The Effectiveness of Acupuncture for Depression – a Systematic Review of Randomised Controlled Trials

Mukaino, Yoshito; Park, Jong-Bae; White, Adrian; Ernst, Edzard

doi:10.1136/aim.23.2.70

Cited by 79 publications

(47 citation statements)

References 31 publications

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“…There was also an increasing demand for acupuncture in this field among Western countries as well. In recent years, four systematic reviews, [10][11][12][13] including one Cochrane systematic review, 11 have tried to evaluate the effectiveness and safety of acupuncture for depression, but none of the authors could give a positive and convincing conclusion to support its efficacy and clinical application, because of insufficient high-quality randomized controlled trials. Our previous result of evidence-based medicine research also indicated that, although acupuncture was a very promising modality for depression, there was still insufficient evidence to determine the efficacy of acupuncture because of lack of well-designed studies.…”

Section: Introductionmentioning

confidence: 98%

Combination of Acupuncture and Fluoxetine for Depression: A Randomized, Double-Blind, Sham-Controlled Trial

Zhang

Yang

Zhong

2009

The Journal of Alternative and Complementary Medicine

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Section: Introductionmentioning

confidence: 98%

Combination of Acupuncture and Fluoxetine for Depression: A Randomized, Double-Blind, Sham-Controlled Trial

Zhang

Yang

Zhong

2009

The Journal of Alternative and Complementary Medicine

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“…Three (3) recent systematic reviews [56][57][58] indicate that there is insufficient evidence to determine acupuncture's efficacy in the treatment of depression, and recommend the need for further studies. In major depression, compared to invasive acupuncture-like controls at valid acupuncture points, [59][60][61] the effect varies between studies; for depression during pregnancy, 62 acupuncture was significantly more effective than sham.…”

Section: Acupuncture In Mental Health (Schnyer)mentioning

confidence: 99%

The Status and Future of Acupuncture Clinical Research

Park

Linde

Manheimer

et al. 2008

The Journal of Alternative and Complementary Medicine

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On November 8-9, 2007, the Society for Acupuncture Research (SAR) hosted an international conference to mark the tenth anniversary of the landmark National Institutes of Health Consensus Development Conference on Acupuncture. More than 300 acupuncture researchers, practitioners, students, funding agency personnel, and health policy analysts from 20 countries attended the SAR meeting held at the University of Maryland School of Medicine, Baltimore, MD. This paper summarizes important invited lectures in the area of clinical research. Specifically, included are: a review of the recently conducted German trials and observational studies on low-back pain (LBP), gonarthrosis, migraine, and tension-type headache (the Acupuncture Research Trials and the German Acupuncture Trials, plus observational studies); a systematic review of acupuncture treatment for knee osteoarthritis (OA); and an overview of acupuncture trials in neurologic conditions, LBP, women's health, psychiatric disorders, and functional bowel disorders. A summary of the use of acupuncture in cancer care is also provided. Researchers involved in the German trials concluded that acupuncture is effective for treating chronic pain, but the correct selection of acupuncture points seems to play a limited role; no conclusions could be drawn about the placebo aspect of acupuncture, due to the design of the studies. Overall, when compared to sham, acupuncture did not show a benefit in treating knee OA or LBP, but acupuncture was better than a wait-list control and standard of care, respectively. In women's health, acupuncture has been found to be beneficial for patients with premenstrual syndrome, dysmenorrhea, several pregnancy-related conditions, and nausea in females who have cancers. Evidence on moxibustion for breech presentation, induction of labor, and reduction of menopausal symptoms is still inconclusive. In mental health, evidence for acupuncture's efficacy in treating neurologic and functional bowel disorder is still inconclusive. For chronic cancer-related problems such as pain, acupuncture may work well in stand-alone clinics; however, for acute or treatment-related symptoms, integration of acupuncture care into a busy and complex clinical environment is unlikely, unless compelling evidence of a considerable patient benefit can be established.

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“…92 Although these data formed a basis for further investigation, the evidence base from systematic reviews in the mid-2000s suggested that there was insufficient evidence to draw conclusions. 93,94 The evidence for pharmacological antidepressant treatment also raised some concern at the time, with pharmacological antidepressant treatment being associated with up to 33% of patients not showing an adequate response. 95 Moreover, 30% of patients have been found to not adhere to their medication regime.…”

Section: Fundingmentioning

confidence: 99%

Acupuncture for chronic pain and depression in primary care: a programme of research

MacPherson

Vickers

Bland

et al. 2017

Programme Grants Appl Res

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BackgroundThere has been an increase in the utilisation of acupuncture in recent years, yet the evidence base is insufficiently well established to be certain about its clinical effectiveness and cost-effectiveness. Addressing the questions related to the evidence base will reduce uncertainty and help policy- and decision-makers with regard to whether or not wider access is appropriate and provides value for money.AimOur aim was to establish the most reliable evidence on the clinical effectiveness and cost-effectiveness of acupuncture for chronic pain by drawing on relevant evidence, including recent high-quality trials, and to develop fresh evidence on acupuncture for depression. To extend the evidence base we synthesised the results of published trials using robust systematic review methodology and conducted a randomised controlled trial (RCT) of acupuncture for depression.Methods and resultsWe synthesised the evidence from high-quality trials of acupuncture for chronic pain, consisting of musculoskeletal pain related to the neck and low back, osteoarthritis of the knee, and headache and migraine, involving nearly 18,000 patients. In an individual patient data (IPD) pairwise meta-analysis, acupuncture was significantly better than both sham acupuncture (p < 0.001) and usual care (p < 0.001) for all conditions. Using network meta-analyses, we compared acupuncture with other physical therapies for osteoarthritis of the knee. In both an analysis of all available evidence and an analysis of a subset of better-quality trials, using aggregate-level data, we found acupuncture to be one of the more effective therapies. We developed new Bayesian methods for analysing multiple individual patient-level data sets to evaluate heterogeneous continuous outcomes. An accompanying cost-effectiveness analysis found transcutaneous electrical nerve stimulation (TENS) to be cost-effective for osteoarthritis at a threshold of £20,000 per quality-adjusted life-year when all trials were synthesised. When the analysis was restricted to trials of higher quality with adequate allocation concealment, acupuncture was cost-effective. In a RCT of acupuncture or counselling compared with usual care for depression, in which half the patients were also experiencing comorbid pain, we found acupuncture and counselling to be clinically effective and acupuncture to be cost-effective. For patients in whom acupuncture is inappropriate or unavailable, counselling is cost-effective.ConclusionWe have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.Trial registrationCurrent Controlled Trials ISRCTN63787732.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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The Effectiveness of Acupuncture for Depression – a Systematic Review of Randomised Controlled Trials

Cited by 79 publications

References 31 publications

Combination of Acupuncture and Fluoxetine for Depression: A Randomized, Double-Blind, Sham-Controlled Trial

Combination of Acupuncture and Fluoxetine for Depression: A Randomized, Double-Blind, Sham-Controlled Trial

The Status and Future of Acupuncture Clinical Research

Acupuncture for chronic pain and depression in primary care: a programme of research

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