TABLE 1.
Characteristics of the included trials.
| No. | References | Methods | Location | Diagnosis | Method of diagnosis | Group | Age (yr) | Sex (male/ female) | Intervention duration | Frequency of treatment | Time points for assessment | Outcomes | Dropout rate and others |
| 1 | (30) | Parallel-arm RCT; Single-center; Single-blind (patients) |
China | PSD. |
Stroke: Guidelines for the diagnosis and treatment of acute ischemic stroke. Depression: DSM-V. |
EA | 67.8 ± 10.91 | 20/13 | 4 weeks | 3 times a week. | 0 week; 2 weeks; 4 weeks; 8 weeks (follow-up). |
HAMD-24; SDS; NIHSS; BI; Depression scale of traditional Chinese medicine; AEs. |
12.30% |
| Non-invasive acupuncture control | 66.7 ± 11.42 | 18/14 | 4 weeks | 3 times a week. | |||||||||
| 2 | (31) | RCT; Multi-center |
China | Primary unipolar depression. | ICD-10. | Paroxetine | 35.37 ± 11.37 | 14/21 | 6 weeks | Sid. | 0 week; 2 weeks; 4 weeks; 6 weeks; 10 weeks (follow-up). |
SCL-90. | 9.52% |
| MA + Paroxetine | 32.11 ± 9.38 | 14/21 | 6 weeks |
Paroxetine: Sid; MA: every other day, 3 times a week. |
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| EA + Paroxetine | 31.89 ± 8.81 | 15/20 | 6 weeks |
Paroxetine: Sid; EA: every other day, 3 times a week. |
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| 3 | (32) | RCT; Single-center |
China | Liver-qi stagnation and spleen deficiency in the elderly with post-stroke depression. |
Stroke: Diagnostic efficacy evaluation criteria for stroke; Diagnostic essentials of various cerebrovascular diseases. Depression: Diagnostic efficacy standard of TCM disease and syndrome; CCMD. |
Stomach acupuncture (manual manipulation) | 72 ± 8 | 8/11 | 6 weeks | Once every other day for 21 times. | 0 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-/; SDS; SDSS; AEs. |
0% |
| EA | 69 ± 7 | 9/10 | 6 weeks | Once every other day for 21 times. | |||||||||
| Basic treatment control | 69 ± 6 | 10/9 | 6 weeks | Sid. | |||||||||
| 4 | (33) | RCT; Single-center |
China | PSD | Diagnostic criteria of 4th National Conference on cerebrovascular disease; Diagnostic criteria for Post Stroke Mood Disorders in Neurorehabilitation (CT/MRI). |
EA | 54–78 | 20/16 | 8 weeks | 5 times a week. | 0 week; 8 weeks; 6 months (follow-up). |
HAMD-/; AEs. |
0% |
| Fluoxetine | 58–72 | 18/18 | 8 weeks | Sid. | |||||||||
| 5 | (34) | RCT; Multi-center; Single-blind (patients and assessors) |
Hong Kong SAR, China | Postpartum depression | DSM-IV. | EA | 35.3 ± 4.7 | 0/20 | 4 weeks | Twice a week, at least 2 days apart. | 0 week; 2 weeks; 4 weeks; 8 weeks (follow-up). |
HAMD-17; EPDS; HADS; CGI; Sheehan Disability Scale; CTRS; AEs. |
30%; Small sample size and high dropout rate. |
| Non-invasive acupuncture control | 34.4 ± 2.2 | 4 weeks | Twice a week, at least 2 days apart. | ||||||||||
| 6 | (35) | RCT; Single-center; Single-blind (patients and assessors) |
Hong Kong SAR, China | Depression with insomnia | DSM-IV. | EA + antidepressants | 48.8 ± 9.9 | 14/46 | 4 weeks |
Antidepressants: /; EA: 3 times a week. |
0 week; 1 week; 5 weeks. |
SE; ISI; PSQI; HAMD-17; HAMA; HADS; SSI; Sheehan Disability Scale; MFI; ESS; SF-36; AEs. |
10.67% |
| Sham acupoints acupuncture + antidepressants | 50.9 ± 9.5 | 14/46 | 4 weeks |
Antidepressants: /; Sham acupoints acupuncture: 3 times a week. |
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| Non-invasive acupuncture + antidepressants | 47.4 ± 9.5 | 3/27 | 4 weeks |
Antidepressants: /; Non-invasive acupuncture: 3 times a week. |
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| 7 | (36) | RCT; Single-center |
