Effectiveness Of Acupuncture Combined With SSRIs For Depression:a Systematic Review And Meta-analysis

BackgroundDepression is a serious emotional disorder with a lifetime prevalence of about 17%and affects at least 350 million people worldwide.Selective serotonin reuptake inhibitors(SSRIs)are the preferred and most widely used drugs for antidepressant treatment,but only 60%of patients respond well to these drugs,and 30%of patients fail to receive a treatment response.Due to the"delayed onset" effect of SSRIs,patients with depression are often disappointed in treatment due to inadequate efficacy and the need to endure the side effects of the medication,thus aggravating the condition and reducing patient compliance.As an effective supplement to the treatment of depression,acupuncture is often used in combination with antidepressants.Clinical trials show that acupuncture and electroacupuncture as additional therapies for SSRIs antidepressants can improve the treatment effect,accelerate the treatment response,and possibly reduce the adverse reactions of SSRIs,and have better effects on patients with primary depression.At present,there is no meta-analysis or systematic review in the treatment of primary depression with acupuncture or electroacupuncture combined with SSRIs,and the advantage mechanism of acupuncture combined with SSRIs in treating depression over antidepressants alone has not been clarified.ObjectiveThrough the meta-analysis of randomized controlled trials of acupuncture or electroacupuncture combined with SSRIs in the treatment of primary depression,to evaluate the clinical efficacy of acupuncture or electroacupuncture combined with SSRIs in the treatment of primary depression,further evidence-based evidence is provided for the quickly work and the reduction of adverse drug reactions of acupuncture or electroacupuncture in the treatment of primary depression.MethodsComputer retrieval of the Chinese Biomedical Literature Database,CNKI,Weipu Database,and Wanfang Digital Journal Group,PubMed,EMBASE,and Cochrane Library;Collection of randomized controlled trials(RCTS);the main outcomes were the treatment effectiveness and the Hamilton Depression Rating Scale(HAMD),as well as adverse event rates and the Asberg's Antidepressant Side Effects Scale(SERS);the secondary outcome indicators were the Zung.Self-Rating Depression Scale(SDS),HAMD factors score,the Clinical Global Impression-severty of illness(CGI-SI),and the Treatment emergent symptom scale(TESS).The RevMan 5.3 software(provided by the Cochrane collaboration Network)was used for meta-analysis.ResultsTotal of 36 clinical trials involving 2874 patients were included.The quality of the included literatures on acupuncture and electroacupuncture combined with SSRIs for the treatment of primary depression was evaluated.It was found that the sample size of the 36 literatures was small,the general quality was not high,and there was a certain risk of bias.For outcome indicators,changes in HAMD score were used as the main outcome indicators in all the studies.The results of meta-analysis showed that the changes of HAMD score in the acupuncture and antidepressant combination group at week 1,2,4,6 and 8 were statistically different from those in the control group,the effective rate and recovery rate of acupuncture and antidepressant combination group were significantly higher than that of the control group;the SERS indexes of the antidepressant combination group were lower than those of the control group at 2,4,and 6 weeks;the incidence of adverse reactions was significantly lower than that of the control group;There were statistically significant differences in SDS score and CGI-SI score between the two groups before and after treatment.Differences in HAMD factors scores between the two groups:after 1,2,4 and 6 weeks of treatment,anxiety/somatization factor scores decreased in the acupuncture and antidepressant combination group compared with the control group,and the differences were statistically significant;the sleep disorder factor scores were different between the two groups at week 1,2 and 6,but no significant difference was found between the two groups at week 4;the cognitive impairment factor scores were different between the two groups at week 1 and 2,but no significant difference was found between the two groups at week 4 and 6;the hysteresis factor score were different between the two groups at week 1,2 and 4,but no difference was found between the two groups at week 6.There was no significant difference in weight factor score between the two groups at week 1,2,4 and 6.ConclusionAcupuncture combined with SSRIs in the treatment of primary depression can significantly improve curative effect,alleviate most clinical symptoms of patients with depression,shorten the onset time,improve other physical discomfort accompanied by depression,aid sleep and reduce anxiety,and quickly restore patient's cognition;at the same time,acupuncture combined with SSRIs antidepressants can reduce other damage to the patient's body,with fewer side effects and higher safety;acupuncture combined with SSRIs antidepressants can help patients return to normal life more quickly,conforms to the needs of society and family,It has practical value in clinical application and is worth promoting.