Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis

Fei-Yi Zhao; Qiang-Qiang Fu; Gerard A Kennedy; Russell Conduit; Wen-Jing Zhang; Zhen Zheng

doi:10.3389/fpsyt.2021.666988

Acupuncture as an Independent or Adjuvant Management to Standard Care for Perimenopausal Depression: A Systematic Review and Meta-Analysis

Front Psychiatry. 2021 May 28:12:666988. doi: 10.3389/fpsyt.2021.666988. eCollection 2021.

Authors

Fei-Yi Zhao^{1

2

3}, Qiang-Qiang Fu⁴, Gerard A Kennedy^{1

5

6}, Russell Conduit¹, Wen-Jing Zhang², Zhen Zheng¹

Affiliations

¹ School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
² Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, China.
⁴ Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.
⁵ School of Science, Psychology and Sport, Federation University, Mount Helen, VIC, Australia.
⁶ Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia.

Abstract

Background: Many women with perimenopausal depression (PMD) have sought alternative therapies such as acupuncture because of concerns about risks associated with antidepressant and hormone replacement therapy (HRT). This systematic review aimed to clarify if acupuncture is effective for PMD compared with waitlist control or placebo/sham acupuncture, and if acupuncture alone or combined with standard care (antidepressant and/or HRT) is more effective in ameliorating PMD in comparison with standard care alone. Methods: Randomized controlled trials (RCTs) of PMD treatment via acupuncture vs. waitlist control or placebo/sham acupuncture, and RCTs of PMD treatment via acupuncture alone or combined with Western pharmacotherapy vs. Western pharmacotherapy were searched for from seven databases from inception to December 2020. Cochrane criteria were followed. Results: Twenty-five studies involving 2,213 women were analyzed. Meta-analyses indicated that acupuncture significantly reduced the global scores of Hamilton Depression Scale (HAMD) [standardized mean difference (SMD) = -0.54, 95% CI (-0.91, -0.16), p < 0.01], compared with standard care. The therapeutic effect of acupuncture maintained at 2-, 4-, and 12-week follow-ups. Acupuncture combined with standard care was more effective than standard care alone in decreasing HAMD scores [SMD = -0.82, 95% CI (-1.07, -0.58), p < 0.01]. Too few RCTs were available to assess the clinical efficacy differences between acupuncture and placebo/sham acupuncture or HRT alone. Acupuncture also showed better effects in decreasing Kupperman index (KI) scores, whether compared with antidepressant alone [MD = -4.55, 95% CI (-8.46, -0.65), p = 0.02] or antidepressant combined with HRT [MD = -0.89, 95% CI (-1.34, -0.43), p < 0.01]. Conclusions: In comparison with standard care, acupuncture alone or combined with standard care was associated with significant improvements in PMD and reductions of other menopausal symptoms. This finding suggests that acupuncture may be a useful addition to treatment for PMD.

Keywords: acupuncture; meta-analysis; perimenopausal depression; standard care; systematic review.

Publication types

Systematic Review