Ceci est une ancienne révision du document !
Sommaire
Dépression post-AVC : évaluation de l'acupuncture
1. Revues systématiques et méta-analyses
| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
| ☆☆ | Evidence for effectiveness of acupuncture |
| ☆ | Limited evidence for effectiveness of acupuncture |
| Ø | No evidence or insufficient evidence |
1.1. Acupuncture générique
1.1.1. Huang 2018
Huang Yingjie, Li Lixia, Zhou Yalan, Wu Juan, Lin Guohua, Ming Kangwen, Zhang Qufei. [A Meta-analysis of the Efficacy of Acupuncture and Electro -acupuncture on Post-stroke Depression]. Modern Hospital Year. 2018;1:120-124. [201798].
| 目的 系统评价针刺及电针治疗对中风后抑郁症(PSD)的有效性.方法 计算机检索The Cochrane Library、PubMed、Embase、Medline、中国生物医学期刊(CBM)、维普(VIP)、中国知网(CNKI)和万方数据库,搜集使用针刺、电针、针刺结合西药或电针结合西药治疗PSD的相关随机对照试验(RCT).由2位研究者独立进行文献筛选、资料提取,并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 最终纳入13个RCT,共1193例患者.Meta分析结果显示:在改善中风后抑郁症患者抑郁状态方面,针刺与单纯西药治疗差异无统计学意义,森林图提示:[MD=-0.54,95％CI(-1.46,0.39),P=0.26];电针与单纯西药治疗差异无统计学意义,森林图提示:[MD=0.13,95％CI(-1.07,1.33),P=0.83];针刺结合西药明显优于单纯西药,森林图提示:[MD=-3.28,95％CI(-4.45,-2.12),P<0.00001].电针结合西药与单纯西药治疗差异无统计学意义,森林图提示:[MD=-0.39,95％CI(-8.92,2.74),P=0.3].结论 针刺及电针是一种有效的改善中风后抑郁症患者抑郁状态的治疗手段,与口服西药等措施联用,可显著提高疗效.但由于纳入本研究的RCT质量及数量有限,存在一定的偏倚风险,本研究结论尚需更多高质量的临床试验进一步验证. | |
| Objective | To systematically evaluate the effectiveness of acupuncture and electroacupuncture on post-stroke depression (PSD). |
|---|---|
| Methods | Computer search The Cochrane Library, PubMed, Embase, Medline, Chinese Biomedical Journal (CBM), VIP (VIP), China Knowledge Network (CNKI) and Wanfang database, collecting randomized controlled trials (RCT) for the treatment of PSD using acupuncture, electroacupuncture, acupuncture combined with western medicine or electroacupuncture combined with western medicine. Two researchers independently conducted literature screening, data extraction, and After evaluating the risk of bias in the included study, Meta-analysis was performed using RevMan 5.3 software. |
| Results | The results were finally included in 13 RCTs with a total of 1193 patients. The results of the meta-analysis showed that acupuncture and western medicine were used to improve the depression status of patients with post-stroke depression. The difference was not statistically significant. The forest map suggested: [MD=-0.54, 95% CI (-1.46, 0.39), P=0.26]; there was no significant difference between electroacupuncture and western medicine treatment. The forest map suggested: [MD= 0.13, 95% CI (-1.07, 1.33), P=0.83]; acupuncture combined with western medicine is significantly better than western medicine alone, forest map suggestion: [MD=-3.28, 95% CI (-4.45, -2.12), P< 0.00001]. There is no statistically significant difference between electroacupuncture combined with western medicine and simple western medicine. The forest map suggests: [MD=-0. 39, 95% CI (-8.92, 2.74), P = 0.3]. |
| Conclusion | Acupuncture and electroacupuncture are effective treatments for improving depression in patients with post-stroke depression, and can be used in combination with oral western medicine. Improve the efficacy. However, due to the limited quality and quantity of RCT included in this study, there is a certain risk of bias. The conclusion of this study needs more high-quality clinical trials to further verify. |
1.1.2. Zhou 2018
Zhou Xin, Ren Lu, Gao Yuanyuan, Wu Weining. [Meta Analysis of Effect of Acupuncture and Antidepressants on Depression in Patients with Post-Stroke Depression]. Chinese Archives of Traditional Chinese Medicine Year. 2018;12:2875-2879. [201757].
