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--- acupuncture:evaluation:neuro-psychiatrie:07. depression post-avc [03 Nov 2019 06:30]
Nguyen Johan
+++ acupuncture:evaluation:neuro-psychiatrie:07. depression post-avc [23 May 2025 16:36] (Version actuelle)
Nguyen Johan [2. Overviews of Systematic Reviews]
@@ Ligne 1: / Ligne 1: @@
+/*English:Poststroke Depression*/
+====== Post-Stroke Depression ======
 ====== Dépression post-AVC : évaluation de l'acupuncture ======
-===== Revues systématiques et méta-analyses  =====
+===== Systematic Reviews and Meta-Analysis =====
-| ☆☆☆ | Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture |
-| ☆☆ | Preuves en faveur d’une efficacité de l’acupuncture |
-| ☆ |Preuves limitées en faveur d’une efficacité de l’acupuncture |
+==== Generic Acupuncture ====
-| Ø |Absence de preuve ou preuves insuffisantes |
+=== Li 2024 ===
+Li Y, Wang Y, Gao L, Meng X, Deng Q. Effect of nonpharmacological interventions on poststroke depression: a network meta-analysis. Front Neurol. 2024 Apr 5;15:1376336.  https://doi.org/10.3389/fneur.2024.1376336
+^Purpose| To investigate the effects of nonpharmacological interventions (NPIs) on poststroke depression (PSD) in stroke patients.|
+^Methods| Computer searches were conducted on the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to December 2023. The selection was made using the inclusion and exclusion criteria, and 40 articles were included to compare the effects of the 17 NPIs on patients with PSD.|
+^Results| Forty studies involving seventeen interventions were included. The network findings indicated that compared with conventional therapy (COT), superior PSD improvement was observed for cognitive behavioral therapy (CBT) + **acupoint acupuncture** (CBTA) (mean difference [MD], -4.25; 95% CI, -5.85 to -2.65), team positive psychotherapy (MD, -4.05; 95% CI, -5.53 to -2.58), music therapy (MT) + positive psychological intervention (MD, -2.25; 95% CI, -3.65 to -0.85), CBT (MD, -1.52; 95% CI, -2.05 to -0.99), mindfulness-based stress reduction (MD, -1.14; 95% CI, -2.14 to -0.14), MT (MD, -0.95; 95% CI, -1.39 to -0.52), **acupoint acupuncture** + MT (AAMT) (MD, -0.69; 95% CI, -1.25 to -0.14). Furthermore, CBT (MD, -3.87; 95% CI, -4.57 to -3.17), AAMT (MD, -1.02; 95% CI, -1.41 to -0.62), **acupressure** + MT (MD, -0.91; 95% CI, -1.27 to -0.54), and narrative care + acupressure (MD, -0.74; 95% CI, -1.19 to -0.29) demonstrated superior Pittsburgh Sleep Quality Index (PSQI) improvement compared with COT.|
+^Conclusion| Evidence from systematic reviews and meta-analyses suggests that CBTA improves depression in patients with PSD. Moreover, CBT improves sleep in these patients. Additional randomized controlled trials are required to further investigate the efficacy and mechanisms of these interventions.|
+=== Xiao 2024 (combined with repetitive transcranial magnetic stimulation) ===
+Xiao K, Li X, Hu W, Li X. Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial. Front Neurol. 2024 May 16;15:1360437.  https://doi.org/10.3389/fneur.2024.1360437
+^Objective| This study aimed to systematically assess the efficacy of combining acupuncture with repetitive transcranial magnetic stimulation (rTMS) in treating post-stroke depression (PSD).|
+^Methods| We conducted a comprehensive search of eight major domestic and international databases, including the China Knowledge Network, from inception until December 2023. Included were randomized controlled trials that investigated acupuncture combined with rTMS for PSD. The screening process adhered to predetermined inclusion and exclusion criteria, and study quality was assessed using Cochrane Handbook 5.1 guidelines. Meta-analysis was conducted using RevMan 5.4 software.|
+^Results| **Twelve studies involving 800 patients** were included in the analysis. The meta-analysis showed that acupuncture combined with rTMS significantly improved the clinical effectiveness rate (RR = 1.19, 95% CI: 1.12 to 1.27, p < 0.00001) and reduced scores on several scales: Hamilton Depression Scale (HAMD) (MD = -3.35, 95% CI: -3.79 to -2.90, p < 0.00001), Self-Depression Scale (SDS) (MD = -9.57, 95% CI: -12.26 to -6.89, p < 0.00001), Chinese Medicine Symptom Score (MD = -3.34, 95% CI: -3.76 to -2.91, p < 0.00001), Pittsburgh Sleep Quality Scale (MD = -3.91, 95% CI: -4.58 to -3.25, p < 0.00001), and National Institutes of Health Stroke Scale (NIHSS) (MD = -2.77, 95% CI: -3.21 to -2.32, p < 0.00001). Furthermore, acupuncture combined with rTMS treatment improved cognitive functioning (MMSE, MoCA scores) (p < 0.00001) and ability to perform activities of daily living scores (MD = 10.40, 95% CI: 9.53 to 11.28, p < 0.00001). Additionally, it was found to reduce interleukin 6, tumor necrosis factor alpha, interleukin 1β, and increase 5-hydroxytryptamine and brain-derived neurotrophic factor levels (p < 0.001).|
+^Conclusion| Acupuncture combined with rTMS therapy is recommended for treating PSD, as it effectively improves clinical outcomes, alleviates depressive symptoms, enhances cognitive function, and daily living capabilities, and modulates inflammatory responses and neurotransmitter levels. However, it is important to note that the limitations of the sample size and quality of the included studies warrant the need for more high-quality research to validate these conclusions. |
+=== Yi 2024 ===
+Yi Y, Zhao W, Lv S, Zhang G, Rong Y, Wang X, Yang J, Li M. Effectiveness of non-pharmacological therapies for treating post-stroke depression: A systematic review and network meta-analysis. Gen Hosp Psychiatry. 2024 Sep-Oct;90:99-107.  https://doi.org/10.1016/j.genhosppsych.2024.07.011
