Acupuncture for the anxiety and depression in Parkinson disease: A systematic review and network meta-analysis

Parkinson disease (PD) is characterized by motor symptoms as the main clinical manifestation. Emotional symptoms such as anxiety and depression are often closely related to the severity of the disease in Parkinson disease patients. Acupuncture therapies have shown effective effects on PD's motor and emotional symptoms. This study aims to evaluate the efficacy of acupuncture in improving anxiety and depression in PD patients and compare the effectiveness of different acupuncture therapies.

A comprehensive search was conducted across 7 databases to identify randomized controlled trials on acupuncture to improve anxiety and depression in PD patients, from inception to July 1, 2023. Two reviewers independently screened the literature, extracted data, and cross-checked the information. The outcome measures included Hamilton Depression Rating Scale scores, Hamilton Anxiety Rating Scale scores, Self-Rating Depression Scale scores, and Self-Rating Anxiety Scale scores. Data analysis was performed using STATA 17.0 software for network meta-analysis, RevMan 5.4 for pairwise meta-analysis, and Cochrane Handbook 5.1 for assessing the risk of bias.

This study included 26 randomized controlled trials, involving 2153 PD patients with anxiety or depression. The network meta-analysis results showed that the combination of acupuncture and Western medicine had better efficacy in improving Hamilton Depression Rating Scale scores, Hamilton Anxiety Rating Scale scores, and Self-Rating Depression Scale scores compared to other treatments. And acupuncture combined with traditional Chinese medicine and western medicine had better efficacy in improving SAS scores than western medicine alone.

The findings of this study suggest that acupuncture combined with western medicine may be considered a feasible treatment option for PD patients with anxiety or depression. However, because of limitations in the quality of the literature, further validation of this conclusion is warranted through future studies.