| Objective | To evaluate the clinical therapeutic effect of acupuncture in the treatment of post-stroke depression. |
|---|---|
| Methods | We retrieved CNKI, VIP, Wanfang database, PubMed and Cochrane Library by computer. Randomize controlled trials of acupuncture for treatment of post-stroke depression collection(RCT)were collected. We evaluated the quality of the included studies according to the evaluation of Cochrane risk bias assessment tool. And then we carried out Meta-analysis using RevMan 5.3 software. |
| Results | A total of 19 randomized controlled trials with 1376 cases of patients with post-stroke depression were included. The Meta-analysis results:(1) HAMD scores changes before and after treatment showed that acupuncture treatment was better than antidepressant in the control group in improving the depressive state of PSD patients and reducing the reuptake of 5-HT in serum.(2)The acupuncture therapy was not clear in improving the neurological deficit of PSD patients. The change of HAMD scale scores before and after treatment indicated that the difference between acupuncture treatment group and antidepressant drug control group was statistically significant. |
| Conclusion | In the clinical treatment of post-stroke depression, acupuncture treatment is better than antidepressant treatment. Acupuncture therapy is safe and effective, with less adverse reactions. However, the conclusion between the subgroups is not clear, and more high-quality randomized controlled trials are needed to further validate the efficacy. |
1.1.3. Zhang 2017
Zhang Dan, Zhang Chunhong, Ma Huijing. [A Systematic Review of the Efficacy of Chinese Therapy on Preventing Post-stroke Depression]. Journal of Emergency in Traditional Chinese Medicine. 2017;04. [52334].
| Objective | To systematically review the efficacy of traditional Chinese medicine therapy in the prevention of post-stroke depression (PSD). |
|---|---|
| Methods | CNKI, VIP database, Wan Fang database, Pub Med, MEDLINE were searched by the key words acupuncture, traditional Chinese medicine, prevention, brain stroke, stroke, post stroke depression in both Chinese and English by two researchers to collect higher quality randomized controlled trails (RCTS) and quasi-randomized controlled trails (CCTS) about traditional Chinese medicine therapy in the prevention of post-stroke depression. Two reviewers used Rev Man5. 3 software to do the meta-analysis after a strict screening and elimination. |
| Results | A total of 8 documents involving 1065 studies were studied by meta-analysis and the results showed that TCM therapy group compared with control group, could effectively prevent the happening of depression after stroke, OR=0. 38, 95%CI [0. 28, 0. 51] (P < 0. 00001). |
| Conclusion | The therapy of traditional Chinese medicine is effective in the prevention of post-stroke depression (PSD). But we still need more high quality studies to verify the conclusion due to small amounts of studies this time. |
1.1.4. Zhang 2014 ☆☆
Zhang J, Chen J, Chen J, Li X, Lai X, Zhang S, Wang S. Early filiform needle acupuncture for poststroke depression: a meta-analysis of 17 randomized controlled clinical trials. Neural Regen Res. 2014; 9(7):773-84. [165595].
| Objectives | To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. |
|---|---|
| Methods | We retrieved data from the Chinese National Knowledge Infrastructure (1979-2012), Wanfang (1980-2012), VIP (1989-2012), Chinese Biomedical Literature (1975-2012), PubMed (1966-2012), Ovid Lww (-2012), and Cochrane Library (-2012) Database using the internet. SELECTION CRITERIA: Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the included articles scored at least 4 points on the Jadad scale. EXCLUSION CRITERIA: other acupuncture therapies as treatment group, not stroke-induced depression patients, score < 4 points, non-randomized controlled trials, or animal trials. MAIN OUTCOME MEASURES: These were the Hamilton Depression Scale scores, clinical effective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events. |
| Results | A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with filiform needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval (CI): 1.03-1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale (17 items) scores were lower than in the antidepressant drug group (mean difference = -2.34, 95%CI: -3.46 to -1.22, P < 0.000,1). At 4 weeks, Hamilton Depression Scale (24 items) scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 articles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group. |
| Conclusions | Early filiform needle acupuncture for poststroke depression can perfectly control depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs. |
1.1.5. Zhang 2014 ☆
Zhang Wei, Sun Jian-Hua, Gao Yang, Pei Li-Xia, Wu Xiao-Liang, Chen Lu et al. System review on treating post-stroke depression with acupuncture. World Journal of Acupuncture- Moxibustion 2014.24(2):52. [176422].
