Acupuncture as an Adjunctive Therapy for Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Major depressive disorder is a leading cause of global disability. Limitations of pharmacological treatments, including delayed onset, incomplete response, and adverse effects, have increased interest in integrative approaches. Although acupuncture is widely used as a complementary therapy for depression, its efficacy and safety remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture, alone or as an adjunct to selective serotonin reuptake inhibitors (SSRIs), in reducing depressive symptoms. Eight English and Chinese databases were searched from inception to June 30, 2025, for randomized controlled trials (RCTs) evaluating manual or electroacupuncture for primary depression. Comparators included sham acupuncture, waitlist, psychotherapy, or SSRIs. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment using Cochrane ROB 2.0. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models, and the certainty of evidence was assessed using GRADE. Seventy-six RCTs involving 5,864 participants were included. Acupuncture was associated with greater reductions in depressive symptom severity compared with non-active controls, although heterogeneity was substantial. As an adjunct to SSRIs, acupuncture demonstrated additional short-term improvement at four weeks (MD -3.02; 95% CI -3.49 to -2.56; moderate-certainty evidence). Electroacupuncture showed potential for earlier symptomatic improvement, although the certainty of evidence was limited. Adjunctive acupuncture was also associated with fewer treatment-related adverse events and modest improvements in quality of life. The overall certainty of evidence ranged from very low to moderate; therefore, these findings should be interpreted cautiously, and the true effects may differ substantially from the observed estimates. Acupuncture, particularly as an adjunct to SSRI therapy, may offer short-term benefits in depressive symptoms and tolerability but should not be considered a replacement for standard treatment. Further high-quality, rigorously designed trials with standardized protocols and prolonged follow-up are required to clarify its role in depression care.