There are more studies available on acupuncture for depression in the general adult population. A 2018 Cochrane Review (11) looked at 64 studies and 7104 participants. 51 of the studies were from China, with the remainder being fairly evenly split between Hong Kong, the USA, Australia and the UK. The authors of the Cochrane Review found that acupuncture’s effectiveness depended on what it was compared to. There was a small to moderate benefit when acupuncture was compared against control acupuncture, no treatment or treatment as usual. The evidence was rated as low quality. There was an unclear effect when comparing acupuncture plus medication vs. medication alone, or acupuncture vs psychotherapy due to very low quality evidence. Overall the risk of adverse events was unclear because most trials unfortunately did not report on this adequately. 

Armour 2019 (12) performed a recent Systematic Review (SR) including 29 studies with 2,268 participants between 1980-2018. 22 studies were from China and 7 others were from either the US, Australia or the UK. The study selection criteria was narrower, explaining why less than half the number of studies were included compared to the 2018 Cochrane Review. The Cochrane Review selected studies for inclusion where study participants could have comorbid physical or mental conditions in addition to a depression diagnosis, “as long as depression was the main focus of the trial”. In the smaller review by Armour et al, depression had to be the primary condition, rather than a comorbidity. Additionally, the Cochrane Review included antidepressants as a valid comparator group, where the Armour study allowed studies where acupuncture plus medication was a comparator group. 

One major way this review was different from the Cochrane Review is that the authors rated the quality of the acupuncture intervention in these trials using the NICMAN Scale in combination with STRICTA guidelines. Surprisingly, no differences in response were found between studies that rated higher or lower on the NICMAN Scale.

Overall the authors found that acupuncture treatments resulted in a clinically significant reduction in the severity of depression when compared with usual care, sham acupuncture and as adjunct to antidepressant medication. Another way the 2019 Review was unique is that they performed subgroup analysis and found greater improvements in studies conducted in China as well as greater improvement when the study called for more frequent acupuncture treatments as well as more acupuncture treatments overall. Studies conducted in China overall tended to have a higher number and frequency of acupuncture treatments performed.