China | PSD |
Stroke: Diagnostic criteria revised at the 4th National Conference on cerebrovascular disease (1995); Stroke diagnosis by CT or MRI. Depression: CCMD-3; DSM-IV. |
EA | 58.4 ± 9.6 | 25/13 | 4 weeks | Once a day, 10 times as a course of treatment, a total of 3 courses of treatment. | 0 day; 4 weeks (30 days). |
HAMD-/; SDS; Serum 5-HT. |
/ |
| MA | 59.21 ± 7.56 | 23/13 | 4 weeks | Once a day, 10 times as a course of treatment, a total of 3 courses of treatment. | |||||||||
| Fluoxetine | 56.61 ± 8.21 | 19/15 | 4 weeks | Sid. | |||||||||
| 8 | (37) | RCT; Single-center |
China | Depression | CCMD-3; Diagnostic efficacy standard of TCM diseases. |
Fluoxetine | 39.47 ± 11.20 | 8/17 | 6 weeks | Sid. | 0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks; 6 weeks. |
HAMD-/; SDS; TESS; AEs. |
6.67% |
| EA | 40.42 ± 10.71 | 9/16 | 6 weeks | Once a day, 5 times a week, 2 days off for the next week of treatment. | |||||||||
| Fluoxetine + EA | 38.17 ± 11.31 | 8/17 | 6 weeks |
Fluoxetine: Sid; EA: once a day, 5 times a week, 2 days off for the next week of treatment. |
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| 9 | (38) | RCT; Single-center; Blind method used (assessors) |
China | Depression | ICD-10. | Fluoxetine | 35 ± 8 | 6/49 | 6 weeks | Sid. | 0 week; 6 weeks. |
HAMD-17; MRI; AEs. |
6.67% |
| EA + fluoxetine | 6 weeks |
Fluoxetine: Sid; EA: once a day, 5 times a week, 2 days off for the next week of treatment. |
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| 10 | (39) | RCT; Single-center |
China | First episode mild to moderate depression | DSM-V. | MA | 39.0 (35.0, 46.5) statistical meaning unknown | 8/17 | 6 weeks | Every other day, 3 times a week. | 0 week; 6 weeks; 6 months (follow-up) |
HAMD-/; SDS. |
10% |
| EA | 37.0 (32.0, 41.5) statistical meaning unknown | 8/17 | 6 weeks | Every other day, 3 times a week. | |||||||||
| 11 | (40) | RCT; Single-center; Blind method used (investigators, assessors, data collectors, and statisticians) |
China | Comorbidity of anxiety and depression (CAD) | CCMD-3. | rTMS | 40.3 ± 13.0 | 13/32 | 10 days | Once a day, 10 times in total. | 0 day; 5 days; 10 days. |
HAMD-/; HAMA. |
23.5% |
| EA + rTMS | 35.4 ± 9.1 | 13/27 | 10 days | Once a day, 10 times in total. | |||||||||
| 12 | (41) | RCT; Single-center |
China | Depression | CCMD-3. | EA | 49.19 ± 13.46 | 15/17 | 6 weeks | Once a day. | 0 week; 6 weeks. |
HAMD-24; Onset time; Effective time. |
/ |
| Fluoxetine/ paroxetine | 47.00 ± 13.08 | 10/14 | 6 weeks | Sid. | |||||||||
| 13 | (42) | RCT; Single-center |
China | PSD | Diagnostic essentials of various cerebrovascular diseases revised at the fourth national cerebrovascular disease academic conference in 1996. | Fluoxetine | 66.42 ± 6.25 | 5/5 | 8 weeks | Sid. | 0 week; 2 weeks; 4 weeks; 8 weeks. |
HAMD-17; SPECT. |
0% |
| EA | 62.56 ± 6.85 | 4/7 | 8 weeks | Once a day, 5 days a week. | |||||||||
| 14 | (43) | RCT; Single-center; Blind method used (assessors and statisticians) |
China | Moderate depression | DSM-IV. | Antidepressants | 38.75 ± 11.45 | 11/19 | 8 weeks | Antidepressants: /; | 0 week; 4 weeks; 8 weeks; 12 weeks (follow-up). |
HAMD-24; Urinary metabolites. |
11.67% |
| EA + antidepressants | 40.3 ± 10.99 | 11/19 | 8 weeks |
Antidepressants: /; EA: once every other day, 3 times a week. |
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| 15 | (44) | RCT; Single-center |
China | Post schizophrenic depression | ICD-10. | EA + sertraline | 29.6 ± 11.2 | 16/14 | 6 weeks |
