The role of acupuncture in the management of insomnia as a major or residual symptom among patients with active or previous depression : a systematic review and meta-analysis

- Zhao, Fei-Yi, Kennedy, Gerard, Spencer, Sarah, Conduit, Russell, Zhang, Wen-Jing, Fu, Qiang-Qiang, Zheng, Zhen

Title
The role of acupuncture in the management of insomnia as a major or residual symptom among patients with active or previous depression : a systematic review and meta-analysis
Creator
Zhao, Fei-Yi; Kennedy, Gerard; Spencer, Sarah; Conduit, Russell; Zhang, Wen-Jing; Fu, Qiang-Qiang; Zheng, Zhen
Date
2022
Type
Text; Journal article; Review
Identifier
http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/188155
Identifier
vital:17253
Identifier
https://doi.org/10.3389/fpsyt.2022.863134
Identifier
ISSN:1664-0640 (ISSN)
Abstract
Background: Due to concerns about risks associated with antidepressants and/or hypnotics, complementary therapies such as acupuncture have been sought by patients with active or previous depression to manage insomnia. This systematic review aimed to clarify if acupuncture is effective and safe enough to be recommended as an alternative or adjuvant therapy to standard care in ameliorating concomitant or residual insomnia, two types of insomnia associated with depression. Methods: Randomized controlled trials (RCTs) of depression-related insomnia (DI) treatment via acupuncture vs. waitlist-control or placebo-/sham-acupuncture and RCTs of DI treatment via acupuncture alone or combined with standard care [Western pharmacotherapy and/or cognitive-behavioral therapy (CBT)] vs. standard care alone were searched for from seven databases from inception to December 2021. Cochrane criteria were followed. Results: Twenty-one studies involving 1,571 participants were analyzed. For insomnia as a major symptom of active depression, meta-analyses suggested that acupuncture significantly reduced the global scores of both the Pittsburg Sleep Quality Index (PSQI) [MD = −3.12, 95% CI (−5.16, −1.08), p < 0.01] and Hamilton Depression Scale (HAMD) [SMD = −2.67, 95% CI (−3.51, −1.84), p < 0.01], in comparison with placebo-acupuncture. When compared with conventional pharmacotherapy (antidepressants and/or hypnotics), the results favored acupuncture in decreasing PSQI [MD = −1.17, 95% CI (−2.26, −0.08), p = 0.03] and HAMD [SMD = −0.47, 95% CI (−0.91, −0.02), p = 0.04]. Acupuncture was comparable to conventional pharmacotherapy in reducing scores of each domain of PSQI. For insomnia as a residual symptom of previous or partially remitted depression, acupuncture conferred a very limited, non-significant therapeutic advantage against sham-/placebo-acupuncture. Whether acupuncture has an add-on effect to conventional pharmacotherapy in this type of insomnia has not been investigated. Also, no study was available to address the efficacy differences between acupuncture and CBT or the synergistic effect of these two therapies. Conclusions: There is a low to moderate level of evidence supporting acupuncture as a safe and effective remedy alternative to or adjuvant to conventional pharmacotherapy (antidepressant and/or hypnotic) in improving insomnia and other depression symptoms among patients with active depression. Furthermore, the patients' complaint of disrupted sleep continuity is most likely to benefit from acupuncture. The benefit of acupuncture on residual insomnia associated with previous or partially remitted depression is limited. Future acupuncture studies need to consider applying optimal dosage and addressing deficiencies in trial quality. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021269880, PROSPERO, identifier: CRD42021269880. Copyright © 2022 Zhao, Kennedy, Spencer, Conduit, Zhang, Fu and Zheng.
Publisher
Frontiers Media S.A.
Relation
Frontiers in Psychiatry Vol. 13, no. (2022), p.
Rights
All metadata describing materials held in, or linked to, the repository is freely available under a CC0 licence
Rights
https://creativecommons.org/licenses/by/4.0/
Rights
Copyright © 2022 Zhao, Kennedy, Spencer, Conduit, Zhang, Fu and Zheng
Rights
Open Access
Subject
3202 Clinical sciences; Acupuncture; Depression; Insomnia; Meta-analysis; RCT; Systematic review
Full Text
Reviewed
Funder
This work was sponsored by RMIT Research Stipend Scholarship, RMIT University, Australia, and University's scientific research project, Shanghai Sanda University (2021zz02-yj) to F-YZ and the National key R&D projects in the 14th five year plan (2021YFC2501500) to W-JZ.
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