Acupuncture as Add-on Therapy to SSRIs Can Improve Outcomes of Treatment for Anxious Depression: Subgroup Analysis of the AcuSDep Trial

Bingcong Zhao; Zhigang Li; Chuan Shi; Yan Liu; Yang Sun; Bin Li; Jie Zhang; Zhizhong Gong; Yuanzheng Wang; Xuehong Ma; Xinjing Yang; Huili Jiang; Yuanbo Fu; Xin Wang; Yang Li; Hengchia Liu; Tuya Bao; Yutong Fei

doi:10.2147/NDT.S446034

Acupuncture as Add-on Therapy to SSRIs Can Improve Outcomes of Treatment for Anxious Depression: Subgroup Analysis of the AcuSDep Trial

Neuropsychiatr Dis Treat. 2024 May 16:20:1049-1064. doi: 10.2147/NDT.S446034. eCollection 2024.

Authors

Bingcong Zhao^{1

2}, Zhigang Li³, Chuan Shi⁴, Yan Liu⁵, Yang Sun³, Bin Li^{1

2}, Jie Zhang⁶, Zhizhong Gong⁷, Yuanzheng Wang⁸, Xuehong Ma⁹, Xinjing Yang¹⁰, Huili Jiang³, Yuanbo Fu^{1

2}, Xin Wang^{1

2}, Yang Li⁶, Hengchia Liu⁶, Tuya Bao³, Yutong Fei^{11

12

13}

Affiliations

¹ Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People's Republic of China.
² Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People's Republic of China.
³ School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, People's Republic of China.
⁴ Psychological Assessment Center, Peking University Sixth Hospital, Beijing, People's Republic of China.
⁵ Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, People's Republic of China.
⁶ Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People's Republic of China.
⁷ Division of Medical Affairs, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People's Republic of China.
⁸ Department of Integrative TCM and Western Medicine, Peking University First Hospital, Beijing, People's Republic of China.
⁹ Department of Acupuncture & Moxibustion, Dongfang Hospital, the Second Clinical Medical College of Beijing University of Chinese Medicine, Beijing, People's Republic of China.
¹⁰ Department of Traditional Chinese Medicine, South China Hospital of Shenzhen University, Shenzhen, People's Republic of China.
¹¹ Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China.
¹² Institute of Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China.
¹³ Beijing GRADE Centre, Beijing, People's Republic of China.

Abstract

Purpose: Anxious depression (AD) is a common, distinct depression subtype. This exploratory subgroup analysis aimed to explore the effects of acupuncture as an add-on therapy of selective serotonin reuptake inhibitors (SSRIs) for patients with AD or non-anxious depression (NAD).

Patients and methods: Four hundred and sixty-five patients with moderate-to-severe depression from the AcuSDep pragmatic trial were included in analysis. Patients were randomly assigned to receive MA+SSRIs, EA+SSRIs, or SSRIs alone (1:1:1) for six weeks. AD was defined by using dimensional criteria. The measurement instruments included 17-items Hamilton Depression Scale (HAMD-17), Self-Rating Depression Scale (SDS), Clinical Global Impression (CGI), Rating Scale for Side Effects (SERS), and WHO Quality of Life-BREF (WHOQOL-BREF). Comparison between AD and NAD subgroups and comparisons between groups within either AD or NAD subgroups were conducted.

Results: Eighty percent of the patients met the criteria for AD. The AD subgroup had poorer clinical manifestations and treatment outcomes compared to those of the NAD subgroup. For AD patients, the HAMD response rate, remission rate, early onset rate, and the score changes on each scale at most measurement points on the two acupuncture groups were significantly better than the SSRIs group. For NAD patients, the HAMD early onset rates of the two acupuncture groups were significantly better than the SSRIs group.

Conclusion: For AD subtype patients, either MA or EA add-on SSRIs showed comprehensive improvements, with small-to-medium effect sizes. For NAD subtype patients, both the add-on acupuncture could accelerate the response to SSRIs treatment. The study contributed to the existing literature by providing insights into the potential benefits of acupuncture in combination with SSRIs, especially for patients with AD subtypes. Due to its limited nature as a post hoc subgroup analysis, prospectively designed, high-quality trials are warranted.

Clinical trials registration: ChiCTR-TRC-08000297.

Keywords: SSRIs; acupuncture; anxious depression; non-anxious depression; subgroup analysis.

Publication types

Case Reports
Clinical Trial

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant number 82004445); the National Science and Technology Support Program of China (grant number 2006BAI12B05-2); the Young Talents Lifting Project of Beijing Association for Science and Technology (grant number BYESS2023338). The funding sources had no role in the study design, data collection, analysis, interpretation of data or manuscript preparation.