Sertraline: Sid; EA: once every other day, 3 times a week. |
0 week; 1 week; 2 weeks; 4 weeks; 6 weeks. |
GAS; HAMD-17; AEs. |
8.33% |
| Sertraline | 29.2 ± 10.5 | 17/13 | 6 weeks | Sid. | |||||||||
| 16 | (45) | RCT; Single-center |
China | Depression | DSM-III. | EA | 39 | 15/12 | 5 weeks | Once a day except Sunday. | 0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks. |
HAMD-24; CGI; SERS (Asberg). |
0% |
| Amitriptyline | 35 | 6/14 | 5 weeks | Tid. | |||||||||
| 17 | (46) | RCT; Multi-center; Single-blind (medication placebo) |
China | Depression | National diagnostic criteria for manic depressive disorder; CCMD; ICD-9. |
EA + placebo | 32 (mini- mum–maxi- mum: 17–64) | 109/132 | 6 weeks |
Placebo: /; EA: once a day. |
0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks; 6 weeks. |
HAMD-/; CGI; SERS (Asberg); AEs; Biochemical test; Electrophysiological examination. |
6.50% |
| Amitriptyline | 6 weeks | /. | |||||||||||
| 18 | (47) | RCT; Multi-center |
China | Depressive psychosis | Criteria presented at the Huangshan Symposium on manic-depression; Handbook of epidemiological investigation mental illness in China. |
EA | 36 | 32/22 | 5 weeks | Once a day. | 0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks; 6 weeks. |
HAMD-24; CGI; SERS (Asberg). |
/ |
| Amitriptyline | 19/28 | 5 weeks | Tid. | ||||||||||
| 19 | (48) | Parallel RCT; Multi-center; Blind method used (statisticians) |
China | Mild or moderate depression | ICD-10. | Paroxetine | 40.52 ± 14.21 | 19/10 | 6 weeks | Sid. | 0 week; 1 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-17; SERS; CGI; AEs. |
3.64% |
| EA | 46.27 ± 13.13 | 17/9 | 6 weeks | Once every other day, 3 times a week. | |||||||||
| 20 | (49) | RCT; Multi-center; Blind method used (statisticians) |
China | Depression | ICD-10. | Paroxetine | 35.58 ± 10.62 | 31/34 | 6 weeks | Sid. | 0 week; 1 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-17; SDS; SERS; AEs. |
2.05% |
| EA + paroxetine | 34.03 ± 10.60 | 28/34 | 6 weeks |
Paroxetine: Sid; EA: once every other day, 3 times a week. |
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| EA | 33.2 ± 9.0 36.58 ± 10.9 |
23/41 | 6 weeks | Once every other day, 3 times a week. | |||||||||
| 21 | (50) | RCT; Single-center; Single-blind (patients and assessors) |
China | Depression | DSM-IV. | Sham acupoints acupuncture + fluoxetine | 33.9 ± 12.4 | 81 (sex not covered in the original text) | 6 weeks |
Fluoxetine: Sid; Sham acupoints acupuncture: every weekend. |
0 week; 6 weeks. |
HAMD-24; Serum G protein. |
/ |
| EA + placebo | 30.8 ± 10.9 | 6 weeks |
Placebo: Sid; EA: every weekday. |
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| Sham acupoints acupuncture + placebo | 30.5 ± 12.0 | 6 weeks |
Placebo: Sid; Sham acupoints acupuncture: every weekday. |
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| 22 | (51) | RCT; Single-center; Single-blind (patients and assessors) |
China | Depression | DSM-IV. | EA + placebo | 30 ± 11 | 13/19 | 6 weeks |
Placebo: Sid; EA: 3 times a week. |
0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks; 6 weeks. |
Serum cytokine; HAMD-24 (21 in the article); CGI. |
12.63% |
| Sham acupoints acupuncture + fluoxetine | 34 ± 13 | 13/18 | 6 weeks |
Fluoxetine: Sid; Sham acupoints acupuncture: 3 times a week. |
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| Sham acupoints acupuncture + placebo | 30 ± 12 | 13/19 | 6 weeks |
Placebo: Sid; Sham acupoints acupuncture: 3 times a week. |
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| 23 | (52) | RCT; Multi-center |
