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Meta-Analysis
. 2018 Mar 4;3(3):CD004046.
doi: 10.1002/14651858.CD004046.pub4.

Acupuncture for depression

Caroline A Smith  1 , Mike Armour, Myeong Soo Lee, Li-Qiong Wang, Phillipa J Hay
Affiliations
Meta-Analysis

Acupuncture for depression

Caroline A Smith et al. Cochrane Database Syst Rev. .

Abstract

Background: Depression is recognised as a major public health problem that has a substantial impact on individuals and on society. People with depression may consider using complementary therapies such as acupuncture, and an increasing body of research has been undertaken to assess the effectiveness of acupuncture for treatment of individuals with depression. This is the second update of this review.

Objectives: To examine the effectiveness and adverse effects of acupuncture for treatment of individuals with depression.To determine:• Whether acupuncture is more effective than treatment as usual/no treatment/wait list control for treating and improving quality of life for individuals with depression.• Whether acupuncture is more effective than control acupuncture for treating and improving quality of life for individuals with depression.• Whether acupuncture is more effective than pharmacological therapies for treating and improving quality of life for individuals with depression.• Whether acupuncture plus pharmacological therapy is more effective than pharmacological therapy alone for treating and improving quality of life for individuals with depression.• Whether acupuncture is more effective than psychological therapies for treating and improving quality of life for individuals with depression.• Adverse effects of acupuncture compared with treatment as usual/no treatment/wait list control, control acupuncture, pharmacological therapies, and psychological therapies for treatment of individuals with depression.

Search methods: We searched the following databases to June 2016: Cochrane Common Mental Disorders Group Controlled Trials Register (CCMD-CTR), Korean Studies Information Service System (KISS), DBPIA (Korean article database website), Korea Institute of Science and Technology Information, Research Information Service System (RISS), Korea Med, Korean Medical Database (KM base), and Oriental Medicine Advanced Searching Integrated System (OASIS), as well as several Korean medical journals.

Selection criteria: Review criteria called for inclusion of all published and unpublished randomised controlled trials comparing acupuncture versus control acupuncture, no treatment, medication, other structured psychotherapies (cognitive-behavioural therapy, psychotherapy, or counselling), or standard care. Modes of treatment included acupuncture, electro-acupuncture, and laser acupuncture. Participants included adult men and women with depression diagnosed by Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), Research Diagnostic Criteria (RDC), International Statistical Classification of Diseases and Related Health Problems (ICD), or Chinese Classification of Mental Disorders Third Edition Revised (CCMD-3-R). If necessary, we used trial authors' definitions of depressive disorder.

Data collection and analysis: We performed meta-analyses using risk ratios (RRs) for dichotomous outcomes and standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Primary outcomes were reduction in the severity of depression, measured by self-rating scales or by clinician-rated scales, and improvement in depression, defined as remission versus no remission. We assessed evidence quality using the GRADE method.

Main results: This review is an update of previous versions and includes 64 studies (7104 participants). Most studies were at high risk of performance bias, at high or unclear risk of detection bias, and at low or unclear risk of selection bias, attrition bias, reporting bias, and other bias.Acupuncture versus no treatment/wait list/treatment as usualWe found low-quality evidence suggesting that acupuncture (manual and electro-) may moderately reduce the severity of depression by end of treatment (SMD -0.66, 95% CI -1.06 to -0.25, five trials, 488 participants). It is unclear whether data show differences between groups in the risk of adverse events (RR 0.89, 95% CI 0.35 to 2.24, one trial, 302 participants; low-quality evidence).Acupuncture versus control acupuncture (invasive, non-invasive sham controls)Acupuncture may be associated with a small reduction in the severity of depression of 1.69 points on the Hamilton Depression Rating Scale (HAMD) by end of treatment (95% CI -3.33 to -0.05, 14 trials, 841 participants; low-quality evidence). It is unclear whether data show differences between groups in the risk of adverse events (RR 1.63, 95% CI 0.93 to 2.86, five trials, 300 participants; moderate-quality evidence).Acupuncture versus medicationWe found very low-quality evidence suggesting that acupuncture may confer small benefit in reducing the severity of depression by end of treatment (SMD -0.23, 95% CI -0.40 to -0.05, 31 trials, 3127 participants). Studies show substantial variation resulting from use of different classes of medications and different modes of acupuncture stimulation. Very low-quality evidence suggests lower ratings of adverse events following acupuncture compared with medication alone, as measured by the Montgomery-Asberg Depression Rating Scale (MADRS) (mean difference (MD) -4.32, 95% CI -7.41 to -1.23, three trials, 481 participants).Acupuncture plus medication versus medication aloneWe found very low-quality evidence suggesting that acupuncture is highly beneficial in reducing the severity of depression by end of treatment (SMD -1.15, 95% CI -1.63 to -0.66, 11 trials, 775 participants). Studies show substantial variation resulting from use of different modes of acupuncture stimulation. It is unclear whether differences in adverse events are associated with different modes of acupuncture (SMD -1.32, 95% CI -2.86 to 0.23, three trials, 200 participants; very low-quality evidence).Acupuncture versus psychological therapyIt is unclear whether data show differences between acupuncture and psychological therapy in the severity of depression by end of treatment (SMD -0.5, 95% CI -1.33 to 0.33, two trials, 497 participants; low-quality evidence). Low-quality evidence suggests no differences between groups in rates of adverse events (RR 0.62, 95% CI 0.29 to 1.33, one trial, 452 participants).