+^Objective| Post-stroke depression (PSD) is a common neurological and psychiatric sequelae following a stroke, often surpassing the primary effects of the stroke due to its strong correlation with high mortality rates. In recent years, non-pharmacological therapy has garnered significant attention as a supplementary treatment for PSD, becoming widely adopted in clinical practice. However, the efficacy of specific intervention strategies remains unclear. This study aimed to conduct a network meta-analysis (NMA) of published studies to compare the efficacy of different non-pharmacological therapies for treating PSD.|
+^Method| We systematically searched five databases from inception through March 2024 to identify randomized controlled trials (RCTs) evaluating non-pharmacological therapies for the treatment of PSD. We considered individual intervention and intervention class. Intervention classes included traditional Chinese medicine (TCM), non-invasive electrotherapy stimulation (NIES), psychotherapy (PT), exercise therapy, hyperbaric oxygen, and combined interventions. The NMA was conducted using R and Stata software, following a frequency-based methodology. Assessment of methodological quality and risk of bias was conducted using the Risk of Bias assessment tool 2.0. Therapies were ranked using the P-score, and box-plots visualization, meta-regression, and sensitivity analysis, were performed to assess transitivity, heterogeneity, and consistency, respectively.|
+^Results| The NMA included 43 studies with a total of 3138 participants. Random-effects models revealed significant efficacy for **acupuncture (ACUP)** (P-score = 0.92; pooled standardized mean difference (95% CI): -3.12 (-4.63 to -1.60)) and transcranial direct current stimulation (P-score = 0.85; -2.78 (-5.06 to -0.49)) compared to the treatment as usual (TAU) group. In categorical comparisons, TCM_PT (P-score = 0.82; -1.91 (-3.54 to -0.28)), TCM (P-score = 0.79; -1.65 (-2.33 to -0.97)), and NIES (P-score = 0.74; -1.54 (-2.62 to -0.46)) showed significant differences compared to TAU group. Furthermore, our results indicated no significant difference between PT and the control groups. However, Confidence in Network Meta-Analysis results indicated very low overall evidence grade.|
+^Conclusion| Limited evidence suggests that ACUP may be the most effective non-pharmacological therapy for improving PSD, and TCM_PT is the best intervention class. However, the evidence quality is very low, underscoring the need for additional high-quality RCTs to validate these findings, particularly given the limited number of RCTs available for each therapy. |
+=== Zhang 2024 (plus music therapy) ===
+Zhang J, Zhao Y, Li H, Yang Y, Tang Q. Effectiveness of acupuncture plus music therapy for post-stroke depression: Systematic review and meta-analysis. Medicine (Baltimore). 2024 Sep 13;103(37):e39681.  https://doi.org/10.1097/MD.0000000000039681
+^Backgound| Post-stroke depression (PSD) is a prevalent complication of stroke that adversely affects patient outcomes. The etiology of PSD is complex, and no universally effective treatment exists. Acupuncture, with its historical use, combined with music therapy, presents a novel approach for PSD treatment. This study aims to systematically evaluate the clinical efficacy of combining acupuncture with music therapy for PSD through a meta-analysis.|
+^Methods| We systematically searched both Chinese and English literature in PubMed, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and the Chinese Science and Technology Periodical Database (VIP Database) for randomized controlled trials evaluating acupuncture combined with music therapy for PSD. Two independent evaluators conducted quality assessments and data extraction. Statistical analyses were performed using RevMan 5.4 and Stata 18.0 software.|
+^Results| This article contains **11 studies, involving a total of 698 patients**. The results of the meta-analysis showed that, compared with the control group, the test group showed significant improvement on multiple outcome measures: HAMD score [mean difference (MD) = -3.18, 95% confidence interval (CI) (-3.61, -2.76), P < .00001], Self-Rating Depression Scale score [MD = -5.12, 95% CI (-6.61, -3.63), P < .00001], Pittsburgh sleep quality index score [MD = -2.40, 95% CI (-2.96, -1.84), P < .00001], BI score [MD = 14.16, 95% CI (4.37, 23.94), P = .005] were all significantly lower, significantly higher effectiveness [risk ratio = 1.21, 95% CI (1.11, 1.33), P < .0001]. These differences were also statistically significant.|
+^Conclusion| The use of acupuncture combined with music therapy is effective in reducing depression in PSD patients.|
+=== Lam 2023 ===
+Lam Ching W, Li HJ, Guo J, Yao L, Chau J, Lo S, Yuen CS, Ng BFL, Chau-Leung Yu E, Bian Z, Lau AY, Zhong LL. Acupuncture for post-stroke depression: a systematic review and network meta-analysis. BMC Psychiatry. 2023 May 4;23(1):314.  https://doi.org/10.1186/s12888-023-04749-1
+^Background| Patients with post-stroke depression (PSD) usually experience anxiety, hopelessness, and insomnia, which have a negative impact on their daily activities and post-stroke rehabilitation. Acupuncture (AC), as a minimally invasive technique, has become a popular choice for improving depression symptoms. However, it is still unclear which therapy is associated with the best outcomes for PSD. In this review, we aimed to explore the impact of AC in alleviating symptoms of PSD and to evaluate the difference in effectiveness between AC combined with pharmacotherapies and various non-pharmacotherapies.|