China | Depression | CCMD-3; DSM-IV. |
EA1 | 35.9 ± 14.5 | 13/15 | 6 weeks | Once a day, 5 days a week, 2 days off on weekends. | 0 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-24; Serum IL-1β, IL-6, and TNF-α. |
6.67% |
| EA2 | 41.1 ± 11.5 | 5/23 | 6 weeks | Once a day, 5 days a week, 2 days off on weekends. | |||||||||
| Fluoxetine | 39.1 ± 13.2 | 3/25 | 6 weeks | Sid. | |||||||||
| 24 | (53) | RCT; Single-center; Blind method used (assessors of GDNF) |
China | Depression | DSM-IV. | EA1 | 43.10 ± 13.86 | 8/12 | 6 weeks | Once a day, 5 times a week. | 0 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-24; Serum GDNF. |
18.67% |
| EA2 | 42.56 ± 10.70 | 3/13 | 6 weeks | Once a day, 5 times a week. | |||||||||
| Fluoxetine | 40.72 ± 12.80 | 3/22 | 6 weeks | Sid. | |||||||||
| 25 | (54) | RCT; Single-center; Non-blind |
China | Depression | DSM-IV. | EA | 48.10 ± 13.40 | 7/17 | 24 weeks | 3 times a week. | 0 week; 24 weeks. |
MMPI; SDS; SAS; MADRS; AEs. |
20% |
| Paroxetine | 47.10 ± 10.60 | 8/16 | 24 weeks | Sid. | |||||||||
| 26 | (55) | Parallel RCT; Multi-center |
China | Mild or moderate depression | ICD-10. | Paroxetine | 48 ± 9 | 6/11 | 6 weeks | Sid. | 0 week; 1 week; 2 weeks; 4 weeks; 6 weeks; 10 weeks (follow-up). |
HAMD-17; SERS; WHOQOL-Bref; AEs. |
12.50% |
| MA + paroxetine | 45 ± 12 | 10/22 | 6 weeks |
Paroxetine: Sid; MA: once every other day, 3 times a week. |
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| EA + paroxetine | 47 ± 11 | 3/20 | 6 weeks |
Paroxetine: Sid; EA: once every other day, 3 times a week. |
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| 27 | (56) | RCT; Single-center (part of multi-center) |
China | Depression | CCMD-3. | SSRIs | 47.42 ± 8.89 | 11/19 | 6 weeks | / | 0 week; 1 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-17. | 0% |
| MA + SSRIs | 48.01 ± 8.16 | 10/15 | 6 weeks |
SSRIs: /; MA: once every other day, 3 times a week. |
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| EA + SSRIs | 47.54 ± 8.03 | 7/13 | 6 weeks |
SSRIs: /; EA: once every other day, 3 times a week. |
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| 28 | (57) | RCT; Single-center; Blind method used (assessors) |
China | Depression | CCMD. | EA | 38 ± 5 | 10/9 | 30 times (possibly 6 weeks) | Once a day. | 0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks; 6 weeks. |
HAMD-/; CGIS. |
0% |
| Amitriptyline | 36 ± 8 | 3/8 | 6 weeks | Tid. | |||||||||
| 29 | (58) | RCT; Single-center |
China | Mental depression | Clinical criteria for diagnosis of manic depression. | EA | 22–57 | 17/24 | 6 weeks | 6 times a week, followed by 1 day off; | 0 week; 1 week; 2 weeks; 3 weeks; 4 weeks; 5 weeks; 6 weeks. |
HAMD-24; EEG. |
0% |
| Amitriptyline | 6 weeks | /. | |||||||||||
| 30 | (59) | Parallel RCT; Single-center; Single-blind (patients and assessors) |
Hong Kong SAR, China | Depression | DSM-IV; With insomnia complaint. |
EA + antidepressants | 47.5 ± 8.5 | 6/20 | 3 weeks |
Antidepressants: /; EA: 3 times a week. |
0 week; 1 week; 4 weeks (follow-up). |
ISI; PSQI; Sleep diary; Actigraphy measures; HAMD-17; AEs. |
9% |
| Sham acupoint acupuncture + antidepressants | 46.7 ± 9.7 | 7/19 | 3 weeks |
Antidepressants: /; Sham acupoints acupuncture: 3 times a week. |
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| Non-invasive acupuncture + antidepressants | 50.1 ± 9.1 | 3/23 | 3 weeks |
Antidepressants: /; Non-invasive acupuncture: 3 times a week. |
|||||||||
| 31 | (60) | RCT; Single-center; Single-blind (patients and assessors) |
