A network meta-analysis on the effectiveness and safety of acupuncture in treating patients with major depressive disorder

Hu Zhichao,Wang Zhiyu,Yao Liang,Zhong L D Linda,Bian Zhaoxiang,Li Huijuan,Huang Weiyang,Lam Wai Ching

doi:10.1038/s41598-021-88263-y

Abstract

Acupuncture is an important alternative therapy in treating major depressive disorder (MDD), but its efficacy and safety are still not well assessed. This study is the first network meta-analysis exploring the effectiveness and safety of acupuncture, common pharmacological treatments or other non-medication therapies for MDD. Eight databases including PubMed, Embase, Allied and Complementary Medicine Database, Cochrane Library, Wan Fang Data, China National Knowledge Infrastructure, China Biology Medicine disc, and Chongqing VIP Database were searched up to Jan 17, 2021. Articles were screened and selected by two reviewers independently. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence. A total of 71 eligible studies were included. The network analysis results indicated that the combined interventions of electro-acupuncture (EA) with selective serotonin reuptake inhibitors (SSRIs) and manual acupuncture (MA) with SSRIs were more effective in improving depression symptoms compared with acupuncture alone, pharmacological interventions alone, or other inactive groups. Among all the regimens, EA with SSRIs was found to have the highest effect in improving depression symptoms of MDD. In addition, there were slight differences in the estimations of the various treatment durations. The combination of acupuncture and serotonin-norepinephrine reuptake inhibitors (SNRIs) was found to be more effective than SNRIs alone. In conclusion, acupuncture and its combinations could be safe and effective interventions for MDD patients. EA with SSRIs seems to be the most effective intervention among the assessed interventions. Well-designed and large-scale studies with long-term follow-up should be conducted in the future.

Highlights

Under the synthesis of data, we suggest that acupuncture with common pharmacological treatments could be considered as better therapeutic approaches
This study had several limitations: (i) various outcome measures were collected, only HAMD was included in NMA because of insufficient data from the other scales; (ii) included studies were mainly carried out in Chinese populations; (iii) incomplete reporting of trial details might have affected the reliability of results; (iv) only 9 types of interventions were analyzed for the main network analysis
Well-designed and large-scale studies with long-term follow-up should be conducted in the future

Summary

Methods

Side Effect Rating Scale (SERS), Treatment Emergent Symptom Scale (TESS), and the number of adverse events or patients dropping out of the study due to any reason were defined as the primary safety outcome. The size of the node and the width of the edges in the network plot were both weighted according to the number of studies involved in each direct comparison. The effects of multiple interventions were compared by estimating mean differences (MDs) on the change score between final and baseline scores on depression symptoms measured by the same scales. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used to assess the certainty of the direct, indirect, and network estimates for all outcomes. We used the MAGICapp platform to develop GRADE summary of finding tables for each outcome

Results

Study design

Discussion

Conclusion