+^Methods| Six databases and three clinical trials registration platforms were searched from inception to March 2023. Randomized clinical trial comparing needle-based AC with pharmacotherapy, and other non-pharmacotherapy or invalid group were included. Two independent reviewers identified eligible studies, and collected data using a pre-made form. A Bayesian network meta-analysis was conducted to assess and compare different techniques using RStudio 3.6.0 with the package 'GEMTC' V.0.8.1. The primary outcome was the efficacy for PSD assessed by scales measuring depressive symptoms. The secondary outcomes were effectiveness for neurological function and the quality of life. The ranking probabilities for all treatment interventions was performed using the Surface Under the Cumulative Ranking curve (SUCRA). The risk of bias was assessed by using the Revised Cochrane Risk of Bias tool 2.|
+^Results|** Sixty-two studies**, involving 5308 participants published from 2003 to 2022, were included. The results showed that compared with western medicine (WM) (defined as pharmacotherapy for PSD), AC alone or with repetitive transcranial magnetic stimulation (RTMS), Traditional Chinese medicine (TCM) alone or with WM, were superior for alleviating depression symptoms. Compared to Usual Care, AC alone or plus other therapies could significantly decrease scores on the Hamilton Depression Rating scale. According to result of SUCRA, AC plus RTMS had the highest probability of improving depressive symptoms with a probability of 49.43%.|
+^Conclusions| The results of this study indicate that AC alone or combined with other therapies appears to be effective in improving depression symptoms of stroke survivors. Moreover, in comparison to WM, AC alone or plus RTMS, TCM, TCM with WM, or WM, were more effective in improving depression symptoms of PSD. Also, AC with RTMS seems to be the most effective with the highest probability. |
+=== Li 2023 (combined with antidepressants) ===
+Li C, Chen S, Liu S, Mu Y, Su M. Effect of acupuncture combined with antidepressants on post-stroke depression: A network meta-analysis of nine acupuncture therapy. Front Neurol. 2023 Mar 23;14:979643.  https://doi.org/10.3389/fneur.2023.979643
+^Background|Post-stroke depression (PSD) is a common psychiatric complication of mental disorders after stroke. Acupuncture for PSD is effective and has few adverse effects. As a classical complementary and alternative therapy, acupuncture is often used in combination with antidepressants for PSD. However, there is a wide variety of acupuncture therapies, and the efficacy of different acupuncture varies. In this study, a network meta-analysis (NMA) was used to assess the clinical efficacy of different acupuncture combined with antidepressants for the treatment of PSD. |
+^Methods| A comprehensive search of PubMed, The Cochrane Library, EMbase, Web of Science, CNKI, CBM, VIP, and Wan-Fang databases for published randomized controlled trials of acupuncture combined with antidepressants for the treatment of PSD was conducted. The time frame for the literature search was from the date of database creation to April 30, 2022. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to evaluate the bias risk of the included studies. Data analysis was performed by STATA 14.0 software. |
+^Results|A total of **38 literatures with 2,898 patients** involving nine acupuncture therapies were included. NMA results were as follows: moxibustion plus antidepressants had the best efficacy in terms of improving total effective rate. Conventional acupuncture plus antidepressants was the most effective in improving HAMD scores. In terms of improving SDS scores, acupressure plus antidepressants was the most effective. In terms of improving NIHSS scores, moxibustion plus antidepressants showed the best results. |
+^Conclusion|A comparison of the efficacy indicators of the nine different acupuncture therapies combined showed that moxibustion plus antidepressants, conventional acupuncture plus antidepressants and acupressure plus antidepressants were superior in the treatment of PSD. Based on the shortcomings of the existing studies, this conclusion needs to be validated by additional high-quality randomized controlled trials. |
+=== Zhang 2022 ===
+Zhang J, Song Z, Gui C, Jiang G, Cheng W, You W, Wang Z, Chen G. Treatments to post-stroke depression, which is more effective to HAMD improvement? A network meta-analysis. Front Pharmacol. 2022 Dec 19;13:1035895.  https://doi.org/10.3389/fphar.2022.1035895
+^Introduction| Post-stroke depression (PSD) is a common mental health problem after cerebrovascular accidents. There are several treatments that have been shown to be effective in treating post-stroke depression. However, it is not clear which treatment is more effective. |
+^Methods|In this meta-analysis, an appropriate search strategy was used to search eligible randomized controlled trials (RCTs) on different treatments to treat patients with Post-stroke depression published up to December 2021 from the CNKI, PubMed, and Cochrane Library. We assessed the mean difference or odds ratio between each treatment and placebo and summarized them as the average and 95% confidence interval (CI) by conducting Bayesian network meta-analyses. |
+^Results|By constructing a Bayesian network meta-analysis, we found that acupuncture combined with fluoxetine (vs placebo MD, -8.9; 95% CI, [-15, -2.9]) or paroxetine (vs placebo MD,-8.5; 95% CI, [-15, -2.5]) was the most effective for change in Hamilton depression scale (HAMD) at the end of the 4th week. For change in Hamilton depression scale at the end of the 8th week, rTMS combined with paroxetine (vs placebo MD, -13; 95% CI, [-17, -7.9]) had the greatest amount of change. The efficacy of medication combined with adjuvant therapy was also superior for the percentage of patients with Hamilton depression scale change over 50%. |