China | Depression with insomnia | DSM-IV. | EA + antidepressants | 47.30 ± 14.89 | 11/19 | 8 weeks |
Antidepressants: /; EA: 3 times a week. |
0 week; 4 weeks; 8 weeks; 12 weeks (follow-up). |
PSQI; SE; TST; SA; HAMD-17; SDS; HAMA; AEs. |
14.44% |
| Sham acupoint acupuncture + antidepressants | 49.80 ± 15.13 | 10/20 | 8 weeks |
Antidepressants: /; Sham acupoints acupuncture: 3 times a week. |
|||||||||
| Non-invasive acupuncture + antidepressants | 46.77 ± 15.57 | 11/19 | 8 weeks |
Antidepressants: /; Non-invasive acupuncture: 3 times a week. |
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| 32 | (61) | RCT; Single-center |
China | Depression | CCMD-3. | Paroxetine | 37.1 ± 10.2 | 9/11 | 6 weeks | Sid. | 0 week; 1 week; 2 weeks; 4 weeks; 6 weeks. |
HAMD-17; TESS; Routine blood, urine test; ECG. |
0% |
| EA + paroxetine | 36.6 + 9.7 | 12/10 | 6 weeks |
Paroxetine: Sid; EA: once a day, 6 times a week. |
|||||||||
| 33 | (62) | RCT; Single-center |
China | PCOS with mild anxiety/depression | Rotterdam PCOS diagnostic criteria; With mild anxiety/depression. |
Lifestyle intervention | 28 ± 3 | 0/40 | 4 months | 1 month is a course of treatment, a total of 4 courses of treatment. | 0 month; 4 months (16 weeks). |
BMI; SAS; SDS; PCOSQ; Hairiness score; Serum sex hormone; AEs. |
13.04% |
| EA + lifestyle intervention | 29 ± 2 | 4 months |
Lifestyle intervention: at least 3 times a day; 1 month is a course of treatment, a total of 4 courses of treatment; EA: once every other day, 3 times a week. |
||||||||||
| 34 | (63) | RCT; Multi-center; Single-blind (assessors) |
China | Depression | ICD-10. | SSRIs | 41.76 ± 12.85 | 57/99 | 6 weeks | Sid. | 0 week; 1 week; 2 weeks; 4 weeks; 6 weeks; 10 weeks (follow-up). |
HAMD-17; SDS; CGI; SERS; AEs. |
20% |
| MA + SSRIs | 41.42 ± 12.53 | 56/105 | 6 weeks |
SSRIs: Sid; MA: 3 times a week. |
|||||||||
| EA + SSRIs | 41.18 ± 12.00 | 52/108 | 6 weeks |
SSRIs: Sid; EA: 3 times a week. |
/, not covered in the original text; 5-HT, 5-hydroxytryptamine; AE, adverse event; BI, Barthel Daily Living Index; BMI, body mass index; CCMD, Chinese Classification and Diagnostic Criteria of Mental Disorders; CGI, Clinical Global Impression Scale; CGIS, Clinical Global Impressions Scale; CTRS, Credibility of Treatment Rating Scale; DSM, Diagnostic and Statistical Manual of Mental Disorders; EA, electroacupuncture; ECG, electrocardiograph; EEG, electroencephalogram; EPDS, Edinburgh Postpartum Depression Scale; ESS, Epworth Sleepiness Scale; GAS, Global Assessment Scale; GDNF, glial cell-derived neurotrophic factor; HADS, Hospital Anxiety and Depression Scale; HAMA, Hamilton Anxiety Rating Scale; HAMD, Hamilton Depression Rating the Scale; ICD, International Classification of Diseases; MA, manual acupuncture; MADRS, Montgomery–Asberg Depression Rating Scale; MFI, multidimensional fatigue inventory; MMPI, Minnesota Multiphasic Personality Inventory; NIHSS, National Institutes of Health Stroke Scale; PCOS, polycystic ovary syndrome; PSD, post stroke depression; PCOSQ, Polycystic Ovary Syndrome Quality of Life scale; PSQI, Pittsburgh Sleep Quality Index; RCTs, randomized controlled trials; SA, sleep awake times; SAS, Self-Rating Anxiety Scale; SCL-90, Symptom Checklist-90; SDS, Self-Rating Depression Scale; SDSS, Social Disability Screening Schedule; SE, sleep efficiency; SERS, Side Effects Rating Scale; SF-36, 36-item Short Form Health Survey; SSI, Somatic Symptom Inventory; TESS, Treatment Emergent Symptoms Scale; TCM, Traditional Chinese Medicine; TST, total sleep time; WHOQOL-BREF, World Health Organization Quality of Life.