ReviewThe effectiveness and safety of acupuncture therapy in depressive disorders: Systematic review and meta-analysis
Introduction
Although the development of various classes of antidepressant drugs, represented by selective serotonin reuptake inhibitors (SSRIs), has considerably improved the prognosis and the tolerability in the treatment of depressive disorders, the currently available antidepressant therapy is unsatisfactory (Arroll et al., 2005). There remains a large portion of depressed patients who cannot obtain full responses and experienced recurrent episodes. Furthermore, undesirable side effects and delay in the onset of the therapeutic action also have hampered the clinical use of antidepressant medications (Arroll et al., 2005). In order to overcome these shortcomings, strenuous attempts have been made to search for alternative strategies that could improve the outcomes of antidepressant treatments (van der Watt et al., 2008).
As an ancient therapeutic modality, acupuncture therapy has become a widely recognized alternative therapy in today clinical practice. As a result, numerous clinical studies aimed at evaluating the efficacy and safety of acupuncture in patients with depressive disorders have been reported over the past decades, especially for major depressive disorder (MDD) and post-stroke depression (PSD) (He and Shen, 2007, Leo and Ligot, 2007, Mukaino et al., 2005, Smith and Hay, 2005, Wang et al., 2008). Nonetheless, great discrepancies are present in the results reported and prior meta-analyses failed to yield significant conclusions, largely due to the incompleteness of data collection and lack of detailed subgroup analyses of different diagnoses of depressive disorders (Leo and Ligot, 2007, Mukaino et al., 2005, Smith and Hay, 2005, Wang et al., 2008).
In the present study, systematic review and meta-analysis performed to evaluate the effectiveness and safety of acupuncture therapy for depression were based on standardized classification of depressive disorders and the definition of high-quality randomized, controlled trials (RCTs) of MDD and PSD. The present study also included several newer trials which were not included in previous meta-analyses.
Section snippets
Search strategy
All case and controlled studies of acupuncture therapy in patients with various depressive disorders were searched. Since most relevant studies were published in English and Chinese bibliographies, the searches were mainly conducted in the following two language databases: PubMed (1950–), MEDLINE (1950–), Cochrane Central Register of Controlled Trials (CENTRAL), China Journals Full-text Database (1915–), China Master and Doctor Theses Full-text Database (1999–), and China Proceedings of
Classification of studies and depressive conditions
A total of 207 studies were retrieved (Table 1). Sixty-one (29.5%) were case studies and 93 (44.9%) were rated for poor-quality RCTs (Jadad score ≤ 2). The remaining 53 (25.6%) were identified for relatively high-quality RCTs (Jadad score ≥ 3). Although the studies covered six depressive conditions: MDD, PSD, postmenstrual depression (PMD), peri-natal depression (PND, including postpartum depression and depression during pregnancy), comorbid depression (CMD), and post-traumatic depression (PTD),
Discussion
The present study represents a systematic investigation reviewing clinical studies of acupuncture therapy in various depressive disorders and determining treatment effects in MDD and PSD with meta-analysis. Unlike previous meta-analyses, in which subgroup analyses for different treatment regimes and different diagnoses of depressive disorders were in general not conducted and poorly-designed RCTs were often included (Leo and Ligot, 2007, Mukaino et al., 2005, Smith and Hay, 2005), the present
Role of funding source
No any fund agencies listed herein have roles in the design, conduct and data analysis of this work.
Conflict of interest
All authors declare that they have no any conflict of interest in this study.
Acknowledgements
The present study was supported by the Hospital Authority of Hong Kong. The authors thank Mr. Steven E. Zhang for grammatically reading the manuscript.
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