Clinical evidence for acupuncture-assisted treatment of depression: A systematic review and meta-analysis with meta-regression

Background Research exploring the clinical application of acupuncture-assisted drug treatment for depression is expanding, yet the findings remain inconsistent, and the moderating factors between the two approaches remain unclear.To assess the efficacy and safety of acupuncture-assisted treatment combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) for depression compared with antidepressant medication alone and to identify the moderating effects of acupuncture-assisted treatment on depression and the presence of publication bias. Methods We conducted a comprehensive search of seven English-language databases and four Chinese-language biomedical databases from inception to December 2024 (INPLASY202420002), without language restrictions.Randomized controlled trials (RCTs) involving participants aged ≥18 years diagnosed with depression and investigating the effects of acupuncture-assisted medication (SSRIs/SNRIs) versus SSRIs/SNRIs alone were included. Random-effects models were used to calculate effect sizes for the included RCTs, and meta-regression was used to analyse potential moderators of acupuncture-assisted interventions. Primary outcomes included depression severity before and after acupuncture-assisted intervention, change measured by self-rating or clinical scales and adverse effects. Secondary outcomes were treatment response rate and remission rate post-intervention. Results Our meta-analysis incorporated 66 studies with 5744 participants. Acupuncture-assisted interventions with SSRIs or SNRIs significantly reduced the Hamilton Depression (HAMD) scores (standardised mean difference [SMD] = −1.185, 95 % confidence interval [CI] [−1.43, −0.94]), as well as the Side Effects Rating Scale [SERS] and Treatment-Emergent Symptoms Scale (TESS) scores (SERS: SMD = −0.896, 95 % CI [−1.39, −0.94]; TESS: SMD = −1.469, 95 % CI [−2.18, −0.76]), while effectively increasing the treatment response (RR = 1.391, 95 % CI [1.28, 1.51]) and remission (RR = 1.597, 95 % CI [1.45, 1.76]) rates compared with controls. Regression analyses indicated that baseline HAMD score (b = 0.405, β = 0.405, 95 % CI [0.15, 0.66], p = 0.002, R 2 = 0.164), treatment duration (b = 0.056, β = 0.324, 95 % CI [0.01, 0.10], p = 0.016, R 2 = 0.105) and disease duration (b = 0.045, β = 0.245, 95 % CI [−0.01, 0.10], p = 0.009, R 2 = 0.060) appear to be effective moderators of acupuncture-assisted treatment. Conclusion This systematic review and meta-analysis demonstrate the efficacy of acupuncture interventions for depression, suggesting it as a viable evidence-based treatment option. However, the high heterogeneity of the studies, the presence of publication bias, and the lack of sham acupuncture controls in many studies limit the strength of these conclusions. Future research should focus on multi-centre, multi-regional and rigorous trials with sham acupuncture controls to elucidate the relationship between acupuncture-assisted interventions and depression, informing clinical guidelines and health insurance systems to alleviate current pressures on clinical care. In the meantime, clinicians should consider these limitations when deciding whether to recommend acupuncture as an adjunctive treatment for depression.