Acupuncture for Patients With Major Depressive Disorder? No, definitely no!

Acupuncture is considered an effective complementary therapy for major depressive disorder (MDD), yet current findings remain inconsistent, and its overall quality is uncertain. Therefore, this systematic review summarizes the existing evidence on acupuncture for MDD, providing an overview of the current research, identifying gaps and limitations in the literature, and offering guidance for future research.

A Chinese team of researchers systematically searched eight electronic databases (PubMed, EMBASE, CDSR, CENTRAL, CNKI, Wanfang, VIP, and SinoMed) and seven guideline repositories (Trip, AHRQ, NICE, NZGG, GIN, CMACPG, and NHMRC) from inception to November 15, 2024, for RCTs, systematic reviews, and clinical practice guidelines on acupuncture for major depressive disorder. Eligibility criteria were defined according to the PICOS framework. Two reviewers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and AMSTAR-2 for systematic reviews (SRs). Key evidence and recommendations were synthesized and presented in tables and figures.

A total of 374 studies were identified, including 330 RCTs, 35 SRs, and 9 clinical guidelines. Among these studies, 307 (93.03%) were published in Chinese and 23 (6.97%) in English. The RCTs generally involved small sample sizes (50 to 100 participants). The primary intervention was acupuncture combined with antidepressant medication (50%), while 79.39% of studies used antidepressants as the main control. Nearly all studies (97.88%) used changes in depression severity as the primary outcome, although the risk of bias was unclear in 80.3% of cases.

Of the SRs, 97.14% reported positive findings favoring acupuncture’s potential benefits, but 74.29% were rated as very low in methodological quality, lacking thorough bias assessments. Among the two acupuncture-specific guidelines and seven broader guidelines, recommendations for acupuncture in managing MDD varied considerably.

The authors concluded that the evidence from RCTs, SRs, and clinical guidelines suggests that acupuncture may reduce depressive symptom severity and provide additional benefits for patients with comorbid anxiety, sleep disturbances, or somatic symptoms, particularly when used as an adjunctive therapy. However, these findings are mainly based on small-scale trials with methodological limitations, and most guidelines recommend acupuncture only as a third-line complementary option. Further large, high-quality RCTs are needed to strengthen the evidence base and inform future guideline development.

For the following reasons, the conclusions are, in my opinion, wrong:

• Almost all RCTs came from China (we have discussed the untrustworthiness of these trials many times previously, e.g. here or here).
• Almost all studies were methodologically flawed.

Therefore, I suggest a more accurate conclusion based on the available data:

The evidence from RCTs, SRs, and clinical guidelines is unreliable due to the poor quality of the available data. Until reliable evidence is available, acupuncture is not a recommendable therapy for MDD, a life-threatening condition.