Acupuncture on 5-hydroxytryptamine levels and clinical outcomes in depression: A systematic review and meta-analysis of randomized controlled trials

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.

Keywords: Acupuncture; Depression; Meta-analysis; 5-hydroxytryptamine; Sleep disturbance; Anxiety

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.