Authors' conclusions: The reduction in severity of depression was less when acupuncture was compared with control acupuncture than when acupuncture was compared with no treatment control, although in both cases, results were rated as providing low-quality evidence. The reduction in severity of depression with acupuncture given alone or in conjunction with medication versus medication alone is uncertain owing to the very low quality of evidence. The effect of acupuncture compared with psychological therapy is unclear. The risk of adverse events with acupuncture is also unclear, as most trials did not report adverse events adequately. Few studies included follow-up periods or assessed important outcomes such as quality of life. High-quality randomised controlled trials are urgently needed to examine the clinical efficacy and acceptability of acupuncture, as well as its effectiveness, compared with acupuncture controls, medication, or psychological therapies.

PubMed Disclaimer

Conflict of interest statement

CS, LQW, MSL, PH: none known.

MA is not currently in clinical practice but remains the director of a private acupuncture and physiotherapy practice.

CA and MA as members of NICM declare that as a medical research institute, NICM receives research grants and donations from foundations, universities, government agencies, and industry. Sponsors and donors provide untied funding for work done to advance the vision and mission of the Institute. In general, NICM respects confidentiality in these arrangements, so as to avoid any likelihood of generating unwelcome further solicitations to the donor or sponsor from outside parties.

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Review authors' judgements about each 'risk of bias' domain for each included study.
4
4
Forest plot of comparison: 1 Acupuncture versus no treatment/wait list/TAU, outcome: 1.1 Severity of depression at the end of treatment.
5
5
Forest plot of comparison: 2 Acupuncture versus control acupuncture, outcome: 2.1 Severity of depression at the end of the intervention.
6
6
Forest plot of comparison: 3 Acupuncture versus medication, outcome: 3.1 Severity of depression at the end of treatment.
7
7
Forest plot of comparison: 4 Acupuncture plus medication vs medication, outcome: 4.1 Severity of depression at the end of treatment.
8
8
Funnel plot of comparison: 2 Acupuncture versus control acupuncture, outcome: 2.1 Severity of depression at the end of the intervention.
9
9
Funnel plot of comparison: 3 Acupuncture versus medication, outcome: 3.1 Severity of depression at the end of treatment.
10
10
Funnel plot of comparison: 4 Acupuncture plus medication vs medication, outcome: 4.1 Severity of depression at the end of treatment.
1.1
1.1. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 1 Severity of depression at the end of treatment.
1.2
1.2. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 2 Adverse events.
1.3
1.3. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 3 Severity of depression during treatment.
1.4
1.4. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 4 Severity of depression 0‐6 months after treatment.
1.5
1.5. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 5 Severity of depression 6‐12 months after treatment.
1.6
1.6. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 6 Remission of depression.
1.7
1.7. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 7 Change in use of medication at the end of treatment.
1.8
1.8. Analysis
Comparison 1 Acupuncture versus no treatment/wait list/TAU, Outcome 8 Dropout from treatment.
2.1
2.1. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 1 Severity of depression at the end of the intervention.
2.2
2.2. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 2 Adverse events.
2.3
2.3. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 3 Severity of depression during treatment.
2.4
2.4. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 4 Severity of depression at 0‐6 months' follow‐up.
2.5
2.5. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 5 Remission of depression.
2.6
2.6. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 6 Quality of life (emotional) during treatment.
2.7
2.7. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 7 Quality of life (emotional) at the end of treatment.
2.8
2.8. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 8 Quality of life (physical) during treatment.
2.9
2.9. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 9 Quality of life (physical) at the end of treatment.
2.10
2.10. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 10 Change in medication.
2.11
2.11. Analysis
Comparison 2 Acupuncture versus control acupuncture, Outcome 11 Dropout from treatment.
3.1
3.1. Analysis
Comparison 3 Acupuncture versus medication, Outcome 1 Severity of depression at the end of treatment.
3.2
3.2. Analysis
Comparison 3 Acupuncture versus medication, Outcome 2 Adverse events.
3.3
3.3. Analysis
Comparison 3 Acupuncture versus medication, Outcome 3 Severity of depression during treatment.
3.4
3.4. Analysis
Comparison 3 Acupuncture versus medication, Outcome 4 Severity of depression 0‐6 months after treatment.
3.5
3.5. Analysis
Comparison 3 Acupuncture versus medication, Outcome 5 Remission of depression.
3.6
3.6. Analysis
