Acupuncture on 5-hydroxytryptamine levels and clinical outcomes in depression: A systematic review and meta-analysis...

Depression is a prevalent global mental health issue with substantial disease burden. Although pharmacotherapy remains the first-line treatment, its efficacy and tolerability are limited. Acupuncture, a core modality in traditional Chinese medicine, has shown promise in improving depressive symptoms via neurotransmitter modulation. However, prior meta-analyses often considered manual and electroacupuncture together, increasing heterogeneity. This review focuses solely on traditional acupuncture to clarify its therapeutic role and provide evidence for standardized clinical application.

To evaluate the efficacy of acupuncture in patients with depression and explore its feasibility as an adjunctive treatment.

Twenty randomized controlled trials on traditional acupuncture for depression-whose quality was assessed using the Cochrane tool-were included in this meta-analysis. Primary outcomes were the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory-II (BDI-II), Self-Rating Depression Scale (SDS), and Montgomery-Åsberg Depression Rating Scale (MADRS). Secondary outcomes were the Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA), Self-Rating Scale for the Side Effects (SERS), and serum 5-hydroxytryptamine (5-HT) levels. RevMan 5.4 software was employed for the meta-analysis.

Results revealed that acupuncture significantly reduced HAM-D, SDS, and MADRS scores. Although BDI-II scores improved in some studies, its overall effect was not statistically significant. Acupuncture also significantly improved HAMA and PSQI scores and increased serum 5-HT levels. Notably, SERS analysis indicated that acupuncture can significantly alleviate adverse reactions associated with antidepressants. However, most pooled results revealed substantial heterogeneity.

The efficacy of traditional acupuncture improving symptoms, sleep, and anxiety and alleviating antidepressant side effects is highly encouraging. However, the low quality of the included studies warrants cautious interpretation.