Manual or electroacupuncture as an add-on therapy to SSRIs for depression: A randomized controlled trial

Selective serotonin reuptake inhibitors (SSRIs) are first-line antidepressants, however, only around 60% of pa tients could benefit from them. Acupuncture is supported by insufficient evidence to help with symptom re lieving and SSRIs tolerance. This pragmatic randomized controlled trial compared SSRIs alone versus SSRI together with manual acupuncture (MA) or electroacupuncture (EA) in moderate to severe depressed patients Patients were randomly allocated to receive MA + SSRIs (161), EA + SSRIs (160), or SSRIs alone (156) for si: weeks, and then followed up for another four weeks. The primary outcome was response rate of the 17-iten Hamilton Depression Scale (HAMD-17) at 6th week. The secondary outcomes were HAMD-17 (remission rate early onset rate, total score), Self-Rating Depression Scale (SDS: total score), Clinical Global Impression (CGI) Rating Scale for Side Effects (SEAS: total and domain scores), number of patients with adjusted dosage of SSRI and adverse events (AEs). Both MA + SSRIs and EA + SSRIs were significantly better than SSRIs at 6th week of HAMD-17 response rate (RR = 1.21, 95% CI 1.04, 1.42, P = 0.013; RR = 1.27, 95% CI 1.09, 1.48, P = 0.0014) HAMD-17 early onset rate (P < 0.0001), HAMD-17 and SDS total scores (P < 0.05), CGI (P < 0.01), SEAS tota score (P < 0.01), number of patients with increased dosage of SSRIs (P < 0.01). For HAMD-17 remission rate EA + SSRIs was significantly higher than SSRIs (P = 0.0083), while MA + SSRIs showed no significant dif ference at 6th week (P = 0.092). No unintended acupuncture-related severe AE was observed. This stud identified that both MA and EA showed beneficial effects in addition to SSRIs alone in patients with moderate tt severe depression, and were well tolerated.