Comparison 3 Acupuncture versus medication, Outcome 6 Dropout from treatment.
4.1
4.1. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 1 Severity of depression at the end of treatment.
4.2
4.2. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 2 Adverse events.
4.3
4.3. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 3 Severity of depression during treatment.
4.4
4.4. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 4 Remission of depression.
4.5
4.5. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 5 Quality of life (physical).
4.6
4.6. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 6 Quality of life (emotional).
4.7
4.7. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 7 Change in use of medication.
4.8
4.8. Analysis
Comparison 4 Acupuncture plus medication versus medication, Outcome 8 Dropout from treatment.
5.1
5.1. Analysis
Comparison 5 Acupuncture versus psychological therapy, Outcome 1 Severity of depression at the end of treatment.
5.2
5.2. Analysis
Comparison 5 Acupuncture versus psychological therapy, Outcome 2 Adverse events.
5.3
5.3. Analysis
Comparison 5 Acupuncture versus psychological therapy, Outcome 3 Severity of depression 0‐6 months after treatment.
5.4
5.4. Analysis
Comparison 5 Acupuncture versus psychological therapy, Outcome 4 Severity of depression 6‐12 months.
5.6
5.6. Analysis
Comparison 5 Acupuncture versus psychological therapy, Outcome 6 Change in use of medication.
5.7
5.7. Analysis
Comparison 5 Acupuncture versus psychological therapy, Outcome 7 Dropout from treatment.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Fan 2013 {published data only}
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He 2012 {published data only}
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Huang 2013 {published data only}
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Li 2004 {published data only}
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Li 2007 {published data only}
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Li 2008 {published data only}
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Li 2011b {published data only}
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Lin 2012 {published data only}
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Liu 2006 {published data only}
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Liu 2013a {published data only}
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Liu 2015 {published data only}
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Luo 1985 {published data only}
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Luo 1988 {published data only}
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Luo 1998 {published data only}
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Lv 2015 {published data only}
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Ma 2011 {published data only}
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Ma 2012 {published data only}
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MacPherson 2013 {published data only}
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Pei 2006 {published data only}
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Qiao 2007 {published data only}
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Qu 2013 {published data only}
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Quah‐Smith 2005 {published data only}
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Quah‐Smith 2013 {published data only}
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Roschke 2000 {published data only}
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Shen 2005 {published data only}
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Sun 2010 {published data only}
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Sun 2013 {published data only}
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Sun 2015b {published data only}
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Tang 2003 {published data only}
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Wang 2014 {published data only}
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Wenbin 2002 {published data only}
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Whiting 2008 {published data only}
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Xiujuan 1994 {published data only}
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Xu 2011 {published data only}
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Yan 2004 {published data only}
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Yeung 2011b {published data only}
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Zhang 2003 {published data only}
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Zhang 2005a {published data only}
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Zhang 2007 {published data only}
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Zhang 2007a {published data only}
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Zhang 2009 {published data only}
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Zhang 2012 {published data only}
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Zhuang 2004 {published data only}
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References to studies excluded from this review

