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      Response to Concerns on “Inadequate Evidence for Acupuncture as an Alternative or Adjunct to Antidepressants/Psychotherapy for Postpartum Depression: A Bayesian Systematic Review and Network Meta-Analysis” [Response to Letter]

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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

            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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              Author and article information

              Journal
              Neuropsychiatr Dis Treat
              Neuropsychiatr Dis Treat
              ndt
              Neuropsychiatric Disease and Treatment
              Dove
              1176-6328
              1178-2021
              10 December 2024
              2024
              : 20
              : 2401-2403
              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 ]School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University , Hong Kong SAR, People’s Republic of China
              [5 ]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
              508485
              10.2147/NDT.S508485
              11645909
              39677506
              e35a2568-af17-4fbd-8b76-5fcb5c594550
              © 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
              : 25 November 2024
              : 25 November 2024
              Page count
              Figures: 0, References: 2, Pages: 3
              Categories
              Response to Letter

              Neurology
              Neurology

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