| Objective | To assess the efficacy and safety of treating post-stroke depression with acupuncture compared to western medicine systematically. |
|---|---|
| Methods | Databases were retrieved such as Cochrane Library, PubMed, Web of Sicence, Embase, CBM, CNKI and WanFang Data so as to look up randomized controlled trials (RCT) of treating post-stroke depression with acupuncture and western medicine, and the time limit for the retrieval spanned from the date of database established to September 2013. By extracting data and evaluating methodological quality of included studies according to inclusion and exclusion criteria, RevMan 5.2 software was applied for Meta-analysis and evidence quality was assessed by adopting the GRADE system. |
| Results | A total of 13 RCTs (845 patients with post-stroke depression) were included in this study. It was revealed by Meta-analysis that the differences of the two groups were statistically significant in terms of HAMD scale scores measured at the end of the treatment by comparing the treatment of acupuncture and western medicine [SMD=0.26, 95% CI (0.11, 0.40)], but via susceptibility analysis (excluding low quality studies), the differences were not statistically significant [SMD=-0.06, 95% CI (-0.37, 0.25)], and the reliability of the results was low; in terms of adverse events, the differences were statistically significant [RR=0.32, 95% CI (0.19, 0.53)], and the risk of adverse events reduced by 68% in the acupuncture group. From the assessment on evidence quality grade based on GRADE system, it was revealed that HAMD scores and adverse events were evidences with fairly low quality. |
| Conclusion | Although this system assessment showed that treating post-stroke depression with acupuncture was more effective compared with western medicine, the result was less reliable and quality of evidences was poor. The above-mentioned results need more highquality randomized controlled trials for further verification. |
1.1.6. Zhang 2012
Zhang GC, Fu WB, Xu NG, Liu JH, Zhu XP, Liang ZH, Huang YF, Chen YF. Meta analysis of the curative effect of acupuncture on post-stroke depression. J Tradit Chin Med. 2012;32(1):6-11. [164843].
| Objectives | To systematically evaluate the curative effect of acupuncture on post-stroke depression (PSD). |
|---|---|
| Methods | The internet was used to retrieve the Wanfang Medical Data System, Chinese Periodical Net, the Weipu Information Resources System, PubMed and the Cochrane Library Database. Relevant articles, up to September 2010, were manually retrieved. These papers included studies that had performed random and semi-random control trials for the use of acupuncture to treat PSD. Fifteen random control tests involving 1096 patients were included in this study and individual cases, interventional measures and curative effects were extracted from this research. Grade methodological quality evaluation and meta-analysis were performed on these studies. |
| Results | Comparison between the acupuncture group and the Western medicine group for the curative rate on PSD revealed an OR of 1.48, 95% CI = [1.11 1.97] and P = 0.008. Comparison of obviously effective rate shows that OR = 1.39, 95% CI = [1.08 1.80] and P = 0.01. Comparison of effective rate shows that OR = 0.83, 95% CI = [0.631.09] and P = 0.18. |
| Conclusions | Comparison between the acupuncture group and Western medicine group in treating PSD revealed that there is a statistical difference in curative rate and remarkably effective rate, but no difference in effective rate. |
1.1.7. Zhang 2010 ☆☆
Zhang ZJ, Chen HY, Yip KC, Ng R, Wong VT. The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis, J Affect Disord. 2009. 124(1-2):9-21. [136615].
| Background | Although acupuncture has been used as an alternative treatment for depressive disorders, its effectiveness and safety are not well defined. The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of acupuncture as monotherapy and as an additional therapy in treating various depressive conditions, particularly major depressive disorder (MDD) and post-stroke depression (PSD). |
|---|---|
| Methods | Following systematic review, meta-analysis was conducted on high-quality randomized controlled trials (RCTs). |
| Results | Of 207 clinical studies of acupuncture for various depression retrieved, 113 (54.6%) were on MDD and 76 (36.7%) on PSD. Twenty RCTs of MDD (n=1998) and 15 of PSD (n=1680) identified for high-quality protocol (Jadad score >/=3) were included for meta-analysis. The efficacy of acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, but not different from sham acupuncture. No sufficient evidence favored the expectation that acupuncture combined with antidepressants could yield better outcomes than antidepressants alone in treating MDD. Acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants. |
| Conclusions | Acupuncture therapy is safe and effective in treating MDD and PSD, and could be considered an alternative option for the two disorders. The efficacy in other forms of depression remains to be further determined. |
1.1.8. Zhang 2009 ☆
Zhang JB, Ren L, Sun Y. [Meta-analysis on acupuncture for treatment of depression in patients of poststroke]. Chinese Acupuncture and Moxibustion. 2009. 29(7):599-602. [154691].
