Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials

Abstract

Objective: To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs.

Data retrieval: We retrieved data from the Chinese National Knowledge Infrastructure (1979-2012), Wanfang (1980-2012), VIP (1989-2012), Chinese Biomedical Literature (1975-2012), PubMed (1966-2012), Ovid Lww (-2012), and Cochrane Library (-2012) Database using the internet.

Selection criteria: Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the included articles scored at least 4 points on the Jadad scale.

Exclusion criteria: other acupuncture therapies as treatment group, not stroke-induced depression patients, score < 4 points, non-randomized controlled trials, or animal trials.

Main outcome measures: These were the Hamilton Depression Scale scores, clinical effective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events.

Results: A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with filiform needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval (CI): 1.03-1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale (17 items) scores were lower than in the antidepressant drug group (mean difference = -2.34, 95%CI: -3.46 to -1.22, P < 0.000,1). At 4 weeks, Hamilton Depression Scale (24 items) scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 articles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group.

Conclusion: Early filiform needle acupuncture for poststroke depression can perfectly control depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs.

Keywords: Stage-III Key Disciplines Construction Project; antidepressant drugs; clinical effective rate; filiform needle acupuncture; meta-analysis; nerve regeneration; neural regeneration; poststroke depression; randomized controlled trials; safety; the Guangdong Provincial “211 Engineering”.

Figure 1

Flow diagram for article retrieval.

Figure 2

Comparison of reducing score rate of the Hamilton Depression Scale after 4-week treatment with filiform needle acupuncture and fluoxetine for poststroke depression (retative risk). The total effective rate of filiform needle acupuncture was higher than that of fluoxetine. Reference sequence number of articles: Chi 2011[25], He 2009[40], Li 2009[33], Ma 2012[35], Sun 2012[37], Wang 2010[38], Zheng 2010[27], Zhu 2008[39]. CI: Confidence interval.

Figure 3

Comparison of reducing score rate of the Hamilton Depression Scale after 4-week treatment with filiform needle acupuncture and fluoxetine for poststroke depression (risk difference). After 4 weeks of treatment, the therapeutic effects of filiform needle acupuncture against poststroke depression were better than that of fluox-etine. Reference sequence number of articles: Chi 2011[25], He 2009[40], Li 2009[33], Ma 2012[35], Sun 2012[37], Wang 2010[38], Zheng 2010[27], Zhu 2008[39]. CI: Confidence interval.

Figure 4

Comparison of reducing score rate of the Hamilton Depression Scale after 6-weeks treatment with filiform needle acupuncture and fluoxetine for poststroke depression (retative risk). The reducing score rates of the Hamilton Depression Scale were identical between filiform needle acupuncture and fluoxetine groups. Reference sequence number of articles: Li 2011[32], Liu 2008[34], Sun 2010[36].

Figure 5

Comparison of reducing score rate of the Hamilton Depression Scale after 6-weeks treatment with filiform needle acupuncture and fluoxetine for poststroke depression (risk difference). After 6 weeks of treatment, the therapeutic effects of filiform needle acupuncture were similar to that of fluoxetine. Reference sequence number of articles: Li 2011[32], Liu 2008[34], Sun 2010[36].

Figure 6

Comparison of the Hamilton Depression Scale (17 items) between filiform needle acupuncture and fluoxetine groups at 2 weeks after treatment (fixed effect model). The Hamilton Depression Scale score was better in the filiform needle acupuncture group compared with the fluoxetine group. Reference sequence number of articles: Li 2009[33], Li 2011[32], Yang 2003[29], Zhu 2008[39].

Figure 7

Comparison of the Hamilton Depression Scale (17 items) between filiform needle acupuncture and fluoxetine groups at 2 weeks after treatment (random effect model). The Hamilton Depression Scale scores were significantly lower in the filiform needle acupuncture group than that in the fluoxetine group. Refer-ence sequence number of articles: Li 2009[33], Li 2011[32], Yang 2003[29], Zhu 2008[39].

Figure 8

Comparison of the Hamilton Depression Scale (24 items) between filiform needle acupuncture and fluoxetine groups at 4 weeks after treatment (random effect model). The therapeutic effects of filiform needle acupuncture and fluoxetine were identical. Reference sequence number of articles: Chi 2011[25], He 2009[40], Ma 2012[35], Sun 2010[36], Wang 2010[38], Zheng 2010[27], Zhou 2012[31].

Figure 9

Comparison of the Hamilton Depression Scale (24 items) between filiform needle acupuncture and fluoxetine groups at 4 weeks after treatment (fixed effect model). The therapeutic effects of filiform needle acupuncture and fluoxetine were identical. Reference sequence number of articles: Chi 2011[25], He 2009[40], Ma 2012[35], Sun 2010[37], Wang 2010[38], Zheng 2010[27], Zhou 2012[31].

Figure 10

Funnel plot of meta-analysis of filiform needle acupuncture and antidepressant drugs for poststroke depression. Partial graph was not symmetrical, indicating that the included articles showed publication bias.