Efficacy and Safety of Acupuncture for Subthreshold Depression: Systematic Review and Meta-analysis

Background Subthreshold depression (SD) precedes major depressive episodes, lacking effective/safe treatments. In this study, we conducted a systematic review and meta-analysis to assess the efficacy and safety of acupuncture for SD. Methods The databases China National Knowledge Infrastructure (CNKI), VIP, Wanfang, China Biomedical Literature Database (CBM), PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) of acupuncture for SD, from inception to 1 March 2024. Two independent groups screened literature, extracted data, and evaluated quality. The meta-analysis was performed using RevMan 5.3. Results A total of 4,380 articles were retrieved, including 23 RCTs (1,698 patients). The meta-analysis showed acupuncture’s efficacy vs. control [RR = 1.6, 95% CI (1.12, 3.35), P < 0.05]. Acupuncture significantly improved Hamilton Rating Scale for Depression [HAMD; mean difference (MD) = 5.62], Self-Rating Depression Scale (SDS; MD = 11.98), Pittsburgh Sleep Quality Index (PSQI; MD = 6.33), traditional Chinese medicine (TCM) syndrome (MD = 3.51), and Center for Epidemiologic Studies Depression Scale (CES-D; MD = 6.43) scores (all P < 0.05). There was no increase in adverse effects vs. placebo [RR = 1.09, 95% CI (0.49, 2.42), P > 0.05]. Conclusion Acupuncture effectively alleviates SD symptoms, improves sleep quality, and demonstrates safety, showing advantages in SD treatment.