Agelink 2003 {published data only}
    1. Agelink MW, Sanner D, Elch H, Pach J, Bertling R, Lemmer W, et al. Does acupuncture influence cardiac autonomic nervous system in patients with minor depression or anxiety disorders. Fortschritte der Neurologie und Psychiatrie 2003;71:141‐9. - PubMed
Arvidsdotter 2014 {published data only}
    1. Arvidsdotter T, Bertil Marklund B, Taft C. Six‐month effects of integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients ‐ follow up from an open,pragmatic randomized controlled trial. BMC Complementary and Alternative Medicine 2014;14:210. - PMC - PubMed
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    1. Bennett CF. Treatment effects of acupuncture on anxiety and depression in working women. Dissertation Abstracts International 1998;58(11B):5886.
Bergmann 2014 {published data only}
    1. Bergmann N, Ballegaard S, Hjalmarson A, Krogh J, Gyntelberg F, Faber J. The effect of daily self‐measurement of pressure pain sensitivity followed by acupressure on depression and quality of life versus treatment as usual in ischemic heart disease: a randomised controlled trial. PLoS One 2014;9(5):e97553. - PMC - PubMed
Bin 2007 {published data only}
    1. Bin F, Lanying L, Fangzhong X, Jiong C, Peirong W, Wensong C, et al. Thirty cases of obsession treated by point‐stimulation and with small dose of chlorimipramine. Journal of Traditional Chinese Medicine 2007;27(1):3‐6. - PubMed
Carvalho 2013 {published data only}
    1. Carvalho F, Weires K, Ebling M, Padiha MSR, Ferrao YA, Vercelino R. Effects of acupuncture on the symptoms of anxiety and depression by premenstrual dysphoric disorder. Acupuncture in Medicine 2013;31:358‐63. - PubMed
Chang 2009 {published data only}
    1. Chang Y. The effect on serotonin and MDA levels in depressed patients with insomnia when Far‐Infared rays are applied to acupoints. American Journal of Chinese Medicine 2009;37(5):837‐42. - PubMed
Chang 2010 {published data only}
    1. Chang SH, Fang MC, Yang YS. Effectiveness of transcutaneous electrical acupoint stimulation for improving depressive mood status among nursing home elders in Taiwan: a pilot study. Geriatric Nursing 2010;31:324‐30. - PubMed
Chang‐du 1994 {published data only}
    1. Chang‐du L, Yong H, Ying‐kun L, Ka‐ming H, Zhen‐ya J. Treating post stroke depression with "mind refreshing antidepressive": acupuncture therapy: a clinical study of 21 cases. International Journal of Clinical Acupuncture 1994;5(4):389‐93.
Cocchi 1977 {published data only}
    1. Cocchi R, Fusari A, Lorini G, Roccia L. Agopuntura, farmaci vitali e psicofarmaci nel trattamento di pazienti psichiatrici a struttura depressiva di fondo. Minerva Medica 1977;68:23092314. - PubMed
Deng 2013 {published data only}
    1. Deng G, Chan Y, Sjoberg D, Vickers A, Yeung KS, Kris M, et al. Acupuncture for the treatment of post‐chemotherapy chronic fatigue: a randomized, blinded, sham controlled trial. Supportive Cancer Care 2013;21:1735‐41. - PMC - PubMed
Dormaemen 2011 {published data only}
    1. Dormaemen A, Heimdal MR, Wang CFA, Grimsgaard AS. Depresion in postmenopause: a study on a subsample of the Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study. Menopause 2011;18(5):525‐30. - PubMed
Duan 2009 {published data only}
    1. Duan D, Chen LP, Wu ZJ. Efficacy evaluation for depression with somatic symptoms treated by electroacupuncture combined with fluoxetine. Journal of Traditional Chinese Medicine 2009;29(3):167‐73. - PubMed
Fan 2015b {published data only}
    1. Fan L, Gong J, Fu W, Chen Z, Xu N, Liu J, et al. Gender‐related differences in outcomes on acupuncture and moxibustion treatment among depression patients. Journal of Alternative and Complementary Medicine 2015;21(11):673‐80. - PubMed
Gallagher 2002 {published data only}
    1. Gallagher SM, Allen JJB, Hitt SK, Schyner RN, Manber R. Six month depression relapse rates among women treated with acupuncture. Complementary Therapies in Medicine 2002;9:216‐8. - PubMed
Guo 2009 {published data only}
    1. Guo RY, Su L, Liu L, Wang CX. Effects of Linggui Bafa on the therapeutic effect and quality of life in patients of post‐stroke depression. Chinese Acupuncture and Moxibustion 2009;29:785‐90. - PubMed
He 2007b {published data only}
