Acupuncture–antidepressant combinations for clinically diagnosed depressive disorders in China: a systematic review and network meta-analysis
5 affiliations
- 1The Second Affiliated Hospital of Xinxiang Medical University
- 2Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia
- 3The First Affiliated Hospital of Xinxiang Medical University
- 4The Fifth People’s Hospital of Lingbao City
- 5Department of Psychiatry and Mental Health, Faculty of Medicine, Universiti Sultan Zainal Abidin
Abstract
Introduction: To evaluate the short-term efficacy and safety of acupuncture–antidepressant combinations for clinically diagnosed depressive disorders among participants recruited in China using a network meta-analysis.
Methods: PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wanfang were searched from inception to February 2025 for randomised controlled trials of acupuncture–antidepressant combinations and relevant pharmacological or acupuncture-related comparators. The principal efficacy outcome was change in Hamilton Depression Rating Scale (HAMD/HDRS) scores; safety outcomes included nausea/vomiting, dry mouth, headache, and treatment discontinuation. Risk of bias was assessed using RoB 2. Random-effects Bayesian network meta-analyses were conducted in R version 3.6.0 using gemtc version 0.8.1. Mean differences or odds ratios are presented with 95% credible intervals (CrIs), together with posterior rank-position probabilities. A standardised mean difference (SMD)-based sensitivity analysis assessed the influence of pooling HAMD-17 and HAMD-24.
Results: Seventy-seven trials (7,031 participants) were included in the systematic review. Within the principal connected eight-node efficacy network, manual acupuncture plus selective serotonin reuptake inhibitors produced the largest reduction versus SSRI monotherapy (mean difference −3.37; 95% CrI −3.86 to −2.89) and the highest probability of occupying Rank 8 (the most effective position). Electroacupuncture plus SSRIs was also associated with a greater reduction in HAMD scores than SSRIs alone (MD −2.98; 95% CrI −3.66 to −2.31). Manual acupuncture plus SNRIs also favoured combination treatment (MD −3.16; 95% CrI −6.03 to −0.28), although the interval was comparatively wide. The SMD sensitivity analysis retained benefit for both EA + SSRIs and MA + SSRIs relative to SSRIs, although their relative ordering differed from the raw-MD analysis. The available adverse-event networks did not identify statistically clear differences from SSRI monotherapy; however, sparse events and very wide CrIs limit the strength of this finding.
Conclusion: Manual acupuncture plus an SSRI was associated with the largest short-term HAMD reduction in the primary raw-MD network. Relative treatment ordering differed in the SMD sensitivity analysis. The estimates should be interpreted cautiously because clinical heterogeneity, risk-of-bias concerns, sparse safety data, and limited follow-up preclude claims of equivalent safety or a preferred first-line strategy.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/View/CRD420251029584 , identifier CRD420251029584.
Related
- Associations between early antidepressant exposure, affective states, and subjective sleep quality among euthymic depressive-onset bipolar patients: a cross-sectional parallel mediation analysis
- Association of neurotransmitter-based polygenic scores with antidepressant treatment outcomes in patients with major depressive disorder
- Comparative effectiveness of acupuncture combined with rehabilitation for post-stroke hemiplegia: a systematic review and network meta-analysis
- Evidence Mapping, Certainty Appraisal, and Acupoint Prescription Pattern Mining of Acupuncture for Poststroke Dysphagia: An Overview of Systematic Reviews.
- Integrative approaches to acupuncture therapies for post-stroke mild cognitive impairment: a systematic review and network meta-analysis
BibTeX
@article{qiu2026acupunctureantidepressant,
title = {{Acupuncture–antidepressant combinations for clinically diagnosed depressive disorders in China: a systematic review and network meta-analysis}},
author = {Qiyue Qiu and Zheng Zhang and Weiwei Yang and Wan Yin Tew and Chenxi Liu and Mohammad Farris Iman Leong Bin Abdullah and Mun Fei Yam and Shichang Yang},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1805745},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1805745/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Acupuncture–antidepressant combinations for clinically diagnosed depressive disorders in China: a systematic review and network meta-analysis
AU - Qiyue Qiu
AU - Zheng Zhang
AU - Weiwei Yang
AU - Wan Yin Tew
AU - Chenxi Liu
AU - Mohammad Farris Iman Leong Bin Abdullah
AU - Mun Fei Yam
AU - Shichang Yang
PY - 2026
DA - 2026/10/20
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1805745
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1805745/full
AB - Introduction: To evaluate the short-term efficacy and safety of acupuncture–antidepressant combinations for clinically diagnosed depressive disorders among participants recruited in China using a network meta-analysis. Methods: PubMed, Embase, the Cochrane Library, Web of Science, CNKI, and Wanfang were searched from inception to February 2025 for randomised controlled trials of acupuncture–antidepressant combinations and relevant pharmacological or acupuncture-related comparators. The principal efficacy outcome was change in Hamilton Depression Rating Scale (HAMD/HDRS) scores; safety outcomes included nausea/vomiting, dry mouth, headache, and treatment discontinuation. Risk of bias was assessed using RoB 2. Random-effects Bayesian network meta-analyses were conducted in R version 3.6.0 using gemtc version 0.8.1. Mean differences or odds ratios are presented with 95% credible intervals (CrIs), together with posterior rank-position probabilities. A standardised mean difference (SMD)-based sensitivity analysis assessed the influence of pooling HAMD-17 and HAMD-24. Results: Seventy-seven trials (7,031 participants) were included in the systematic review. Within the principal connected eight-node efficacy network, manual acupuncture plus selective serotonin reuptake inhibitors produced the largest reduction versus SSRI monotherapy (mean difference −3.37; 95% CrI −3.86 to −2.89) and the highest probability of occupying Rank 8 (the most effective position). Electroacupuncture plus SSRIs was also associated with a greater reduction in HAMD scores than SSRIs alone (MD −2.98; 95% CrI −3.66 to −2.31). Manual acupuncture plus SNRIs also favoured combination treatment (MD −3.16; 95% CrI −6.03 to −0.28), although the interval was comparatively wide. The SMD sensitivity analysis retained benefit for both EA + SSRIs and MA + SSRIs relative to SSRIs, although their relative ordering differed from the raw-MD analysis. The available adverse-event networks did not identify statistically clear differences from SSRI monotherapy; however, sparse events and very wide CrIs limit the strength of this finding. Conclusion: Manual acupuncture plus an SSRI was associated with the largest short-term HAMD reduction in the primary raw-MD network. Relative treatment ordering differed in the SMD sensitivity analysis. The estimates should be interpreted cautiously because clinical heterogeneity, risk-of-bias concerns, sparse safety data, and limited follow-up preclude claims of equivalent safety or a preferred first-line strategy. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/View/CRD420251029584 , identifier CRD420251029584.
SN - 1664-0640
ER -