+^Discussion| The combination of antidepressants with adjuvant therapy may enhance the efficacy of antidepressants and achieve better results than antidepressant monotherapy in both Hamilton depression scale changes at the end of week 4 or 8 and 50% Hamilton depression scale improvement rate. Acupuncture combined with fluoxetine treatment was more effective in the treatment of post-stroke depression at week 4, while rTMS combined with paroxetine was more effective at week 8. Further research is needed to determine whether acupuncture combined with fluoxetine is better than rTMS combined with paroxetine for post-stroke depression at week 8.|
+=== Liu 2021 ===
+Liu R, Zhang K, Tong QY, Cui GW, Ma W, Shen WD. Acupuncture for post-stroke depression: a systematic review and meta-analysis. BMC Complement Med Ther. 2021;21(1):109. [217736]. [[https://doi.org/10.1186/s12906-021-03277-3]]
+^ Background| Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs. |
+^ Methods| An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. |
+^ Results |A total of **17 RCTs involving 1402 patients** were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D17, HAM-D24 and HAM-D (MD, − 5.08 [95% CI, − 6.48 to − 3.67], I2 = 0%), (MD, − 9.72 [95% CI, − 14.54 to − 4.91], I2 = 65%) and (MD, − 2.72 [95% CI, − 3.61 to − 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, − 0.43 [95% CI, − 1.61 to 0.75], I2 = 51%), (MD, − 3.09 [95% CI, − 10.81 to 4.63], I2 = 90%) and (MD, − 1.55 [95% CI, − 4.36 to 1.26], I2 = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I2 = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I2 = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies. |
+^ Conclusions |The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.|
+=== Wang 2021 ===
+Wang X, Xiong J, Yang J, Yuan T, Jiang Y, Zhou X, Liao K, Xu L. Meta-analysis of the clinical effectiveness of combined acupuncture and Western Medicine to treat post-stroke depression. Journal of TCM. 2021;41(1):6-16.   [216956]. [[https://doi.org/10.19852/j.cnki.jtcm.2021.01.002|doi]]
+^ Objective|To evaluate the clinical efficacy and safety of combined acupuncture and Western Medicine in the treatment of post-stroke depression using a meta-analysis. |
+^Methods|The China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, Chinese Biomedical Literature Database, PubMed, Embase, and the Cochrane Library were searched from their establishment to August 2018 for randomized controlled trials (RCTs) of combined acupuncture and Western Medicine to treat post-stroke depression. Two researchers independently extracted and cross-checked data, and then applied the modified Jadad scale and the Cochrane-recommended assessment method to evaluate the risk of bias. Review Manager 5.3 was used to conduct the meta-analysis.|
+^Results|A total of **1860 patients in 24 RCTs** were analyzed. The results of the Meta-analysis showed that: (a) The effective rate of acupuncture + fluoxetine hydrochloride vs fluoxetine hydrochloride was significant [relative risk (RR) = 1.16, 95% confidence interval (CI) (1.08, 1.26)], as was that of acupuncture + flupentixol/melitracen vs flupentixol/melitracen [RR = 1.23, 95% CI (1.10, 1.37)]. (b) When analyzing Hamilton Depression Scale (HAMD)-17 scores, six trials showed that acupuncture combined with Western Medicine was superior to Western Medicine alone, and could relieve the depressive symptoms of patients. For HAMD-24 scores, five trials were included for acupuncture + fluoxetine hydrochloride vs fluoxetine hydrochloride, with significance at 2 weeks [WMD = －6.51, 95% CI(－ 8.62, － 4.40)], as well as at 4 weeks [WMD = －8.40, 95% CI (－11.86, －4.94)] and 8 weeks. (c)For the activities of daily living scale, acupuncture + fluoxetine hydrochloride vs fluoxetine hydrochloride [WMD = 22.65, 95% CI (18.34, 26.95)], acupuncture + flupentixol/melitracen vs flupentixol/melitracen [WMD = 8.08, 95% CI (2.57, 13.59)], acupuncture + sertraline hydrochloride vs sertraline hydrochloride [WMD = 6.94, 95% CI (3.59, 10.29)], and acupuncture + doxepin hydrochloride vs doxepin hydrochloride [WMD = 18.80, 95% CI (15.84, 21.76)] had significance. (d) For Treatment Emergent Symptom Scale scores, there was significance in all four included studies. |
+^ Conclusion|The therapeutic effects of acupuncture combined with Western Medicine on post-stroke depression are often better than those of Western Medicine alone, and fewer adverse reactions occur. However, more high-quality RCTs are needed to further confirm these findings. |
+=== Zhang 2021 (combined with antidepressants) ===
+Zhang K, Cui G, Gao Y, Shen W. Does acupuncture combined with antidepressants have a better therapeutic effect on post-stroke depression? A systematic review and meta-analysis. Acupunct Med. 2021 Oct;39(5):432-440.  https://doi.org/10.1177/0964528420967675
+^Objective|To evaluate the effectiveness of acupuncture combined with antidepressants in the treatment of post-stroke depression (PSD).|
+^Methods|The following electronic databases were systematically searched: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Wanfang Data, China National Knowledge Infrastructure and Chongqing VIP database. The primary outcome was the Hamilton depression scale (HAMD) score. Two independent investigators screened for eligible clinical trials. The Cochrane risk of bias tool was used to assess the methodological quality, and RevMan 5.3 was applied for meta-analysis.|
+^Results|**Thirteen randomized controlled trials** (RCTs) involving **904 participants** were included in the study. The results of this meta-analysis showed that, compared with antidepressants alone, acupuncture combined with antidepressants led to a significant decrease in the HAMD score (mean difference (MD): −3.60, 95% confidence interval (CI): −4.25 to −2.95, P < 0.001), had a better effective rate (risk ratio (RR): 1.33, 95% CI 1.19 to 1.49, P < 0.001) and lower National Institutes of Health Stroke Scale (NIHSS) scores (MD: −2.39, 95% CI: −3.37 to −1.41, P < 0.001), and led to a significant increase in the Barthel index scores (MD: 8.10, 95% CI: 5.25 to 10.94; P < 0.001).|
