Wang Y, Wu PT, Penpat I, Zeng FC, Lu Q, Hu ZH. Acupuncture on 5-hydroxytryptamine levels and clinical outcomes in depression: A systematic review and meta-analysis of randomized controlled trials. World J Psychiatry 2026; 16(2): 113049 [DOI: 10.5498/wjp.v16.i2.113049]
Corresponding Author of This Article
Zhi-Hai Hu, Associate Professor, Department of Acupuncture and Moxibusion, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, No. 230 Baoding Road, Hongkou District, Shanghai 200082, China. shennong923@163.com
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Psychiatry
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Systematic Reviews
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Feb 19, 2026 (publication date) through Feb 2, 2026
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World Journal of Psychiatry
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2220-3206
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Wang Y, Wu PT, Penpat I, Zeng FC, Lu Q, Hu ZH. Acupuncture on 5-hydroxytryptamine levels and clinical outcomes in depression: A systematic review and meta-analysis of randomized controlled trials. World J Psychiatry 2026; 16(2): 113049 [DOI: 10.5498/wjp.v16.i2.113049]
World J Psychiatry. Feb 19, 2026; 16(2): 113049 Published online Feb 19, 2026. doi: 10.5498/wjp.v16.i2.113049
Acupuncture on 5-hydroxytryptamine levels and clinical outcomes in depression: A systematic review and meta-analysis of randomized controlled trials
Yi Wang, Peng-Tao Wu, Ittipalanukul Penpat, Fei-Cui Zeng, Qun Lu, Zhi-Hai Hu
Yi Wang, Zhi-Hai Hu, Department of Acupuncture and Moxibusion, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China
Peng-Tao Wu, Department of Traditional Chinese Medicine, Puxing Community Health Service Center in Pudong New District, Shanghai 200129, China
Ittipalanukul Penpat, International Education College, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Fei-Cui Zeng, Department of Traditional Chinese Medicine, Community Health Service Center of Beiwaitan Street in Hongkou District, Shanghai 200080, China
Qun Lu, Department of Clinical Laboratory, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China
Co-first authors: Yi Wang and Peng-Tao Wu.
Co-corresponding authors: Qun Lu and Zhi-Hai Hu.
Author contributions: Wang Y and Wu PT contributed equally to this work as co-first authors; Hu ZH and Lu Q contributed equally to this work as co-corresponding authors; Wang Y and Hu ZH designed and conducted the research and participated in drafting the manuscript; Wu PT participated in drafting the manuscript, co-designed the research, and provided clinical advice; Lu Q co-designed the research and supervised the report; Penpat I and Zeng FC co-designed the research and contributed to data analysis.
Supported by Outstanding Young Medical Talents Training Program of the Health System in Pudong New District, Shanghai, No. PWRq2023-37.
Conflict-of-interest statement: The authors report no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Hai Hu, Associate Professor, Department of Acupuncture and Moxibusion, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, No. 230 Baoding Road, Hongkou District, Shanghai 200082, China. shennong923@163.com
Received: September 12, 2025 Revised: October 27, 2025 Accepted: November 18, 2025 Published online: February 19, 2026 Processing time: 139 Days and 23.2 Hours
Abstract
BACKGROUND
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.
AIM
To evaluate the efficacy of acupuncture in patients with depression and explore its feasibility as an adjunctive treatment.
METHODS
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
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.
CONCLUSION
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.
Core Tip: This meta-analysis focused exclusively on traditional manual acupuncture, excluding electroacupuncture, to determine its independent therapeutic effect on depression. Twenty randomized controlled trials were included. The findings reveal that acupuncture significantly improves depressive symptoms, anxiety, sleep quality, and serum 5-hydroxytryptamine levels, while reducing antidepressant-related side effects. By eliminating heterogeneity caused by different acupuncture modalities, this study provides stronger evidence for the clinical application of acupuncture as an effective adjunctive therapy for depression.
