Research Question

  1. Is needle acupuncture, as a monotherapy or adjunctive therapy, more effective than sham acupuncture, treatment as usual, waitlists, no treatment, or other active treatments in reducing depressive symptoms and relapse rates in adults with major depressive disorder (MDD), and how common and severe are adverse 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.

Key Findings

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.

Recommendations

  • Future studies should improve on the weaknesses pervasive in the current body of work, including a lack of patient blinding to assigned conditions, suboptimal participant retention, and the lack of intention-to-treat analyses.
  • Further research examining the effect of acupuncture on depression should include large samples that allow results to be stratified by disease severity, focus on better understanding whether there is a minimum frequency or duration of acupuncture for it to be effective, and include measures of health-related quality of life.

Table of Contents

  • 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

This research was sponsored by the Office of the Secretary of Defense and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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