    1. He Q, Zhang J, Tang Y. A controlled study on treatment of mental depression by acupuncture plus TCM medication. Journal of Traditional Chinese Medicine 2007;27(3):166‐9. - PubMed
He 2011 {published data only}
    1. He LL, Zheng Z, Cai DJ, Zou K. Randomized controlled trial on comorbid anxiety and depression treated with electroacupuncture combined with rTMS. Chinese Acupuncture and Moxibustion 2011;31:294‐8. - PubMed
Hmwe 2015 {published data only}
    1. Hmwe NTT, Subramanian P, Tan LP, Chong WK. The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: a randomized controlled trial. International Journal of Nursing Studies 2015;52(2):509–18. - PubMed
Honda 2012 {published data only}
    1. Honda Y, Tsuda A, Horiuchi S. Four week self administered acupressure improves depressive mood. Psychology 2012;3:802‐4.
Hou 1996 {published data only}
    1. Hou DF, Lo HC. Clinical observation of therapeutic effect of baihui (GV20)‐yintang (EX‐HN3) electro‐acupuncture in 30 cases of post‐apoplectic depression. Chinese Acupuncture and Moxibustion 1996;16(8):432‐3.
Hu 2013 {published data only}
    1. Hu J, Chen C, Bi X, Yu Z, Yang P, Fan Z, et al. Effect of early intervention of liver‐smoothing and blood‐activating decoction combined with acupuncture on patients with post‐stroke depression. China Journal of Chinese Materia Medica 2013;38(14):2403‐5. - PubMed
Huang 2003 {published data only}
    1. Huang Y, Xia D, Zhou J. Clinical observation on treating 46 cases of post‐windstroke depression by scalp‐electrical acupuncture. China Journal of Basic Medicine in Traditional Chinese Medicine 2003;9:60‐2.
Huang 2004 {published data only}
    1. Huang DH, Wang CY, Huang JH, Ye Y, Chen XH. Point injection therapy combining baihui acupuncture with parental solution of breviscapine for post cerebral infarction depression. Chinese Journal of Chinese Rehabilitation 2004;28(8):6132‐3.
Huang 2005 {published data only}
    1. Huang Y, Jing C, Jun Z. Effect of scalp acupuncture on post stroke depression. Chinese Journal of Clinical Rehabilitation 2005;9(40):172‐3.
Huo 2013 {published data only}
    1. Huo ZJ, Guo J, Li D. Effects of acupuncture with meridian acupoints and three anmian acupoints on insomnia and related depression and anxiety state. Chinese Journal of Integrative Medicine 2013;19(3):187‐91. - PubMed
Khang 2002 {published data only}
    1. Kang B, Zhang PG, Xiong SC, et al. Control observation on electroacupuncture and amitriptyline for treatment of depression. Chinese Acupuncture and Moxibustion 2002;22(6):383‐4.
Kim 2015 {published data only}
    1. Kim JE, Seo BK, Choi JB, Kim HJ, Kim TH, Lee MH, et al. Acupuncture for chronic fatigue syndrome and idiopathic chronic fatigue: a multicenter, nonblinded, randomized controlled trial. Trials 2015;16:314. - PMC - PubMed
Li 2011 {published data only}
    1. Li H, Zhong B, Fan Y, Hu H. Acupuncture for post‐stroke depression: a randomized controlled trial. Chinese Acupuncture and Moxibustion 2011;31:3‐6. - PubMed
Liu 2013 {published data only}
    1. Liu Y, Zhang YH, Jin M, Liu WJ. Study on clinical effect enhancement of acupuncture for depression with chronic pain treated with SSRI antidepressants. Chinese Acupuncture and Moxibustion 2013;33(6):689‐91. - PubMed
Lu 2004 {published data only}
    1. Lu M, Wang LL, Lui LY, Maho L. Clinical research on treatment of depression with electroacupuncture and SSRI. Journal of Nanjing University of Traditional Chinese Medicine 2004;20:149‐51.
Man 2014 {published data only}
    1. Man SC, Hung BH, Ng RMK, Yu XC, Cheung H, Fung MPM, et al. A pilot controlled trial of a combination of dense cranial electro‐acupuncture stimulation and body acupuncture for post stroke depression. BMC Complementary and Alternative Medicine 2014;14:255. - PMC - PubMed
Mischoulon 2012 {published data only}
    1. Mischoulon D, Brill CD, Ameral V, Fava M, Yeung AS. A pilot study of acupuncture monotherapy in patients with major depressive disorder. Journal of Affective Disorders 2012;141:469‐73. - PubMed
Niu 2006 {published data only}
    1. Niu SY, Li N, You H, Shi SX, Liu CM. Effect of integrated therapy of Chinese and western medicine on differentiation of symptoms and signs of patients with depression. Chinese Journal of Clinical Rehabilitation 2006;10:7‐9.
Shi 2014 {published data only}
