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

Table 1 Characteristics of included randomized controlled trials

Ref.	Country or region	Language	Diagnosis	Sample size (intervention/control)	Control	Intervention	Frequency and duration of intervention	Follow-up	Outcomes
Bosch et al[18], 2015	The Netherlands	English	Depression	25/25	Wait-list control	Acupuncture	Weekly, 12 consecutive treatments	-	BDI-II
Gao et al[19], 2023	China	Chinese	Depression	36/35	SSRIs	Acupuncture + HAMA	3 times a week, continuous treatment for 8 weeks	12 weeks	HAMA
Huang et al[20], 2013	China	Chinese	Depressive episode	30/30	SSRIs	Acupuncture + SSRIs	3 times a week, continuous treatment for 6 weeks	-	HAM-D-17, SDS, SERS
Liu et al[21], 2013	China	Chinese	Depressive episode	45/45	SSRIs	Acupuncture + SSRIs	Treatment once in 2 days, continuous treatment for 4 weeks	-	HAM-D-17, SERS
Liu et al[22], 2015	China	Chinese	Depression episode	45/45	SSRIs	Acupuncture + SSRIs	Treatment once in 2 days, continuous treatment for 4 weeks	-	HAM-D-17, 5-HT
Liu et al[23], 2015	China	English	Depressive disorder	60/60	SSRIs	Acupuncture + SSRIs	Treatment once in 2 days, continuous treatment for 6 weeks	-	MADRS, SERS, 5-HT
Liu et al[24], 2018	China	Chinese	Depression	21/21	Fluoxetine hydrochloride	Acupuncture + fluoxetine hydrochloride	Once a day for the first 3 days and once every 3 days thereafter for a total of 8 weeks	-	SDS, MADRS
MacPherson et al[25], 2013	United Kingdom	English	Depression	294/128	Usual care	Acupuncture + usual care	1 session per week, up to 12 weeks	12 months	BDI-II
Qu et al[26], 2013	China	English	Major depressive disorder	51/43	Paroxetine	Manual acupuncture + paroxetine	3 sessions per week over 6 consecutive weeks	4 weeks	HAM-D-17, SDS
Wang et al[27], 2019	China	Chinese	Depression	30/30	Venlafaxine	Acupuncture + venlafaxine	3 times a week for 12 weeks	-	HAM-D-17, SERS
Wong et al[28], 2021	HKSAR, China	English	Depression	40/20	Wait-list control	Acupuncture	Twice per week for 3 consecutive weeks	-	HAM-D-17
Wu et al[29], 2025	China	English	Major depressive disorder	36/36	SSRIs	Intradermal acupuncture + SSRIs	Treatment for 10 times within 6 weeks	10 weeks	HAM-D-17, SDS
Xu et al[30], 2011	China	Chinese	Depressive episode	25/30	SSRIs	Acupuncture + SSRIs	3 times a week for 6 weeks	-	HAM-D-17
Yan et al[31], 2023	China	Chinese	Depressive disorder	30/30	Sertraline	Acupuncture + sertraline	3 sessions per week over 8 consecutive weeks	-	SDS
Yan et al[32], 2023	China	Chinese	Depressive disorder	29/28	False acupuncture + low-frequency rTMS	Acupuncture + low-frequency rTMS	3 times a week for 4 weeks	-	HAM-D-17
Yin et al[33], 2022	China	Chinese	Post-stroke depression	30/29	Western medicine + rTMS	Acupuncture + Western medicine + rTMS	5 times a week for 4 weeks	-	HAM-D-17, PSQI
You et al[34], 2020	China	English	Post-stroke depression	34/33	Sham wrist-ankle acupuncture + Fluoxetine	Thin wrist-ankle acupuncture + fluoxetine	6 days a week, a total of 4 weeks	8 weeks	HAM-D-17, SDS
Zhang et al[35], 2018	China	Chinese	Depression	30/30	Five elements music	Acupuncture + five elements music	5 days a week for 8 weeks	-	HAM-D-17, HAMA
Zhao et al[36], 2019	China	English	Depressive disorder	157/155	SSRIs	Manual acupuncture + SSRIs	3 times a week for 6 weeks	10 weeks	HAM-D-17, SDS, SERS
Zhao et al[37], 2023	China	English	Depressive episode	35/35	Sham-acupuncture	Real-acupuncture	17 sessions for eight consecutive weeks	16 weeks	HAM-D-17, PSQI, HAMA

BDI-II: Beck Depression Inventory-II; HAMA: Hamilton Anxiety Rating Scale; HAM-D: Hamilton Depression Rating Scale; MADRS: Montgomery-Åsberg Depression Rating Scale; PSQI: Pittsburgh Sleep Quality Index; SERS: Self-Rating Scale for the Side Effects; SDS: Self-Rating Depression Scale; SSRI: Selective serotonin reuptake inhibitor; rTMS: Repetitive transcranial magnetic stimulation; 5-HT: 5-hydroxytryptamine.

Table 2 Egger’s test for publication bias

Outcome	Egger’s test P value	Publication bias
HAM-D	0.0424	Possible
HAM-D (antidepressants vs acupuncture + antidepressants)	0.6546	No
SDS	0.5065	No
SERS	0.8065	No

HAM-D: Hamilton Depression Rating Scale; SERS: Self-Rating Scale for the Side Effects; SDS: Self-Rating Depression Scale.