+^Conclusions|Acupuncture combined with antidepressants showed a more favourable effect on the treatment of PSD than antidepressants alone. However, given the limited methodological quality, more high-quality RCTs conducted based on the Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) guidelines are necessary.|
+=== Zhang 2021 (vs antidepressant therapy) ===
+Zhang L, Chen B, Yao Q, Chen W, Yang W, Yang W, He L, Zhang Y. Comparison between acupuncture and antidepressant therapy for the treatment of poststroke depression: Systematic review and meta-analysis. Medicine (Baltimore). 2021;100(22). [217816]. [[https://doi.org/10.1097/md.0000000000025950|doi]]
+^Background| In this paper, a systematic review and meta-analysis of published randomized controlled trials (RCTs) was conducted to compare the efficacies of acupuncture and antidepressant therapy for the treatment of poststroke depression (PSD).|
+^Methods| The research team searched RCTs published on PubMed; Medline; Cochrane library; Chinese National Knowledge Infrastructure (CNKI); Wanfang; Embase; Scopus, and Sinomed from their respective establishments to January 2019. We evaluated the Hamilton Depression Rating Scale (HAMD) scores, Treatment Emergent Symptom Scale (TESS) scores, National Institute of Health Stroke Scale (NIHSS) scores, and total clinical efficacy using fixed effects models.|
+^ Results| Fourteen RCTs, representing a total of 1124 patients, were studied.showed that acupuncture was more effective in improving HAMD scores at 3 weeks after administration (mean difference [MD] = -1.17, 95%CI = -2.18 to -0.16), at 4 weeks (MD = -4.44, 95% CI = -5.64 to -3.23), at 6 weeks (MD = -1.02, 95% CI = -1.68 to -0.36), and at 8 weeks (MD = -4.33, 95% CI = -4.96 to -3.70). Similarly, acupuncture more dramatically decreased NIHSS scores (MD = -2.31, 95% CI = -2.53 to -2.09), and TESS scores (MD = -4.70, 95% CI = -4.93 to -4.48) than conventional Western medicinal therapy. Further, the total clinical efficacy in the acupuncture group was significantly higher than in the antidepressants group (risk ratio [RR] = 1.15, 95% CI = 1.08-1.21). |
+^Conclusions| The results of this study suggest that acupuncture not only can reduce the severity of PSD, but also has significant effects on decreasing the appearance of other adverse events.|
-==== Acupuncture générique ====
 === Huang 2018 ===
@@ Ligne 88: / Ligne 191: @@
-==== Techniques particulières ====
+==== Special Acupuncture Techniques ====
 === Electro-acupuncture ===
+== Wang 2021 ==
+Wang X, Cai W, Wang Y, Huang S, Zhang Q, Wang F. Is Electroacupuncture an Effective and Safe Treatment for Poststroke Depression? An Updated Systematic Review and Meta-Analysis. Biomed Res Int. 2021.   [222765]. https://doi.org/10.1155/2021/8661162
+^Objective|To observe and compare the efficacy and safety of electroacupuncture and antidepressants in the treatment of poststroke depression (PSD) using a meta-analysis method.|
+^Methods|The VIP, CNKI, Wanfang, CMB, Embase, PubMed, and Cochrane databases were searched. All randomized controlled trials (RCT) on electroacupuncture treatment of PSD were searched and further screened. Meta-analysis was performed on electroacupuncture and western medicine for PSD to explore the difference in efficacy between electroacupuncture and western medicine for PSD. |
+^Results|Nineteen RCTs were included in the meta-analysis. Compared with the Western medicine group, the meta-analysis showed no significant changes in Hamilton Depression Scale (HAMD) scores between the electroacupuncture group and the antidepressant group (P > 0.05). The number of adverse events in the electroacupuncture group was less than that in the antidepressant group. |
+^Conclusion| Compared with antidepressants, electroacupuncture is not less effective in improving depression symptoms in PSD patients with greater safety.|
@@ Ligne 104: / Ligne 219: @@
 === Moxibustion ===
+== Guo 2022 ==
+Guo SQ, Zhao GZ, Li ST, Yao Q, Han L, Li B, Wang H, Liu YJ, Zhao BX. Moxibustion for treating patients with post-stroke depression: a systematic review and meta-analysis. Ann Palliat Med. 2022 Jan;11(1):85-97.  https://doi.org/10.21037/apm-21-3421
+^Background| To assess the effectiveness and safety of moxibustion for post-stroke depression (PSD).|
+^Methods|A search was conducted in the following English and Chinese databases: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature (CBM), VIP and Wanfang. The outcomes included Hamilton Depression Rating Scale (HAMD), effective rate, and Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scale. The formulation of search strategy, data extraction, and quality evaluation of involved studies was performed according to Cochrane handbook guidelines. The software RevMan 5.4 and Stata 16 were used for data analysis. The evidence quality of each outcome was evaluated by GRADEpro guideline development tool (GDT).|
+^Results|A total of **14 trials with 863 participants** were included. A certain risk of bias of unclear or high was detected in the included studies. Compared with the control group, adding moxibustion could change the value of HAMD [standardized mean difference (SMD) =-1.17; 95% confidence interval (CI): -1.55 to -0.79; I2=85.5%; P<0.01] and the effective rate [risk ratio (RR) =1.22; 95% CI: 1.13 to 1.32; I2=0.0%; P=0.56], and the differences in the MESSS scale (SMD =-0.72; 95% CI: -1.06 to -0.38; I2=0.0%; P=0.80) had statistical differences. The certainty was low in effective rate, and very low in HAMD and MESSS. Besides, moxibustion was shown to be generally safe.|
+^Discussion| This review found that moxibustion may be an effective intervention for PSD. However, the results of this study have a certain limitation. The benefits of moxibustion for PSD need to be confirmed in the future by more high-quality randomized controlled trials (RCTs).|
