Efficacy and safety of acupuncture therapies for adult patients with mild and moderate major depressive disorder: A systematic review and meta-analysis.

Hong-Jun KUANG; Hui-Sheng YANG; Yi-Xuan FENG; Han TANG; Qi FAN; Yu-Qin XU; Shuo CUI; Richard MUSIL; Hedi LUXENBURGER; Yi-Xuan ZHANG; Hong ZHAO; Yu-Qing ZHANG

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Efficacy and safety of acupuncture therapies for adult patients with mild and moderate major depressive disorder: A systematic review and meta-analysis.

Author: Hong-Jun KUANG ¹ ; Hui-Sheng YANG ² ; Yi-Xuan FENG ³ ; Han TANG ¹ ; Qi FAN ⁴ ; Yu-Qin XU ⁵ ; Shuo CUI ⁶ ; Richard MUSIL ⁷ ; Hedi LUXENBURGER ⁸ ; Yi-Xuan ZHANG ¹ ; Hong ZHAO ⁹ ; Yu-Qing ZHANG ¹⁰
Author Information

1. Department of Acupuncture and Moxibustion, Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine, Shenzhen 518001, Guangdong Province, China; Department of Acupuncture and Moxibustion, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong Province, China.
2. Department of Acupuncture and Tuina, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, Guangdong Province, China; Women and Children's Medical Center, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, Guangdong Province, China.
3. Department of Senior Citizens Welfare, China Civil Affairs University, Beijing 102600, China.
4. Department of Rehabilitation Medicine Center, the Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an 271000, Shandong Province, China.
5. Department of Acupuncture and Moxibustion, the Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China.
6. Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China.
7. Psychiatric Clinic of University Munich, Munich 80336, Germany; Oberberg Fachklinik Bad Tölz, Bad Tölz 82057, Germany.
8. President of the International Council of Medical Acupuncture and Related Techniques, Aachen 52066, Germany.
9. Department of Acupuncture and Moxibustion, Shenzhen Hospital, Shanghai University of Traditional Chinese Medicine, Shenzhen 518001, Guangdong Province, China; Department of Acupuncture and Moxibustion, Shenzhen Luohu Hospital of Traditional Chinese Medicine, Shenzhen 518001, Guangdong Province, China. Electronic address: hongzhao2005@aliyun.com.
10. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton L8S 4L8, Canada; School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, Ningbo 315100, Zhejiang Province, China.
Publication Type:Meta-Analysis
Keywords: Acupuncture; Major depressive disorder; Meta-analysis; Systematic review
MeSH: Humans; Acupuncture Therapy/methods*; Depressive Disorder, Major/therapy*; Adult; Antidepressive Agents/therapeutic use*; Treatment Outcome; Randomized Controlled Trials as Topic
From: Journal of Integrative Medicine 2025;23(5):471-491
CountryChina
Language:English
Abstract: BACKGROUND:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder (MDD), but its efficacy and safety have still not been comprehensively assessed. Recently published systematic reviews remain confusing and inconclusive.
OBJECTIVE:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.
SEARCH STRATEGY:Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Science and Technology Journal Database, PubMed, Embase, and Cochrane Library were searched from their inceptions to March 2025.
INCLUSION CRITERIA:Randomized controlled trials that compared acupuncture therapy with antidepressants, or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.
DATA EXTRACTION AND ANALYSIS:Five reviewers independently extracted data from original literature using a standardized form, and the data were verified by two reviewers to ensure accuracy. Statistical meta-analyses, publication bias analyses, and subgroup analyses were performed by using Review Manager 5.3 software. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of the evidence.
RESULTS:A total of 60 eligible studies including 4675 participants were included. Low-certainty evidence showed that compared with antidepressants, acupuncture therapy (standardized mean difference [SMD] = -0.57; 95% confidence interval [CI] = [-0.87, -0.27]; I² = 86%; P = 0.006) or acupuncture therapy plus antidepressants (SMD = -1.00; 95% CI = [-1.18, -0.81]; I² = 77%; P < 0.00001) may reduce the severity of depression at the end of treatment. Low-certainty evidence indicated that compared with acupuncture therapy alone, acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment (SMD = -0.38; 95% CI = [-0.61, -0.14]; I² = 18%; P = 0.002). Similar results were also found for acupuncture's relief of insomnia. The reported adverse effects of acupuncture therapy were mild and transient. For most of the subgroup analyses, acupuncture type, scale type, and the course of treatment did not show a significant relative effect.
CONCLUSION:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD. But the certainty of evidence was very low. More high-quality, well designed, large-scale studies with long-term follow-up are needed in the future. Please cite this article as: Kuang HJ, Yang HS, Feng YX, Tang H, Fan Q, Xu YQ, Cui S, Musil R, Luxenburger H, Zhang YX, Zhao H, Zhang YQ. Efficacy and safety of acupuncture therapies for adult patients with mild and moderate major depressive disorder: A systematic review and meta-analysis. J Integr Med. 2025; 23(5):471-491.