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      Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis

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          Abstract

          Background

          Acupuncture is popular in the treatment of mental illness. This study determined its feasibility and role in managing postpartum depression (PPD) using a network meta-analysis.

          Methods

          We systematically searched seven databases up to May 2024 for randomized controlled trials (RCTs) appraising acupuncture’s efficacy and safety against waitlist-control, placebo, standard control, or as an add-on treatment. Cochrane criteria were followed.

          Results

          Thirteen studies encompassing 872 participants underwent analysis. Both pairwise and network meta-analysis indicated that acupuncture, psychotherapy, and antidepressants were comparable in clinical efficacy rate and in reducing Hamilton Depression Scale and Edinburgh Postnatal Depression Scale scores. Acupuncture and psychotherapy also effectively mitigated concurrent anxiety symptoms. Combining acupuncture with antidepressants augmented therapeutic efficacy and reduced reported gastrointestinal adverse effects associated with antidepressant use. Acupuncture combined with psychotherapy offered similar benefits with superior safety profile. However, the quality of evidence ranged from very low to low due to significant risks of bias and limited sample sizes. The efficacy of psychotherapy and the combination of acupuncture and psychotherapy might be underestimated, as most RCTs used supportive therapy or individual counseling as positive controls instead of recommended approaches like interpersonal psychotherapy (IPT) or cognitive behavioral therapy (CBT) per PPD guidelines.

          Conclusion

          Current evidence precludes strong recommendations of administering acupuncture in PPD. Rigorous RCTs are essential to validate promising outcomes observed in comparisons between acupuncture, antidepressants, and their combined application. It remains inconclusive whether acupuncture’s antidepressive effect is specific or non-specific. Given that psychotherapy is a recommended first-line treatment, investigating the potential efficacy enhancement of combining acupuncture with IPT/CBT is paramount to ascertain the preferred therapeutic approach for PPD.

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          Most cited references61

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          The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

          The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.
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            Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness.

            Systematic review aims to systematically identify, critically appraise, and summarize all relevant studies that match predefined criteria and answer predefined questions. The most common type of systematic review is that assessing the effectiveness of an intervention or therapy. In this article, we discuss some of the common methodological issues that arise when conducting systematic reviews and meta-analyses of effectiveness data, including issues related to study designs, meta-analysis, and the use and interpretation of effect sizes.
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              Postpartum depression: current status and future directions.

              Postpartum depression (PPD) is a common and serious mental health problem that is associated with maternal suffering and numerous negative consequences for offspring. The first six months after delivery may represent a high-risk time for depression. Estimates of prevalence range from 13% to 19%. Risk factors mirror those typically found with major depression, with the exception of postpartum-specific factors such as sensitivity to hormone changes. Controlled trials of psychological interventions have validated a variety of individual and group interventions. Medication often leads to depression improvement, but in controlled trials there are often no significant differences in outcomes between patients in the medication condition and those in placebo or active control conditions. Reviews converge on recommendations for particular antidepressant medications for use while breastfeeding. Prevention of PPD appears to be feasible and effective. Finally, there is a growing movement to integrate mental health screening into routine primary care for pregnant and postpartum women and to follow up this screening with treatment or referral and with follow-up care. Research and clinical recommendations are made throughout this review.
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                Author and article information

                Journal
                Neuropsychiatr Dis Treat
                Neuropsychiatr Dis Treat
                ndt
                Neuropsychiatric Disease and Treatment
                Dove
                1176-6328
                1178-2021
                21 September 2024
                2024
                : 20
                : 1741-1755
                Affiliations
                [1 ]Department of Nursing, School of International Medical Technology, Shanghai Sanda University , Shanghai, 201209, People’s Republic of China
                [2 ]School of Health and Biomedical Sciences, RMIT University , Bundoora, VIC, 3083, Australia
                [3 ]Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, 200071, People’s Republic of China
                [4 ]Shanghai Changning Center for Disease Control and Prevention , Shanghai, 200335, People’s Republic of China
                [5 ]School of Computing Technologies, RMIT University , Melbourne, VIC, 3000, Australia
                [6 ]School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University , Hong Kong, SAR, People’s Republic of China
                [7 ]Yangpu Hospital, School of Medicine, Tongji University , Shanghai, 200090, People’s Republic of China
                Author notes
                Correspondence: Yuen-Shan Ho, School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University , Hong Kong, SAR, People’s Republic of China, Tel +852 2766-6410, Fax +852 2364-9663, Email janice.ys.ho@polyu.edu.hk
                Qiang-Qiang Fu, Yangpu Hospital, School of Medicine, Tongji University , Shanghai, 200090, People’s Republic of China, Tel + 86 021-6569 0520, Fax + 86 021-6569 6249, Email qiangqiang.fu@tongji.edu.cn
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0000-0001-9009-8870
                http://orcid.org/0000-0002-4419-050X
                http://orcid.org/0000-0002-2369-1508
                http://orcid.org/0000-0001-9356-6844
                Article
                484387
                10.2147/NDT.S484387
                11423827
                39323936
                c9987a1a-fd44-413d-a162-6e0996b43f74
                © 2024 Zhao et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 01 August 2024
                : 13 September 2024
                Page count
                Figures: 4, References: 61, Pages: 15
                Funding
                This work was supported by the Health and Medical Research Fund [20212801], Health Bureau, Hong Kong SAR and the Chinese Medicine Development Fund [23B2/030A], Hong Kong SAR to YS-H; Scientific Research Fund Project of Shanghai Sanda University [2024BSZX03] to FY-Z; and TCM Research Project, Shanghai Municipal Health Commission [2022CX007] to WJ-Z.
                Categories
                Review

                Neurology
                postpartum depression,acupuncture,antidepressants,interpersonal psychotherapy,cognitive behavioral therapy,clinical trials

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