Abstract
There is interest from the community in the use of self help and complementary
therapies for depression. This review examined the currently available
evidence supporting the use of acupuncture to treat depression.To
examine the effectiveness and adverse effects of acupuncture in the
treatment for depression.The following databases were searched: CCDAN-CTR,
Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE
(1966 to Dec 2008), EMBASE (1980 to Dec 2008), PSYCINFO (1874 to
Dec 2008), the Database of Abstracts of Reviews of Effectiveness
(DARE), CINAHL (1980 to Dec 2008), Wan Fang database (to Dec 2008).
The following terms were used: depression, depressive disorder, dysthymic
disorder and acupuncture.Inclusion criteria included all published
and unpublished randomised controlled trials comparing acupuncture
with sham acupuncture, no treatment, pharmacological treatment, other
structured psychotherapies (cognitive behavioural therapy, psychotherapy
or counselling), or standard care. The following modes of treatment
were included: acupuncture, electro acupuncture or laser acupuncture.
The participants included adult men and women with depression defined
by clinical state description, or diagnosed by the Diagnostic and
Statistical Manual (DSM-IV), Research Diagnostic Criteria (RDC),
International Classification of Disease (ICD) or the Criteria for
Classification and Diagnosis of Mental Diseases CCMD-3-R.Meta-analyses
were performed using relative risk for dichotomous outcomes and standard
mean differences for continuous outcomes, with 95\% confidence intervals.
Primary outcomes were reduction in the severity of depression, measured
by self rating scales, or by clinician rated scales and an improvement
in depression defined as remission versus no remission.This review
is an update and now contains data from 30 studies. Following recent
searches, 23 new studies have been added and a further 11 trials
were excluded (due to suboptimal doses of medication, no clinical
outcomes, insufficient reporting). Thirty trials with 2,812 participants
are included in the meta-analysis.There was a high risk of bias in
the majority of trials. There was insufficient evidence of a consistent
beneficial effect from acupuncture compared with a wait list control
or sham acupuncture control. Two trials found acupuncture may have
an additive benefit when combined with medication compared with medication
alone. A subgroup of participants with depression as a co-morbidity
experienced a reduction in depression with manual acupuncture compared
with SSRIs (RR 1.66, 95\%CI 1.03, 2.68) (three trials, 94 participants).
The majority of trials compared manual and electro acupuncture with
medication and found no effect between groups.We found insufficient
evidence to recommend the use of acupuncture for people with depression.
The results are limited by the high risk of bias in the majority
of trials meeting inclusion criteria.
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