School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
The First Hospital of Lanzhou University, Lanzhou, 730000, China.
Complement Ther Med. 2020 May;50:102202. doi: 10.1016/j.ctim.2019.102202. Epub 2019 Oct 23.
To provide an overview of existing meta-analysis (MAs) on the efficacy and safety of acupuncture for depression, and assess the methodological quality and the strength of evidence of the included MAs.
We searched MAs of randomized trials that have evaluated the effects of acupuncture on depression in three international and three Chinese databases from their inception until August 2019. The methodological quality of included MAs was evaluated with the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the strength of evidence with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We used the intra-class correlation coefficient (ICC) to assess reviewer agreement in the pre-experiment.
We included 31 MAs and 59 RCTs. The results of included MAs were conflicting, our meta-analyses found that acupuncture may confer small benefit in reducing the severity of depression by end of treatment than no treatment/wait list/treatment as usual(SMD -0.74, 95% CI -1.06 to -0.41, eight trials, 624 participants), control acupuncture (invasive, non-invasive sham controls) (SMD 0.27, 95% CI -0.51 to -0.04, 20 trials, 1055 participants), antidepressants(Selective serotonin reuptake inhibitors (SSRI)/ Tetracyclic antidepressants(TCAs)) (SMD -0.28, 95% CI -0.46 to -0.10, 30 trials, 3068 participants), acupuncture plus antidepressants versus antidepressants(SSRI/TCAs) (SMD -0.99, 95% CI -1.37 to -0.61, 17 trials, 1110 participants). Subgroup analyses showed that there was no difference between electro-acupuncture and invasive control (P = 0.37), electro-acupuncture and non-invasive control (P = 0.90), manual acupuncture and Tetracyclic antidepressants (P = 0.57), electro-acupuncture and Tetracyclic antidepressants (P = 0.07). Six MAs concluded that acupuncture reduced the incidence of adverse events compared with antidepressants. The evaluation with AMSTAR-2 showed that the quality of included MAs was low or critically low. The results of the GRADE evaluation showed that the strength of evidence was low to very low for most outcomes.
Although acupuncture appears to be more effective and safer than no treatment, control acupuncture and antidepressants, the quality of the available evidence was very low. Further methodologically rigorous and adequately powered primary studies are needed to confirm the effectiveness of acupuncture for depression.
提供对针刺治疗抑郁症的疗效和安全性的现有荟萃分析（MAs）的概述，并评估纳入的 MAs 的方法学质量和证据强度。
我们从三个国际数据库和三个中文数据库中检索了评价针刺治疗抑郁症的随机试验的 MAs，检索时间从建库至 2019 年 8 月。采用 AMSTAR-2 评估纳入 MAs 的方法学质量，采用 GRADE 评估证据强度。我们使用组内相关系数（ICC）评估预实验中的审稿人一致性。
我们纳入了 31 项 MAs 和 59 项 RCT。纳入 MAs 的结果相互矛盾，我们的荟萃分析发现，与无治疗/等待名单/常规治疗相比，针刺治疗在治疗结束时可能会降低抑郁严重程度（SMD-0.74，95%CI-1.06 至-0.41，八项试验，624 名参与者）、对照针刺（侵入性、非侵入性假对照）（SMD0.27，95%CI-0.51 至-0.04，20 项试验，1055 名参与者）、抗抑郁药（选择性 5-羟色胺再摄取抑制剂（SSRIs）/三环抗抑郁药（TCAs））（SMD-0.28，95%CI-0.46 至-0.10，30 项试验，3068 名参与者）、针刺加抗抑郁药与抗抑郁药（SSRIs/TCAs）（SMD-0.99，95%CI-1.37 至-0.61，17 项试验，1110 名参与者）。亚组分析显示，电针与侵入性对照（P=0.37）、电针与非侵入性对照（P=0.90）、手动针刺与三环抗抑郁药（P=0.57）、电针与三环抗抑郁药（P=0.07）之间无差异。六项 MAs 得出结论，与抗抑郁药相比，针刺降低了不良事件的发生率。采用 AMSTAR-2 评估发现，纳入 MAs 的质量低或极低。GRADE 评估结果显示，大多数结局的证据强度为低至极低。
尽管针刺似乎比无治疗、对照针刺和抗抑郁药更有效且更安全，但现有证据的质量非常低。需要进一步开展方法学严谨且充分有力的原始研究，以证实针刺治疗抑郁症的疗效。
