combination — was associated with better SUCRA ranking performance than Western medication as monotherapy for reducing depressive symptoms measured by the HAMD. The combination of acupuncture with rTMS (AC+rTMS) reached the highest SUCRA ranking (49.43%), indicating greater relative probability of being the most effective intervention in the evaluated set — a result that should be interpreted with caution given the clinical and methodological heterogeneity across the included studies and the low-to-moderate GRADE quality.
In addition to mood outcomes, acupuncture-based interventions showed additional benefits in neurologic function scales — a relevant finding considering that post-stroke depression occurs in a context of concurrent neurologic recovery. Neurologic functional improvement may be both a direct consequence of the mechanisms of acupuncture on brain plasticity and a mediating factor for mood improvement.
Acupuncture modalities evaluated
The 62 included RCTs evaluated multiple technical variants of acupuncture. Scalp acupuncture was represented in part of the studies, leveraging its direct action on scalp zones that correspond to cortical areas related to mood and executive function — a mechanism distinct from conventional peripheral acupuncture. Electroacupuncture, with low-frequency electrical stimulation at points such as PC-6, HT-7, GV-20, and GV-24, was the most frequent modality in studies with the best effects on the HAMD.
Frequently Asked Questions
This NMA indicated that acupuncture was associated with better SUCRA ranking performance compared with Western pharmacotherapy as monotherapy for reducing depressive symptoms — a result that should be interpreted with caution given the heterogeneity and low-to-moderate GRADE quality. The decision to use acupuncture as a substitute for or complement to antidepressants should be individualized by the physician, considering the severity of the depression, profile of medications in use (anticoagulants, antiplatelets), tolerance, and patient preference. Acupuncture is particularly valuable in patients with intolerance or medication contraindications.
There is no single “most important” acupoint — the protocol is always individualized. The points most frequently used in studies with the best results include GV-20 (Baihui), GV-24 (Shenting), PC-6 (Neiguan), and HT-7 (Shenmen) for central antidepressant effect. Scalp acupuncture in the frontal zone (of Jiao) is used specifically for depression associated with frontal deficits. The medical acupuncturist evaluates the complete picture to define the protocol.
The studies included in this NMA varied in duration. Most RCTs with significant results used 4 to 8 weeks of treatment with 3–5 sessions per week. In clinical practice, it is reasonable to reassess response after 6–8 sessions to adjust the protocol. The antidepressant effect tends to be progressive, with perceptible improvement starting in the second or third week of consistent treatment.
Fonte Original
BMC Psychiatry(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).