Rapid Onset of the Effects of Combined Selective Serotonin Reuptake Inhibitors and Electroacupuncture on Primary Depression: A Meta-Analysis

Abstract

Objectives:

To evaluate the efficacy and safety of combined selective serotonin reuptake inhibitors (SSRIs) and electroacupuncture therapies for the early treatment of primary depression.

Methods:

Randomized controlled trials (RCTs) were analyzed to compare therapy combining SSRIs and electroacupuncture to SSRI therapy alone. The RCTs were identified by searching, among others, PubMed, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and the Chinese Biological Medical Literature Database. Scores from Self-Rated Depression Scale (SDS), the Hamilton Depression Scale (HAMD), the Side Effect Rating Scale (SERS), and the Treatment Emergent Symptom Scale (TESS) were analyzed and coded by two independent investigators and used to evaluate the safety and efficacy of treatment. Statistical analyses were performed using RevMan 5.2 software.

Results:

Six RCTs were analyzed. The meta-analysis revealed that the combined therapy of SSRIs and electroacupuncture were associated with superior scores on the HAMD, SDS, and SERS measures compared with SSRIs alone after 1–4 weeks of treatment: HAMD scores, mean difference (MD)_{1 week}, 2.32 (95% confidence interval [CI]_{1 week}, 1.47–3.16, p _{1 week}<0.00001); MD_{2 weeks}, 2.65 (95% CI_{2 weeks}, 1.81– 3.50, p _{2 weeks}<0.00001); MD_{4 weeks}, 2.70 (95% CI_{4 weeks}, 1.90–3.51, p _{4 weeks}<0.00001); SDS scores: MD_{1 week}, 3.13 (95% CI_{1 week,} 1.22–5.03, p _{1 week} = 0.001); MD_{2 weeks}, 4.05 (95% CI_{2 weeks}, 0.22–7.87, p _{2 weeks} = 0.04); MD_{4 weeks}, 5.02 (95% CI_{4 weeks}, 1.61–8.43, p _{4 weeks} = 0.004); SERS scores: MD_{2 weeks}, 2.20 (95% CI_{2 weeks,} 1.43–2.96, p _{2 weeks}<0.00001); MD_{4 weeks}, 2.12 (95% CI_{4 weeks}, 1.42–2.83, p _{4 weeks}<0.00001). However, two of the aforementioned outcomes were rated as medium quality because of heterogeneity, as assessed using the Grading of Recommendations Assessment, Development and Evaluation system.

Conclusions:

The available evidence suggests that the early treatment of primary depression using both SSRI and electroacupuncture therapies is more efficient than treatments with SSRIs alone and leads to a better and earlier control of depressive symptoms.