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

Abstract

Fei-Yi Zhao,1– 3,* Li Li,4,* Peijie Xu,5,* Wen-Jing Zhang,3,* Gerard A Kennedy,2 Zhen Zheng,2 Yan-Mei Wang,3 Li-Ping Yue,1 Yuen-Shan Ho,6 Qiang-Qiang Fu,7 Russell Conduit2 1Department of Nursing, School of International Medical Technology, Shanghai Sanda University, Shanghai, 201209, People’s Republic of China; 2School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia; 3Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, People’s Republic of China; 4Shanghai Changning Center for Disease Control and Prevention, Shanghai, 200335, People’s Republic of China; 5School of Computing Technologies, RMIT University, Melbourne, VIC, 3000, Australia; 6School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China; 7Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuen-Shan Ho, School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected] Qiang-Qiang Fu, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200090, People’s Republic of China, Tel + 86 021-6569 0520, Fax + 86 021-6569 6249, Email [email protected]: 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: postpartum depression, acupuncture, antidepressants, interpersonal psychotherapy, cognitive behavioral therapy, clinical trials

Keywords

• postpartum depression
• acupuncture
• antidepressants
• interpersonal psychotherapy
• cognitive behavioral therapy
• clinical trials