@@ Ligne 114: / Ligne 241: @@
 ^Results | Analysis of 5 included pieces of literature showed that **moxibustion therapy had a definite effect on post-stroke depression** with higher safety margin.|
-=== Acupuncture oculaire ===
+=== Abdominal Acupuncture ===
+== Su 2021 ==
+Su IJ, Liao L, Huang F. A Meta-Analysis of the Effect of Abdominal Acupuncture on Post-Stroke Depression. Medical Acupuncture. 2021;33(4):269-277.   [221442]. https://doi.org/10.1089/acu.2021.0001
+^Objective|China has the highest stroke incidence in the world, with a large percentage of post-stroke depression (PSD). Abdominal acupuncture is used frequently to treat PSD. This research systematically evaluated the clinical efficacy of this treatment for PSD. |
+^Methods|A literature search retrieved randomized controlled trials in English and Chinese on abdominal acupuncture in conjunction with other therapies (experimental groups), compared to conventional therapies (control groups) for treating PSD from January 2000 to November 2020. Literature quality was evaluated with the Cochrane Library bias-risk assessment tool. RevMan5.3 software was used for the meta-analysis. |
+^Results|A total of **10 RCTs involving 708 patients** were evaluated. Hamilton Depression Scale scores of the experimental groups were significantly lower than in the control groups (mean difference [MD] = -2.34; 95% confidence interval [CI]: -2.89, -1.78; P < 0.00001). Total effective rates of the experimental groups were significantly higher than in the control groups (odds ratio = 3.90; 95% CI: 2.29, 6.62, P < 0.00001). Barthel index scores in the experimental groups were significantly higher than in the control groups (MD = -11.39; 95% CI: 9.07, 13.72; P < 0.00001). There were no significant differences in National Institutes of Health Stroke Scale (NIHSS) scores between the 2 groups (MD = -0.03; 95% CI: -0.68, 0.62; P = 0.93). |
+^Conclusions| Abdominal acupuncture for treating PSD is generally effective. However, the degree of neurologic improvement needs further investigation.|
+=== Ocular Acupuncture ===
@@ Ligne 126: / Ligne 270: @@
 ^Questions and prospects| Eye acupuncture combined with medicine or body acupuncture is superior to non-eye acupuncture in the treatment of post-stroke depression. However, the total sample size is relatively small, and the evidence for efficacy is insufficient. The quality of included literature methodological studies is not high, and more high-quality clinical studies are expected to improve the evidence intensity. |
-===== Revues de revues systématiques =====
+=== Scalp Acupuncture ===
+== Jiang 2023 ==
+Jiang W, Jiang X, Yu T, Gao Y, Sun Y. Efficacy and safety of scalp acupuncture for poststroke depression: A meta-analysis and systematic review. Medicine (Baltimore). 2023 Aug 4;102(31):e34561.  https://doi.org/10.1097/MD.0000000000034561
+^Background| Poststroke depression (PSD) is a common clinical poststroke complication that adversely affects cognitive and physical function rehabilitation. Scalp acupuncture (SA) can significantly improve somatic dysfunction and emotional disorder in stroke patients. This meta-analysis aims to evaluate the effectiveness and safety of SA in the treatment of PSD.|
+^Methods| We conducted a comprehensive search of multiple electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Internet, China Science and Technology Journal Database, Wan Fang Data Knowledge Service Platform, and China Biology Medicine databases until December 20, 2022, to identify randomized controlled trials investigating the efficacy of SA in the treatment of PSD. Two independent researchers screened the literature, extracted data, and assessed the risk of bias in the included studies based on the inclusion and exclusion criteria. We performed a meta-analysis of the eligible literature using RevMan 5.4.1 and Stata 15.0 software.|
+^Results| This study comprised a total of **14 randomized controlled trials**, 10 of which used SA and 4 of which used SA in combination with electroacupuncture therapy. The results of the meta-analysis revealed that the effective rate of the SA group was significantly higher than that of the Western medicine group (relative risk = 1.09, 95% confidence interval (CI) [1.02, 1.16], P = .008). Moreover, compared to the Western medicine group, the SA group demonstrated significant improvements in Hamilton depression scale scores (mean difference = -2.29, 95% CI [-3.88, -0.70], P = .005) and neurological function deficit scores (mean difference = -3.06, 95% CI [-5.91, -0.21], P = .04). Additionally, the SA group has a lower incidence of adverse events than the western medicine group (relative risk = 0.12, 95% CI [0.05, 0.29], P < .00001).|
+^Conclusion| SA has superior efficacy and safety compared to Western medicine for PSD. These findings suggest that SA could be a promising alternative treatment for the assessed condition. Due to the limited number and quality of the included literature, the above conclusions must be confirmed by additional high-quality research. |
+== Zhong 2023 ==
+Zhong D, Cheng H, Pan Z, Ou X, Liu P, Kong X, Liu D, Chen J, Li J. Efficacy of scalp acupuncture combined with conventional therapy in the intervention of post-stroke depression: A systematic review and meta-analysis. Complement Ther Med. 2023 Oct;77:102975.  https://doi.org/10.1016/j.ctim.2023.102975
