Acupuncture for Poststroke Depression: Can It Help Improve Symptoms?

Acupuncture with repetitive transcranial magnetic stimulation appeared to be the most effective therapy with the highest probability in improving poststroke depression.

Acupuncture used alone or in combination with other therapies has demonstrated effectiveness for the treatment of poststroke depression, according to findings from a systematic review and meta-analysis published in BMC Psychiatry.

Individuals who experience poststroke depression report feelings of anxiety, unwillingness to communicate, hopelessness, and insomnia, all of which might have a negative effect on their activities of daily living and their rehabilitation following stroke. Among survivors of stroke, poststroke depression has been associated with an increased risk for mortality as well.

Using the network meta-analysis method, researchers sought to evaluate the true impact of acupuncture in alleviating the symptoms of poststroke depression. Additionally, they sought to explore the difference in effectiveness between the use of acupuncture combined with various pharmacotherapies and nonpharmacotherapies, in an effort to offer optimized guidance and advice for clinicians.

From inception through March 2023, the researchers conducted a search of 6 databases and 3 clinical trials. All studies that compared the use of needle-based acupuncture (either alone or in combination with other therapies) with pharmacotherapy, other nonpharmacotherapy, or invalid groups (eg, placebo, waitlist, and blank control) were included. Study inclusion criteria, based on the PICOS (Population [P], Intervention [I], Comparison [C], Outcomes [O], and Study [S]) design, were as follows:

  • P: Participants ≥18 years of age who had been clinically diagnosed with stroke and exhibited any degree of stroke impairment severity
  • I: Acupuncture treatments alone or combined with other treatments
  • C: Pharmacotherapy, other nonpharmacotherapy, or invalid groups
  • O: Primary outcome was efficacy of poststroke depression evaluated on scales that measured symptoms of depression; secondary outcomes included effectiveness for neurologic function and quality of life
  • S: Only a randomized controlled trial (RCT)
This is the first review to compare the effectiveness of acupuncture with other therapies for PSD using a net­work meta-analysis, which may provide novel and useful guidance for clinicians and readers.

Ultimately, a total of 62 studies involving 5,500 participants, all of which were published between 2003 and 2022, were included in the review. All of the studies had been conducted in China. Other than usual care, there were 12 different treatments included:

  • Acupuncture plus repetitive transcranial magnetic stimulation (RTMS)
  • Acupuncture plus traditional Chinese medicine (TCM) plus Western medicine
  • Acupuncture plus TCM
  • Acupuncture plus Tai Chi
  • Acupuncture plus cognitive therapy
  • TCM
  • Acupuncture and moxibustion (AM)
  • Acupuncture plus Western medicine
  • AM plus WM
  • Acupuncture
  • Western medicine
  • Usual care

The researchers found that compared with Western medicine alone — defined as pharmacotherapy for poststroke depression — the following treatments were superior for the alleviation of symptoms of poststroke depression:

  • acupuncture alone;
  • acupuncture combined with RTMS;
  • TCM alone; or
  • TCM combined with Western medicine

Additionally, compared with usual care, the use of acupuncture alone or in combination with other therapies was shown to significantly decrease scores on the Hamilton Depression Rating scale. Based on the Surface Under the Cumulative Ranking curve, acupuncture plus RTMS exhibited the highest probability of improving symptoms of depression, with a probability of 49.43% reported.

Study limitations included only using studies published in China in the meta-analysis and the use of the risk of bias tool to evaluate the quality of the RCTs included in the analysis, which showed that the overall quality of the RCTs was not high.

“This is the first review to compare the effectiveness of acupuncture with other therapies for PSD [poststroke depression] using a net­work meta-analysis, which may provide novel and useful guidance for clinicians and readers,” the researchers acknowledged.

They concluded, “Nonetheless, more high-quality studies are needed to provide sufficient evidence.”


Lam Ching W, Li HJ, Guo J, et al. Acupuncture for poststroke depression: a systematic review and network meta-analysis. BMC Psychiatry. Published online May 4, 2023.  doi:10.1186/s12888-023-04749-1