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Evidence for Using Needle Acupuncture to Treat MDD Is Limited

• We identified 18 randomized controlled trials that examined acupuncture in the treatment of MDD. We found that the methodological quality of the studies was generally poor, with limited blinding, high attrition, and limited use of intention-to-treat analysis.
• The limited evidence suggests a higher rate of responders with adjunctive acupuncture plus antidepressants than with antidepressants alone, but the studies were of poor quality (low quality of evidence).
• Monotherapy acupuncture may be superior to waitlist (low quality of evidence), but findings for effect estimates compared with other comparators are inconclusive.
• Few studies reported on patients achieving remission. The effect of acupuncture on relapse rates could not be determined. Too few studies assessed quality of life to estimate treatment effects.
• Reported adverse events were typically mild in nature, but the assessment lacked rigor and studies were not designed to detect rare events.

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of acupuncture — used adjunctively or as monotherapy — to assess its efficacy and safety in treating adults with major depressive disorder.

Outcomes of interest included depressive symptoms, response to treatment, remission, relapse, health-related quality of life, and adverse events. Study details were documented in detailed evidence tables and summarized in a narrative synthesis. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (or GRADE) approach.

In total, 18 studies met inclusion criteria. Eleven of these studies focused on acupuncture as a monotherapy, and seven examined its use as an adjunctive therapy to antidepressants or treatment as usual. We found that monotherapy acupuncture may be superior to waitlist, but the methodological quality of the studies was generally poor, with limited blinding, high attrition, and limited use of intention-to-treat analysis. The limited evidence suggests a higher rate of responders with adjunctive acupuncture plus antidepressants than with antidepressants alone, but the studies were of poor quality. Findings for effect estimates of acupuncture compared with other comparators are inconclusive. Reported adverse events were typically mild in nature, but the assessment lacked rigor and studies were not designed to detect rare events.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion

• Appendix A

  PubMed Search Strategy

• Appendix B

  Excluded Full-Text Articles

• Appendix C

  Evidence Tables of Included Studies