+^Background| Post-stroke depression (PSD) is a common complication following a stroke, significantly impacting patients' quality of life and mental well-being. Currently, two primary approaches are employed to treat PSD: drug therapy and non-drug therapy. Among these, acupuncture, specifically scalp acupuncture (SA), has gained attention due to its cost-effectiveness and broad social benefits. SA is a precise and direct form of acupuncture that has been utilized in the treatment of PSD. Although several randomized controlled trials (RCTs) have demonstrated the efficacy of SA in treating PSD, there is a lack of comprehensive systematic reviews. Given the limitations of existing evidence, we conducted a systematic evaluation to assess the effectiveness of SA in combination with conventional therapy (CT) for intervening in PSD.|
+^Methods| We systematically searched five databases for articles published up until May 31, 2023, pertaining to SA treatment of PSD. A team of researchers meticulously screened and assessed these articles to identify the final included studies. After extracting relevant information and outcome indicators from the selected articles, we employed RevMan5.3 software to evaluate their quality and perform statistical analysis. Throughout our research, we strictly adhered to the PRISMA 2020 guidelines.|
+^Results| A total of **11 articles** were included, and a meta-analysis was conducted to evaluate the effectiveness of SA combined with CT for treating PSD. The results revealed that SA combined with CT can effectively improve the treatment's success rate for PSD and reduce the severity of depressive symptoms measured by the Self-Rating Depression Scale. However, SA combined with CT did not show significant reductions in depressive symptoms assessed by the Hamilton Rating Scale for Depression, which may be related to the inclusion of high heterogeneity articles. Importantly, the combination treatment did not lead to an increase in adverse reactions among PSD patients.|
+^Conclusion| While the effectiveness of SA combined with CT in treating PSD still requires further validation through rigorous randomized double-blind trials, this study provides a comprehensive collection of studies that meet the criteria for SA combined with CT in PSD treatment. It objectively and systematically evaluated the impact of SA combined with CT on PSD. Consequently, the findings of this study hold certain clinical significance.|
+=== Comparison of acupuncture techniques ===
+== Hang 2021 ==
+Hang X, Li J, Zhang Y, Li Z, Zhang Y, Ye X, Tang Q, Sun W. Efficacy of frequently-used acupuncture methods for specific parts and conventional pharmaceutical interventions in treating post-stroke depression patients: A network meta-analysis. Complement Ther Clin Pract. 2021 Nov;45:101471.  [[https://doi.org/10.1016/j.ctcp.2021.101471]].
+===== Overviews of Systematic Reviews =====
+==== Miao 2025 ====
+Miao RQ, Zhu FY, Wang TY, Yin S, Shuai C, Li T, Li Z, Luo L, Yang B. The effectiveness and safety of acupuncture for post-stroke depression: an overview of systematic reviews. Complement Ther Med. 2025 Apr 19:103178.  https://doi.org/10.1016/j.ctim.2025.103178.
+^Backgound| In recent years, research on acupuncture for post-stroke depression (PSD) has grown significantly, yet findings remain inconsistent. Few researchers have conducted comprehensive assessments of systematic reviews (SRs) in this area. Consequently, there is a need for a thorough and objective synthesis of clinical evidence regarding acupuncture's effectiveness in treating PSD.|
+^Objective| To evaluate and synthesize evidence on the efficacy and safety of acupuncture for PSD through systematic reviews, offering valuable insights for clinical practice and guiding future research directions.|
+^Methods| We searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang, VIP and Google Scholar databases for relevant literature. The search covered publications from database inception to September 10, 2024. Literature selection and data extraction were independently performed by two reviewers. The methodological quality, bias risk, and evidence level of included SRs were assessed using AMSTAR 2, ROBIS, and GRADE tools. The corrected covered area (CCA) was calculated to assess overlap in original studies. Data from included SRs were subjected to quantitative or descriptive analysis.|
+^Results| A total of **38 SRs **on acupuncture for PSD were included. After assessment using AMSTAR 2, one SR was rated as moderate quality, two as low quality, and 35 as very low quality. According to ROBIS, 21 SRs were classified as high risk of overall bias, and 17 as low risk. Acupuncture showed potential to improve depressive symptoms, stroke-related symptoms, and activities of daily living in PSD patients, though the quality of evidence is limited. Some studies suggested possible effects on cognitive function, biomarkers, sleep quality, and Traditional Chinese Medicine syndromes, but these findings require further validation with higher-quality research. While no serious adverse effects were reported in the reviewed studies, more rigorous safety evaluations are needed before definitive conclusions about acupuncture's safety for PSD can be made.|
+^Conclusion| Acupuncture shows potential as a treatment for PSD, though more high-quality research is needed to establish its effectiveness and safety. Currently, the majority of systematic reviews exhibit deficiencies in protocol pre-registration, documentation of excluded studies, and disclosure of funding sources, resulting in systematic reviews of suboptimal quality. Current evidence suggests possible benefits for depressive symptoms, stroke-related symptoms, activities of daily living, cognitive function, biomarkers, sleep quality, and TCM syndromes, but these findings should be interpreted cautiously given the limitations in study quality. Further high-quality studies are needed to confirm the efficacy and safety of acupuncture for PSD.|
+==== Xie 2022 ====
+Xie J, Geng X, Fan F, Fu X, He S, Li T. The efficacy of therapies for post-stroke depression in aging: An umbrella review. Front Aging Neurosci. 2022 Aug 23;14:993250.  https://doi.org/10.3389/fnagi.2022.993250.