    1. Shi X, Wang H, Wang L, Zhao Z, Litscher D, Tao J, et al. Can tongue acupuncture enhance body acupuncture? First results from heart rate variability and clinical scores in patients with depression. Evidence‐Based Complementary and Alternative Medicine 2014;2014:329746. - PMC - PubMed
Song 1999 {published data only}
    1. Song Y, Liang HR. Observation of the curative effect of scalp acupuncture on cerebral postapoplectic depression. Shanghai Journal of Acupuncture‐Moxibustion 1999;18(1):8‐9.
Sun 2012 {published data only}
    1. Sun ZG, Lian F, Zhang JW. Effects of acupuncture combined Chinese materia medica for tonifying shen and soothing gan on the anxiety and depression of patients with in vitro fertilization and embryo transplantation and on the treatment outcomes. Chinese Journal of Integrated Traditional and Western Medicine 2012;32(8):1023‐7. - PubMed
Tang 2003b {published data only}
    1. Tang JX, Guan NH, Li L, Liu JF. Influence of electroacupuncture on the quality of life in patients with post apoplectic depression. Shanghai Journal of Acupuncture and Moxibustion 2003;22:12‐4.
Tse 2010 {published data only}
    1. Tse M, Au J. The effects of acupressure in older adults with chronic knee pain: depression, pain, activities of daily living and mobility. Journal of Pain Management 2010;3(4):399‐410.
Wang 2003 {published data only}
    1. Wang H. Clinical observation on acupuncture for treatment of depression after apoplexy. Chinese Acupuncture and Moxibustion 2003;23:442‐4. - PubMed
Wang 2004 {published data only}
    1. Wang Y, Zhao ZF, Wu Y. Clinical therapeutic effect of acupuncture on post stroke depression with insomnia. Chinese Acupuncture and Moxibustion 2004;24(9):603‐6.
Wang 2005 {published data only}
    1. Wang TJ. Clinical observation on acupuncture for treatment of depression. Chinese Acupuncture and Moxibustion 2005;25:107‐10. - PubMed
Wang 2006 {published data only}
    1. Wang J. Clinical observation on Governor Vessel Daoqi method for treatment of dysomnia in the patient of depression. Chinese Acupuncture and Moxibustion 2006;26:328‐30. - PubMed
Wu 2010 {published data only}
    1. Wu JP. Clinical observation on acupuncture treatment of 150 cases of post‐stroke depression according to syndrome differentiation. Acupuncture Research 2010;35:303‐6. - PubMed
Xie 2009 {published data only}
    1. Xie YC, Li YH. Observation on therapeutic effect of acupuncture at Zhongwan (CV 12) and Si‐guan points combined with reinforcing‐reducing manipulation of respiration for treatment of depression. Chinese Acupuncture and Moxibustion 2009;29:521‐4. - PubMed
Xie 2012 {published data only}
    1. Xie HW, Bai CY, Yi Y, Xu FM, Song YE, Li LM, Tang X. Observation on therapeutic effect of acupuncture of five Shu‐points of the liver meridian combined with bloodletting for depression patients and concomitant changes of blood rheology. Acupuncture Research 2012;37:140‐44. - PubMed
Yeung 2011 {published data only}
    1. Yeing AS, Ameral VE, Chuzi SE, Fava M, Mischoulon D. A pilot study of acupuncture augmentation therapy in antidepressant partial and non‐responders with major depressive disorder. Journal of Affective Disorders 2011;130:285‐9. - PubMed
Zhang 2004 {published data only}
    1. Zhang J, Liu X, Zhang H. A controlled study of electro‐acupuncture and amitriptyline in the treatment of depression. Journal of Clinical Psychosomatic Diseases 2004;19:98‐9.
Zhang 2004b {published data only}
    1. Zhang Y. Study of acupuncture on depression after apoplexy and rehabilitation effect of nerve function. Modern Journal of Integrated Traditional Chinese and Western Medicine 2004;13:864.
Zhao 2014 {published data only}
    1. Zhao YD, Han DY, Guo X. Warming‐promotion acupuncture for post‐earthquake depression: a randomized controlled study. Chinese Acupuncture and Moxibusion 2014;34:755‐8. - PubMed
Zhou 2007 {published data only}
    1. Zhou SH. Acupuncture in the treatment of female climacteric depression in 60 cases. Journal of Clinical Rehabilitation Tissue Engineering Research 2007;11(39):7817‐9.
Zhou 2015 {published data only}
    1. Zhou X, Li Y, Zhou Z, Pan S. Clinical observation of acupuncture in patients with depression and its impact on serum 5‐HT. Chinese Acupuncture and Moxibustion 2015;35:123‐6. - PubMed

