Papers Introduction The most common conventional treatments for depression, ie psychotherapy and anti- depressant medication, are well-researched and known to be efficacious. However, their effectiveness in practice is reduced by high rates of dropout, lack of effect in some individuals, and relapse. 1-4 Many patients terminate treatment with antidepressant medications prematurely because of intolerable adverse effects. 2 Psychotherapy appears to produce equivalent outcomes to those obtained with antidepressant medication, but not to be uniformly accepted, 2 and the rate of withdrawal from treatment is similar to that with anti- depressants. 5 Faced with these limitations of conventional treatments, patients suffering from depression often seek alternative treatment. 6 A recent survey revealed the popularity of complementary and alternative medicine (CAM) such as acupuncture for psychiatric and emotional disorders. 7 In China, Japan and Korea, acupuncture has long been used for emotional, psychological and spiritual disorders including anxiety, stress, insomnia and depression. There seems to be an increasing demand for acupuncture in this field among western countries as well. According to a recent survey of acupuncture in the UK, acupuncturists are dealing with emotional, psychological and spiritual disorders in 9% of their patients, which is higher than acute and chronic back pain at 6%. 8 The results of three overviews of CAM for treating depression indicate that acupuncture is a promising modality. 9-11 Recently the efficacy of acupuncture for depression has attracted the attention of conventional researchers and three new studies on this subject are underway. 12-14 Despite the importance of the subject matter, there has been no comprehensive review of studies using acupuncture for depression. We therefore undertook a review with the aim of summarising the existing evidence for or against the hypothesis that acupuncture is an efficacious therapy for depression. Yoshito Mukaino professor Faculty of Sports and Health Science Fukuoka University Japan. Jongbae Park acupuncturist researcher Division for Research and Education in Complementary and Integrative Medical Therapies Harvard Medical School, Boston, USA Adrian White acupuncturist researcher Peninsula Medical School Plymouth, UK Edzard Ernst professor Peninsula Medical School Exeter, UK Correspondence: Yoshito Mukaino mukaino@fukuoka-u.ac.jp The effectiveness of acupuncture for depression – a systematic review of randomised controlled trials Yoshito Mukaino, Jongbae Park, Adrian White, Edzard Ernst Abstract Objective To summarise the existing evidence on acupuncture as a therapy for depression. Methods RCTs were included, in which either manual acupuncture or electroacupuncture was compared with any control procedure in subjects with depression. Data were extracted independently by two authors. The methodological quality was assessed. Pre and post means and SDs for depression specific measures were extracted, when available, for meta-analysis. Results Seven randomised comparative trials involving 509 patients were included. The evidence is inconsistent on whether manual acupuncture is superior to sham, and suggests that acupuncture was not superior to waiting list. Evidence suggests that the effect of electroacupuncture may not be significantly different from antidepressant medication, weighted mean difference -0.43(95% CI -5.61 to 4.76). There is inconclusive evidence on whether acupuncture has an additive effect when given as an adjunct to antidepressant drugs. Conclusion The evidence from controlled trials is insufficient to conclude whether acupuncture is an effective treatment for depression, but justifies further trials of electroacupuncture. Keywords Depression, acupuncture, electroacupuncture, systematic review. ACUPUNCTURE IN MEDICINE 2005;23(2):70-76. 70 www.medical-acupuncture.co.uk/aimintro.htm group.bmj.com on February 19, 2013 - Published by aim.bmj.com Downloaded from