+^Objective|Post-stroke depression (PSD) is a common complication after stroke. PSD is associated with emotional disorders and psychological dependence, which are potential risk factors for stroke recurrence and suicidality. This study aimed to perform an umbrella review of therapies for PSD through a comprehensive literature search. |
+^Methods|A systematic search was conducted in the PubMed and Web of Science by two independent authors. We examined the Hamilton Depression Scale (HAMD), Activities of daily living (ADL), Neurologic function as efficacy endpoints, and the incidence of adverse events as safety profiles. Seventeen eligible studies, including 267 clinical trials were included in this study. |
+^Results|The results showed that High-Frequency Repetitive Transcranial Magnetic Stimulation (HfrTMS), **Acupuncture/EA+conventional treatment**, Escitalopram, Modified Sini San, Moxibustion, Xiaoyao Formula, Paroxetine, Chinese herbal medicine, Exercise, Citalopram, and Cognitive behavioral therapy are beneficial for improving the depression symptoms of patients with PSD. HfrTMS and Sertraline may have an impact on slowing the scores of activities of daily living or neurologic function. In addition, **Acupuncture/EA+conventional**, Escitalopram, Citalopram, Sertraline, and Fluoxetine showed no serious adverse events in PSD patients. |
+^Conclusions| Our study demonstrated that 11 treatment methods can effectively improve the condition of PSD patients. |
@@ Ligne 139: / Ligne 331: @@
 ^Results|Four systematic reviews on post stroke cognitive impairment and ten systematic reviews on post stroke depression with good methodological quality were included. Meta-analyses revealed that acupuncture plus cognitive rehabilitation; and acupuncture or moxibustion plus cognitive rehabilitation, versus cognitive rehabilitation demonstrated statistically significant increase in Mini-Mental State Examination scores in compared to cognitive rehabilitation after 4 weeks treatment [Pooled weighted mean difference (WMD) = 3.14, 95% confidence interval (CI) = 2.06 to 4.21, I2 = 36%]; and (Pooled WMD = 3.22, 95% CI = 2.09 to 4.34, I2 = 0%). Furthermore, acupuncture versus antidepressant demonstrated statistically significant improve depression measured by increasing in 17-item Hamilton Depression Rating Scale in comparing to cognitive rehabilitation after 2 weeks treatment (Pooled WMD= -2.34, 95% CI= -3.46 to -1.22, I2 = 5%). Acupuncture usage was not associated with increased risk of adverse events. |
 ^Conclusions| Acupuncture is safe and improves cognitive function and depressive disorder without obvious serious adverse events for post stroke patients. |
+===== Clinical Practice Guidelines =====
+| ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation, (or lack of evidence) |
+==== Department of Veterans Affairs and Department of Defense (VA/DoD, USA) 2024 Ø ====
+VA/DoD Clinical Practice Guideline for Management of Stroke Rehabilitation. Department of Veterans Affairs and Department of Defense. Washington, DC: U.S. Government Printing Office. 2024. https://www.healthquality.va.gov/guidelines/Rehab/stroke/VADoD-2024-Stroke-Rehab-CPG-Full-CPG_final_508.pdf
+| 43. There is insufficient evidence to recommend for or against acupuncture, either alone or as an adjunct to pharmacotherapy, for depression following stroke. (Neither for nor against / Reviewed, New-added) |
+==== Stroke Foundation (Australia, New-Zealand) 2022 ⊕  ====
+Australian and New Zealand Clinical Guidelines for Stroke Management - Chapter 6: Managing complications. https://app.magicapp.org/#/guideline/WE8wOn
+|For stroke survivors with depression or depressive symptoms, acupuncture may be used. (Zhang et al 2010) [Weak recommendation]. |
+==== Japan Stroke Society (JSS, Japan) 2021 ⊕ ====
+The Japan Stroke Society. [Japanese Guidelines for the Management of Stroke, 2021] . Kyowa Kikaku Co. Ltd.; 2021 [in Japanese] .
+//Cited b//y Okawa Y, Yamashita H, Masuyama S, Fukazawa Y, Wakayama I. Quality assessment of Japanese clinical practice guidelines including recommendations for acupuncture. Integr Med Res. 2022 Sep;11(3):100838.  https://doi.org/10.1016/j.imr.2022.100838
+| Acupuncture. May be considered for post stroke depression.|
+==== Canadian Partnership for Stroke Recovery (CPSR, Canada) 2018 ⊕ ====
+Evidence-based review of stroke rehabilitation: 18th edition, Canadian Partnership for Stroke Recovery (CPSR). 2018.   {{:medias securises:acupuncture:evaluation:neuro-psychiatrie:cpsr-197578.pdf|[197578]}}. [[http://www.ebrsr.com|URL]]/
+|//Post Stroke Depression and Mood Disorders.// There is Level 1b evidence that a combination of acupuncture and herbal medicine reduces depressive symptoms post stroke when compared to standard care. There is Level 1b evidence that acupuncture is no more effective than sham acupuncture in reducing depressive symptoms post stroke. There is Level 1b evidence that dense cranial acupuncture reduces post-stroke depressive symptoms in the short term when compared to non-invasive cranial acupuncture. There is Level 1b and Level 2 evidence that acupuncture reduces post-stroke depressive symptoms in the short term when compared to antidepressants. There is Level 2 and Level 4 evidence that electroacupuncture reduces depressive symptoms post stroke. There is limited Level 2 evidence that meridian acupressure reduces depressive symptoms post stroke when compared to standard care.|

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