School of Traditional Chinese Medicine, Jinan University, Guangzhou 510632, Guangdong Province, China; Acupuncture and Tuina School/Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China.
School of Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan Province, China.
J Integr Med. 2022 Jul;20(4):305-320. doi: 10.1016/j.joim.2022.05.002. Epub 2022 May 6.
BACKGROUND: Some depressed patients receive acupuncture as an adjunct to their conventional medications. OBJECTIVE: This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants. SEARCH STRATEGY: English and Chinese databases were searched for randomized controlled trials (RCTs) published until December 1, 2021. INCLUSION CRITERIA: RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone. DATA EXTRACTION AND ANALYSIS: Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran's Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence in the included studies. RESULTS: This review included 16 studies (with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17 (HAMD-17) scores (standard mean difference [SMD] -0.44, 95% confidence interval [CI] -0.55 to -0.33, P < 0.01; I = 14%), Self-rating Depression Scale (SDS) scores (SMD -0.53, 95% CI -0.84 to -0.23, P < 0.01; I = 79%), and the Side Effect Rating Scale (SERS) scores (SMD -1.11, 95% CI -1.56 to -0.66, P < 0.01; I = 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I = 15%), decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I = 0%), and resulted in significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I = 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality. CONCLUSION: Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control. SYSTEMATIC REVIEW REGISTRATION: INPLASY202150008.
背景：一些抑郁患者会在接受常规药物治疗的同时接受针刺治疗。
目的：本综述旨在提供针刺是否能增强抗抑郁药治疗抑郁症的疗效，以及是否能减少抗抑郁药相关不良反应的证据。
检索策略：检索了截至 2021 年 12 月 1 日发表的英文和中文数据库的随机对照试验（RCT）。
纳入标准：如果将一组接受针刺联合抗抑郁药治疗的抑郁患者与接受单纯抗抑郁药治疗的对照组进行比较，且改良 Jadad 量表评分≥4，则纳入符合条件的 RCT。
数据提取和分析：进行了荟萃分析，并根据 Cochran's Q 统计量及其相关 P 值评估统计异质性。主要结局是抑郁严重程度和抗抑郁药相关不良反应的减轻，次要结局包括缓解率、治疗反应、社会功能和抗抑郁药剂量的变化。使用推荐评估、制定与评价（GRADE）框架评估纳入研究的总体证据质量。
结果：本综述纳入了 16 项研究（共 1958 名参与者）。大多数研究存在高度的偏倚风险，且在选择偏倚、检测偏倚、失访偏倚、报告偏倚和其他偏倚方面存在低或不明确的风险。对 16 项 RCT 的分析表明，与单纯使用抗抑郁药相比，针刺联合抗抑郁药可降低汉密尔顿抑郁量表-17（HAMD-17）评分（标准均数差 [SMD] -0.44，95%置信区间 [CI] -0.55 至 -0.33，P<0.01；I²=14%）、自评抑郁量表（SDS）评分（SMD -0.53，95%CI -0.84 至 -0.23，P<0.01；I²=79%）和副反应量表（SERS）评分（SMD -1.11，95%CI -1.56 至 -0.66，P<0.01；I²=89%）。与单纯使用抗抑郁药相比，针刺联合抗抑郁药可改善世界卫生组织生活质量量表 BREF 评分（SMD 0.31，95%CI 0.18 至 0.44，P<0.01；I²=15%）、减少需要增加抗抑郁药剂量的参与者人数（相对风险 [RR] 0.32，95%CI 0.22 至 0.48，P<0.01；I²=0%），并显著提高缓解率（RR 1.52，95%CI 1.26 至 1.83，P<0.01；I²=0%）和治疗反应率（RR 1.35，95%CI 1.24 至 1.47，P<0.01；I²=19%），以 HAMD-17 评分为依据。HAMD-17、SDS 和 SERS 评分通过 GRADE 评估为低质量，其他指标为中质量。
结论：针刺作为抗抑郁药的辅助治疗手段，可能会增强抗抑郁药治疗患者的疗效，并减少抗抑郁药的不良反应。这些发现必须谨慎解释，因为证据质量为低或中质量，且缺乏与安慰剂对照的比较数据。
系统综述注册：INPLASY202150008。
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