References to studies awaiting assessment

Fu 2003 {published data only}
    1. Fu WB. Observations on the curative effect of acupuncture on depressive neurosis. Journal of Acupuncture and Tuina Science 2003;1(4):15‐7.
Guo 2012 {published data only (unpublished sought but not used)}
    1. Guo T, Wang Y, Sun L, Zhang W, Ma W. Acupuncture combined with an antidepressant has a better effect on major depression: a multi‐centre, randomized controlled clinical trial. BMC Complementary and Alternative Medicine 2012;12(Suppl 1):P155.
Guo 2015 {published data only (unpublished sought but not used)}
    1. Guo T, Ya T, Guo Z, Zhang W, Yang X, Ma W, et al. Are early interventions beneficial for depressive status? A pragmatic randomized controlled trial. Integrative Medicine Research 2015;4.
Haiyan 2004 {published data only}
    1. Haiyan L, Dongfeng Z, Yuqing S. Effect of platelet protein kinase C of electro‐acupuncture and fluoxetine treatment in patients with major depressive disorder. Chinese Mental Health Journal 2004;18:688‐91.
Han 2002b {published data only}
    1. Han C, Wang L, Li X. Dynamic study of electrical acupuncture on serum cytokines in depressive patients. Journal of Beijing University of Traditional Chinese Medicine 2002;11:277‐9.
Han 2006 {published data only}
    1. Han C. Randomsied clinical trial comparing the effects of electro‐acupuncture and maprotiline in treating depression. International Journal of Clinical Acupuncture 2006;15(1):7‐14.
Li 2003 {published data only}
    1. Li X. Clinical effect of acupuncture and moxibustion as accessory treatment of depressive patients. Health Psychology Journal 2003;11:363‐4.
Lin 2004 {published data only}
    1. Lin H, Gen‐Qi U, Zhou Z. Clinical study on treatment of depression with combined acupuncture and antidepressant. Journal of Clinical Acupuncture and Moxibustion 2004;20:17‐9.
Lin 2005 {published data only}
    1. Lin H, Li GQ, Zhou ZB, Liu JX. Observation on therapeutic effect of combination of acupuncture with drug on depression. Chinese Acupuncture and Moxibustion 2005;25:27‐9. - PubMed
Lu 2009 {published data only}
    1. Liu LY, Lu Q, Wang LL. Influence of electro‐acupuncture on the side effects of fluoxetine on depression patients. Journal of Traditional Chinese Medicine 2009;29(4):271‐4. - PubMed
Song 2007 {published data only}
    1. Song YQ, Zhou DF, Fan JH, Luo H, Halbreich U. Effects of electroacupuncture and fluoxetine on the density of GTP‐binding‐proteins in platelet membrane in patients with major depressive disorder. Journal of Affective Disorders 2007;98:253‐7. - PubMed
Song 2009 {published data only}
    1. Song C, Halbreich U, Han C, Leonard BE, Luo H. Imbalance between pro‐and anti‐inflammatory cytokines, and between Th1 and Th2 cytokines in depressed patients: the effect of electro‐acupuncture or fluoxetine treatment. Pharmacopsychiatry 2009;42:182‐8. - PubMed
Sun 2015 {published data only}
    1. Sun Y, Bao Y, Wang S, Chu J, Li L. Efficacy on post‐stroke depression treated with acupuncture at the acupoints based on ziwuliuzhu and Prozac. Chinese Acupuncture and Moxibustion 2015;35:119‐22. - PubMed
Vázquez 2011 {published data only}
    1. Vázquez RD, González‐Macías L, Berlanga C, Aedo FJ. Effect of acupuncture treatment on depression: correlation between psychological outcomes and salivary cortisol levels. Salud Mental 2011;34:21‐6.
Zhang 1996 {published data only}
    1. Zhang B, Wenyou M, Baoting Z, Shuling L. A control study of clinical therapeutic effects of laser acupuncture on depressive neurosis. World Journal of Acupuncture and Moxibustion 1996;6(2):12‐7.
Zhang 2005 {published data only}
    1. Zhang C. The brain resuscitation acupuncture method for treatment of post wind stroke mental depression: a report of 45 cases. Journal of Traditional Chinese Medicine 2005;25:243‐6. - PubMed
Zhao 2006 {published data only}
    1. Zhao J, Peng S. Clinical observation on acupuncture treatment of depressive neurosis in 30 cases. Journal of Traditional Chinese Medicine 2006;26(3):191‐2. - PubMed