| Objective | To assess therapeutic effect and the safety of acupuncture for treatment of the depression in patients of poststroke. |
|---|---|
| Methods | The clinical research documents in recent 10 years of acupuncture for treatment of depression in patients of poststroke were retrieved, the homogeneity test was used and the effect amount was complicated in the clinical randomized controlled trials (RCT) documents which had been adopted in the Meta-analysis, and furthermore the Meta-analysis was used in the Hamilton Depression Scale (HAMD) score of both acupuncture group and medication group after treatment. |
| Results | Seventeen RCT heterogeneity test results which were adopted in the study indicated that chi2 = 21.98, P = 0.14, proved that they had homogeneity, and fixed effect model was adopted to analyse, after combination, OR = 2.54, 95% confidence interval was (1.91, 3.38), according to Z test, Z = 6.41, P < 0.00001, the diamond was in the right side of the vertical line, indicated that there was a significant difference in the therapeutic effect between the acupuncture group and the medication group. The evaluation of the influence of acupuncture on HAMD indicated that there was a significant difference between the acupuncture group and the medication group. |
| Conclusion | The therapeutic effect of acupuncture for treatment of the depression in patients of poststroke is superior to other common medicine with safety, but it still needs more large sample RCTs to verify. |
1.2. Techniques particulières
1.2.1. Electro-acupuncture
1.2.1.1. Li 2018
Li XB , Wang J , Xu AD , Huang JM , Meng LQ , Huang RY , Xu J. Clinical effects and safety of electroacupuncture for the treatment of post-stroke depression: a systematic review and meta-analysis of randomised controlled trials. Acupuncture in Medicine. 2018;36(5):284-293. [200331].
| Objective | The aim of this systematic review was to assess the efficacy/effectiveness and safety of electroacupuncture (EA) in the treatment of post-stroke depression (PSD). |
|---|---|
| Methods | A comprehensive literature search in the Pubmed, Embase, CENTRAL, ISI Web of Science, CNKI and Wanfang databases was conducted, and all relevant randomised controlled trials (RCTs) were screened for eligibility by two independent reviewers. The Cochrane Collaboration's tool and Jadad score were used to assess the risk of bias of included studies, and only RCTs scoring ≥3 were included in a meta-analysis. |
| Results | 18 RCTs involving a total of 813 participants (mean age 61.6 years) in the EA groups and 723 participants (mean age 61.9 years) in the control groups were included. The included studies had an average 3-point Jadad score. PSD was diagnosed according to the Chinese Classification of Cerebrovascular Disease (CCCD) and the Chinese Classification of Mental Disease (CCMD) criteria. There was no significant difference between EA and antidepressants (fluoxetine 10-40 mg/day, citalopram 20 mg/day, sertraline 50 mg/day) in terms of the Hamilton Depression Rating Scale (HAMD) scores at week 4 after treatment (standardised mean difference (SMD) -0.11, 95% CI -0.31 to 0.10), at week 6 after treatment (SMD 0.04, 95% CI -0.43 to 0.51) or at week 8 after treatment (SMD -0.01, 95% CI -0.23 to 0.22). However, the combined incidence of adverse events in the EA groups was significantly lower than in the antidepressant groups (RR 0.21, 95% CI 0.14 to 0.33). |
| Conclusion | There was no significant difference between EA and antidepressants in the severity of depression, however EA caused fewer adverse events than antidepressants. Additional larger scale RCTs with rigorous study design are required. |
1.2.2. Moxibustion
1.2.2.1. Lu 2013 ☆
Lu Xiao-Lin, Sun Zhong-Ren, Zhang Qin-Hong, Du Wei. [Systematic review of clinical moxibustion treatment for post-stroke depression]. Shanghai Journal of Acupuncture and Moxibustion 2013.32(11):954. [178908]
| Objective | To evaluate the clinical efficacy of moxibustion in treating post-stroke depression. |
|---|---|
| Methods | Searches of CNKI, Wanfang, VIP and PubMed databases retrieved 157 pieces of literature. Finally, 5 pieces of literature met the inclusion criteria and were qualitatively assessed using CLEAR NPT. |
| Results | Analysis of 5 included pieces of literature showed that moxibustion therapy had a definite effect on post-stroke depression with higher safety margin. |
1.2.3. Acupuncture oculaire
1.2.3.1. Yang 2019
Yang Wei, Wang Pengqin. [Systematic Review and Meta-Analysis of the Clinical Efficacy of Eye Acupuncture in the Treatment of Poststroke Depression]. Journal of Practical Traditional Chinese Internal Medicine. 2019;4:1-5+77. [201713].
