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Assessment of the evidence base for acupuncture is complicated by the fact that many reports are in Asian languages and therefore often overlooked by English language literature searches. Results from studies in acupuncture are difficult to interpret, because the description of the methods is often limited and there is variability in diagnosis and in interventions (403). Wang et al. (407) published a recent meta-analysis of eight trials of acupuncture and depression chosen from more than 200 studies on the basis of having a randomized design, specific diagnostic criteria for depression, and specific acupuncture interventions (manual, electro-acupuncture, or laser). The depression criteria included DSM, International Classification of Diseases, and Chinese Classification of Mental Disorders criteria. The meta-analysis did not demonstrate a benefit of acupuncture over control conditions on either response rates or remission but was based on a small number of trials with variable methodological quality. Consequently, additional systematic study is required to assess the role of acupuncture for major depressive disorder.

There have been few randomized, double-blind, placebo-controlled studies to inform the use of acupuncture for depression. In one published study, Allen et al. (405) compared 38 women, ages 18–45 years, who were assigned to three different groups: an acupuncture regimen specifically chosen to address their depression, sham acupuncture, or a waiting-list control condition. The active acupuncture group experienced a significantly greater remission rate. However, Allen et al. (406) failed to replicate these results in a larger randomized trial, in which 151 patients with major depressive disorder received acupuncture specific for depression, sham acupuncture, or a waiting-list condition. After 8 weeks, there was no evidence of benefit for the acupuncture intervention specific for depression, compared with sham acupuncture or the waiting-list condition. Response rates were 22% for the depression-specific acupuncture treatment and 39% for the sham acupuncture treatment.

In another randomized study, Luo et al. (404) compared effects of electro-acupuncture combined with placebo medication to the effects of amitriptyline in 241 inpatients. Electro-acupuncture appeared equivalent to amitriptyline at a dose of 150–175 mg/day in treating depression, with greater improvement for symptoms of anxiety, cognitive problems, and somatization; it also resulted in a lower side effect burden than amitriptyline. However, no group received the placebo medication alone, and no sham treatment was used to elucidate nonspecific benefits of acupuncture treatment.

References

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