References to ongoing studies

Deng 2015 {published data only}
    1. ChiCTR‐OPC‐15005873. Effect of acupuncture on the DMN of brain in patients with major depressive disorder: a resting‐state fMRI study. chictr.org.cn/showproj.aspx?proj=10316 (first received 21 January 2015).
Fan 2015 {published data only}
    1. ChiCTR‐ICR‐15005935. Clinical study of acupuncture for mild and moderate depressive episodes. chictr.org.cn/showproj.aspx?proj=10394 (first received 2 April 2015).
Fu 2011 {published data only}
    1. ChiCTR‐TRC‐00000481. Clinical study on acupuncture treating insomnia with depression. chictr.org.cn/showproj.aspx?proj=7943 (first received 13 May 2011).
Li 2015 {published data only}
    1. NCT02472613. Comparison of Acupuncture and Fluoxetine for of Ischemic Post‐stroke Depression:A Multicentre Randomized Controlled Trial. clinicaltrials.gov/show/NCT02472613 (first received 8 June 2015).
Prater 2015 {published data only}
    1. NCT02579343. Adjunctive treatment of major depression utilizing auricular acupuncture. clinicaltrials.gov/show/NCT02579343 (first received 5th October 2015).
Tai 2013 {published data only}
    1. ChiCTR‐TRC‐13003434. Acupuncture based on five elements body characteristics in the treatment of patients with post‐stroke depression. chictr.org.cn/showproj.aspx?proj=6125 (first received 25th July 2013).
Wang 2014a {published data only}
    1. ChiCTR‐TRC‐14005228. Abdominal acupuncture on moderate and severe depression female patients: a randomized controlled blind clinical trial. chictr.org.cn/showproj.aspx?proj=4348 (first received 1st September 2014).
Weidong 2015 {published data only}
    1. ChiCTR‐ICR‐15006455. Clinical evaluation of depression treated by disease and syndrome combined method. chictr.org.cn/showproj.aspx?proj=10994 (first received 17 May 2015).
Weidong 2016 {published data only}
    1. ChiCTR‐IOR‐16008327. A clinical evaluation research for the treatment of major depression by integrated disease with Zheng of TCM method. chictr.org.cn/showproj.aspx?proj=14018 (first received 20th April 2016).
Wenben 2015 {published data only}
    1. NCT02423694. Effectiveness and safety of electro‐acupuncture for mild‐to‐moderate perimenopausal depression. clinicaltrials.gov/show/NCT02423694 (received 11th April 2014).
Ya 2008 {published data only}
    1. ChiCTR‐TRC‐08000297. The clinical study of the best treatment option in acupuncture on depression. chictr.org.cn/showproj.aspx?proj=9233 (first received 26th December 2008).
Ya 2015 {published data only}
    1. ChiCTR‐IPR‐15006503. The clinical curative effect of acupuncture treatment in depression. chictr.org.cn/showproj.aspx?proj=11116 (first received 4th June 2014).
Yan 2012 {published data only}
    1. NCT01558154. Comparison of treatment effect of Chinese Medicine and Western Medicine on depression in China and America. clinicaltrials.gov/show/NCT01558154 (first received 2nd March 2012.
Yanli 2015 {published data only}
    1. ChiCTR‐IOR‐15006313. Wrist‐ankle acupuncture combined with Prozac in the treatment of post‐stroke depression: clinical research. chictr.org.cn/showproj.aspx?proj=10820 (first received 21st April 2015).

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