Acupuncture-adjuvant therapies for treating perimenopausal depression: A network meta-analysis

BACKGROUND: The issues related to the treatment of perimenopausal depression (PMD) are the side effects of antidepressants and hormone replacement therapy. The aim of this study was to assess the efficiency and safety of acupuncture and moxibustion in PMD patients. METHODS: Databases, namely PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, CBM, VIP, and WanFang, were reviewed for related randomized controlled trials dated between database inception and November 22, 2022. The primary outcomes were the efficacy rate and the Hamilton Depression Scale score. The secondary outcomes were the levels of follicle-stimulating hormone, luteinizing hormone, and estradiol and the Kupperman score. Odds ratios (ORs) were generated as the effect size for dichotomous outcomes, while the standard mean difference (SMD) ± standard deviation was used for continuous outcomes. Matrices were developed to demonstrate pairwise comparisons of regimens related to each endpoint. Utilizing Review Manager (RevMan) 5.3, Stata 16.0 and SPSS 21, data were analyzed. RESULTS: In total, 27 studies involving 2269 PMD patients and 8 therapeutic measures were incorporated into the network meta-analysis (NMA). The NMA showed that warm acupuncture (OR = 1.55, 95% CI: 1.00–2.44), electroacupuncture (OR = 1.34, 95% CI: 1.00–1.8), abdominal acupuncture (OR = 1.19, 95% CI: 0.73–1.96), and common acupuncture (OR = 1.4, 95% CI: 0.9–2.17) were more effective than fluoxetine + menopausal hormone treatment in the treatment of PMD. The NMA also showed that, based on the Hamilton Depression Scale score, warm acupuncture was more effective than the other 4 acupuncture-related treatments, i.e., electroacupuncture (SMD = −1.22, 95% CI: −2.34 to −0.09), thread embedding (SMD = −1.31, 95% CI: −2.21 to −0.40), abdominal acupuncture (SMD = −1.33, 95% CI: −2.42 to −0.24), and common acupuncture (SMD = −1.46, 95% CI: −2.26 to −0.66). The cumulative ranking probability (SUCRA) showed that warm acupuncture (99.6%) was the best treatment method. CONCLUSIONS: The findings of this network meta-analysis may help patients and therapists choose the best acupuncture therapy for treating perimenopausal depression patients and furnish reliable evidence for guidelines.