Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis

Fei-Yi Zhao; Li Li; Peijie Xu; Wen-Jing Zhang; Gerard A Kennedy; Zhen Zheng; Yan-Mei Wang; Li-Ping Yue; Yuen-Shan Ho; Qiang-Qiang Fu; Russell Conduit

doi:10.2147/NDT.S484387

Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis

Neuropsychiatr Dis Treat. 2024 Sep 21:20:1741-1755. doi: 10.2147/NDT.S484387. eCollection 2024.

Authors

Fei-Yi Zhao^#^{1

2

3}, Li Li^#⁴, Peijie Xu^#⁵, Wen-Jing Zhang^#³, Gerard A Kennedy², Zhen Zheng², Yan-Mei Wang³, Li-Ping Yue¹, Yuen-Shan Ho⁶, Qiang-Qiang Fu⁷, Russell Conduit²

Affiliations

¹ Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People's Republic of China.
² School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia.
³ Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People's Republic of China.
⁴ Shanghai Changning Center for Disease Control and Prevention, Shanghai, 200335, People's Republic of China.
⁵ School of Computing Technologies, RMIT University, Melbourne, VIC, 3000, Australia.
⁶ School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, People's Republic of China.
⁷ Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People's Republic of China.

^# Contributed equally.

Abstract

Background: Acupuncture is popular in the treatment of mental illness. This study determined its feasibility and role in managing postpartum depression (PPD) using a network meta-analysis.

Methods: We systematically searched seven databases up to May 2024 for randomized controlled trials (RCTs) appraising acupuncture's efficacy and safety against waitlist-control, placebo, standard control, or as an add-on treatment. Cochrane criteria were followed.

Results: Thirteen studies encompassing 872 participants underwent analysis. Both pairwise and network meta-analysis indicated that acupuncture, psychotherapy, and antidepressants were comparable in clinical efficacy rate and in reducing Hamilton Depression Scale and Edinburgh Postnatal Depression Scale scores. Acupuncture and psychotherapy also effectively mitigated concurrent anxiety symptoms. Combining acupuncture with antidepressants augmented therapeutic efficacy and reduced reported gastrointestinal adverse effects associated with antidepressant use. Acupuncture combined with psychotherapy offered similar benefits with superior safety profile. However, the quality of evidence ranged from very low to low due to significant risks of bias and limited sample sizes. The efficacy of psychotherapy and the combination of acupuncture and psychotherapy might be underestimated, as most RCTs used supportive therapy or individual counseling as positive controls instead of recommended approaches like interpersonal psychotherapy (IPT) or cognitive behavioral therapy (CBT) per PPD guidelines.

Conclusion: Current evidence precludes strong recommendations of administering acupuncture in PPD. Rigorous RCTs are essential to validate promising outcomes observed in comparisons between acupuncture, antidepressants, and their combined application. It remains inconclusive whether acupuncture's antidepressive effect is specific or non-specific. Given that psychotherapy is a recommended first-line treatment, investigating the potential efficacy enhancement of combining acupuncture with IPT/CBT is paramount to ascertain the preferred therapeutic approach for PPD.

Keywords: acupuncture; antidepressants; clinical trials; cognitive behavioral therapy; interpersonal psychotherapy; postpartum depression.

Publication types

Review

Grants and funding

This work was supported by the Health and Medical Research Fund [20212801], Health Bureau, Hong Kong SAR and the Chinese Medicine Development Fund [23B2/030A], Hong Kong SAR to YS-H; Scientific Research Fund Project of Shanghai Sanda University [2024BSZX03] to FY-Z; and TCM Research Project, Shanghai Municipal Health Commission [2022CX007] to WJ-Z.