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. 2023 Jan 6:13:1012606.
doi: 10.3389/fpsyt.2022.1012606. eCollection 2022.

Electroacupuncture as a rapid-onset and safer complementary therapy for depression: A systematic review and meta-analysis

Zhinan Zhang  1 , Xiaowen Cai  1 , Yuying Liang  1 , Rui Zhang  1 , Xinyu Liu  1 , Liming Lu  2 , Yong Huang  1
Affiliations

Electroacupuncture as a rapid-onset and safer complementary therapy for depression: A systematic review and meta-analysis

Zhinan Zhang et al. Front Psychiatry. .

Abstract

Background: Electroacupuncture (EA) is a promising therapy for depression. However, a comprehensive review of EA for depression is needed.

Methods: We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2020) guidelines to evaluate the efficacy and safety of EA for depression. Potentially relevant trials and reviews were searched in MEDLINE, EMBASE, PsycINFO, and CENTRAL from inception to March 2022. EA alone and combined with other therapy were eligible for inclusion. The severity of depression during and after treatment and the number of adverse events were assessed as outcomes. Risk of bias (ROB) evaluation, subgroup analysis, sensitivity analysis, reporting bias assessment, and GRADE system evaluation were also conducted.

Results: Thirty-four trials were included. The overall ROB was medium. Low-quality evidence showed that the efficacy of EA was not less than that of antidepressants [EA + selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)] and manual acupuncture (MA). EA and EA + SSRIs had better efficacy than SSRIs alone in decreasing the severity of depression during the early treatment. Moderate-quality evidence also showed that EA and EA + SSRIs were safer than SSRIs alone. Sensitivity analysis was mostly not feasible. Major publication bias was unlikely.

Conclusion: These results indicate that the efficacy of EA is not less than that of antidepressants and MA. Moreover, EA and EA + SSRI treatments show a more rapid onset and greater safety than SSRIs. More high-quality trials are needed for further confirmation.

Systematic review registration: [www.crd.york.ac.uk/prospero/display_ record.php?RecordID=329143], identifier [CRD42022329143].

Keywords: depression; electroacupuncture; meta-analysis; rapid-onset; safety.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study flow diagram.
FIGURE 2
FIGURE 2
Risk of bias summary: review authors’ judgments about each risk of bias item for each included study.
FIGURE 3
FIGURE 3
Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies.
FIGURE 4
FIGURE 4
Forest plot of comparison: EA vs. antidepressants. (A) Severity of depression at the end of treatment. (B) Severity of depression at week 2 during treatment. (C) Severity of depression at week 4 during treatment. (D) Severity of depression at week 6 during treatment. (E) Adverse events. 1HAMD; 2SDS.
FIGURE 5
FIGURE 5
Forest plot of comparison: EA + antidepressants vs. antidepressants. (A) Severity of depression at the end of treatment. (B) Severity of depression at week 2 during treatment. (C) Severity of depression at week 4 during treatment. (D) Severity of depression at week 6 during treatment. (E) Severity of depression at end of follow-up. (F) Adverse events. 1HAMD; 3checklist 90 depression score.
FIGURE 6
FIGURE 6
Funnel plots of comparisons. (A) EA vs. antidepressants in severity of depression at the end of treatment. (B) EA vs. antidepressants in severity of depression at week 6 during treatment. (C) EA + antidepressants vs. antidepressants in severity of depression at the end of treatment. (D) EA + antidepressants vs. antidepressants in severity of depression at week 6 during treatment. (E) EA + antidepressants vs. antidepressants in adverse events.
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