| Background | ocular acupuncture is effective in treating apoplexy sequelae. |
|---|---|
| Objective | To systematically evaluate the clinical study of eye acupuncture in the treatment of post-stroke depression, and to explore the effectiveness of eye acupuncture in the treatment of post-stroke depression. |
| Methods | [Retrieval strategies] The databases of CNKI, Wanfang, VIP, CBM, PubMed and Cochrane library were comprehensively searched. The retrieval time is from the establishment of the database to December 2018. [Inclusion criteria]research design :① a randomized controlled trial(RCT)of eye acupuncture for the treatment of poststroke depression. ② object of observation: poststroke depression was clearly diagnosed, meeting the criteria for the diagnosis and evaluation of therapeutic effect of stroke or the diagnostic essentials of various cerebrovascular diseases and the diagnostic criteria for depression syndrome in 1995. ③ intervention measures: the treatment group used eye acupuncture therapy or eye acupuncture with other therapies, the control group used noneye acupuncture therapy.④ outcome index: effective rate, HAMD, SDS, ADL, SSS, TCM syndrome effect evaluation scale. [Data collection and analysis] The retrieved literatures were imported into NoteExpress software for preliminary screening, and then two researchers independently screened and identified the literatures according to the admission criteria. In case of any disagreement, a third party was invited to arbitrate. Data extraction table was used, and the extraction contents included: baseline condition, intervention measures, effective rate, Hamilton depression scale(HAMD), self-rating depression scale(SDS), etc… |
| Main results | A total of 59 references were obtained through screening, 31 duplicates were deleted, reading excerpts and original texts were deleted, 1 animal experiment, 8 research progress articles, 8 non-post-stroke depression related diseases articles, 2 clinical studies that did not meet the exclusion criteria were excluded, and 9 articles were finally included. Meta analysis results showed that the total effective rate RR=1.22 [1.12,1.33], P=0.68>0.05. HAMD MD=3.22 [3.04, 3.39]; SDS score MD=3.73 [3.63, 3.83]. |
| 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. |
2. Overview of Systematic Reviews
2.1. Hung 2019
Hung CY, Wu XY, Chung VC, Tang EC, Wu JC, Lau AY. Overview of systematic reviews with meta-analyses on acupuncture in post-stroke cognitive impairment and depression management. Integr Med Res. 2019;8(3):145-159. [199813].
| Background | Acupuncture has been using as an alternative non-pharmacological therapy in the management of post stroke depression and cognitive impairment but its effectiveness and safety remain controversial. We conducted an overview of systematic reviews with meta-analyses to evaluate the evidence on the effect of acupuncture in the treatment of stroke with conventional medicine intervention. |
|---|---|
| Methods | Systematic reviews summarized the treatment effects of acupuncture for post stroke cognitive impairment and post stroke depression were considered eligible. Methodological quality of included systematic reviews was assessed using A Measurement Tool to Assess systematic Reviews 2 (AMSTAR 2). |
| 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. |
3. Guidelines
| ⊕ positive recommendation (quel que soit le niveau de preuve annoncé) Ø recommandation négative, absence de preuve ou non conclusif |
3.1. Canadian Partnership for Stroke Recovery (CPSR, Canada) 2018 ⊕
Evidence-based review of stroke rehabilitation: 18th edition, Canadian Partnership for Stroke Recovery (CPSR). 2018. [197578]. 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. |
