Treatment of perimenopausal depressive disorder with acupuncture combined with traditional Chinese medicine decoction: A systematic review and meta-analysis

BACKGROUND: In recent years, an increasing number of randomized controlled trials (RCTs) have investigated acupuncture combined with traditional Chinese medicine (TCM) decoction for the treatment of perimenopausal depressive disorder (PDD). However, high-quality evidence regarding its efficacy and safety remains limited. This study aimed to systematically evaluate the effectiveness and safety of this combined therapy and to identify optimal treatment strategies for PDD. METHODS: RCTs evaluating acupuncture combined with TCM decoction for PDD, published up to April 2021, were systematically searched in China National Knowledge Infrastructure, VIP, Wanfang, PubMed, Web of Science, the Cochrane Library, Sinomed, and Embase. Data were analyzed using Review Manager 5.4 in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1). RESULTS: A total of 9 studies involving 601 participants were included. Compared with TCM decoction alone, the combined therapy significantly improved the clinical effective rate (RR = 1.18, 95% confidence interval [CI]: 1.07-1.29), reduced HAMD scores (standardized mean difference [SMD] = -0.87, 95% CI: -1.08--0.65), Kupperman scores (SMD = -0.61, 95% CI: -1.14--0.08), and self-rating depression scale scores (mean difference [MD] = -13.58, 95% CI: -18.67--8.49), and increased estradiol (17β-estradiol) levels (MD = 7.90, 95% CI: 2.90-12.91). Compared with Western medicine, the combined therapy also showed higher clinical effectiveness (RR = 1.16, 95% CI: 1.02-1.33), lower HAMD scores (SMD = -0.54, 95% CI: -0.90--0.17), and higher estradiol (17β-estradiol) levels (MD = 17.47, 95% CI: 10.12-24.82). The incidence of adverse reactions was lower in the combined therapy group (0.3%) than in the control group (3.3%). CONCLUSION: Acupuncture combined with TCM decoction appears to be an effective and safe treatment for PDD, showing superior outcomes compared with TCM decoction alone or Western medicine. However, further large-scale, high-quality RCTs are needed to confirm these findings.