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

IF 3.7 2区 医学 Q1 PSYCHIATRY
Lei Yang , Qin Zhang , Min Wen , Sini Li , Aijuan Lu , Kang Li , Ciyan Peng , Jing Chen
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引用次数: 0

Abstract

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, R2 = 0.164), treatment duration (b = 0.056, β = 0.324, 95 % CI [0.01, 0.10], p = 0.016, R2 = 0.105) and disease duration (b = 0.045, β = 0.245, 95 % CI [−0.01, 0.10], p = 0.009, R2 = 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.
针灸辅助治疗抑郁症的临床证据:系统回顾和meta回归分析。
背景:针灸辅助药物治疗抑郁症的临床应用研究正在不断扩大,但研究结果并不一致,两种方法之间的调节因素尚不清楚。评估针灸辅助治疗联合选择性5 -羟色胺再摄取抑制剂(SSRIs)或5 -羟色胺-去甲肾上腺素再摄取抑制剂(SNRIs)治疗抑郁症的疗效和安全性,与单独使用抗抑郁药物进行比较,并确定针灸辅助治疗对抑郁症的调节作用和是否存在发表偏倚。方法:在无语言限制的情况下,对7个英文数据库和4个中文生物医学数据库(INPLASY202420002)进行全面检索。随机对照试验(RCTs)纳入年龄≥18岁的抑郁症患者,研究针灸辅助用药(SSRIs/SNRIs)与单独使用SSRIs/SNRIs的效果。采用随机效应模型计算纳入的随机对照试验的效应量,并采用元回归分析针灸辅助干预的潜在调节因子。主要结局包括针灸辅助干预前后的抑郁严重程度、自评或临床量表测量的变化和不良反应。次要结局是治疗缓解率和干预后缓解率。结果:我们的荟萃分析纳入了66项研究,5744名参与者。针刺辅助干预SSRIs或SNRIs显著降低汉密尔顿抑郁(HAMD)评分(标准化平均差[SMD] = -1.185, 95%可信区间[CI][-1.43, -0.94]),以及副作用评定量表[SERS]和治疗-紧急症状量表(TESS)评分(SERS: SMD = -0.896, 95% CI [-1.39, -0.94];TESS: SMD = -1.469, 95% CI[-2.18, -0.76]),同时与对照组相比,有效提高了治疗反应(RR = 1.391, 95% CI[1.28, 1.51])和缓解(RR = 1.597, 95% CI[1.45, 1.76])率。回归分析表明,基线HAMD评分(b = 0.405, β = 0.405, 95% CI [0.15, 0.66], p = 0.002, R2 = 0.164)、治疗时间(b = 0.056, β = 0.324, 95% CI [0.01, 0.10], p = 0.016, R2 = 0.105)和病程(b = 0.045, β = 0.245, 95% CI [-0.01, 0.10], p = 0.009, R2 = 0.060)是针灸辅助治疗的有效调节因子。结论:本系统综述和荟萃分析证明了针灸干预抑郁症的有效性,表明它是一种可行的循证治疗选择。然而,研究的高度异质性、发表偏倚的存在,以及许多研究中缺乏假针灸对照,限制了这些结论的强度。未来的研究应侧重于多中心、多区域和严格的试验,以假针灸为对照,阐明针灸辅助干预与抑郁症之间的关系,为临床指南和健康保险系统提供信息,以减轻当前临床护理的压力。同时,临床医生在决定是否推荐针灸作为抑郁症的辅助治疗时,应该考虑到这些局限性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
General hospital psychiatry
General hospital psychiatry 医学-精神病学
CiteScore
9.60
自引率
2.90%
发文量
125
审稿时长
20 days
期刊介绍: General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.
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