Acupuncture for depression: a critique of the evidence base.

AIM: The aim of this review is to examine the evidence for acupuncture's effectiveness as a depression intervention. Unlike other reviews, which consider methodological concerns relevant to all experimental evaluations, this review focuses on the scope of studies, and uses a PICO (patients, intervention, comparison, and outcome) structure to determine what can potentially be learned from primary studies that have already been screened for methodological quality by reviewers. DISCUSSION: The review identified a number of study limitations. (i) PATIENTS: majority of trial reports have not described a rationale for the selection of patients or inclusion/exclusion criteria. Prognostic indicators were not reported and there were also concerns about the generalizability of study populations. (ii) INTERVENTION: most trials investigate poorly rationalized standardized acupuncture protocols thus quality of care may be an issue and generalizability to routine clinical practice is a main concern. In trials using other methods generalizability is also poor. (iii) Comparisons: concerns were raised about using therapeutically inappropriate acupuncture. (iv) OUTCOMES: short-term focus and the narrow range of outcomes explored. According to more recent systematic review evidence it is probable the shortcomings identified in the PICO review have not been addressed by subsequent research. The concept of model validity, proposed by other researchers, is discussed, and suggestions put forward about complex intervention evaluation methods, which may be better suited to evaluating acupuncture care.
CONCLUSION: Uncertainty remains about the value of acupuncture care, as it is routinely practiced in the West, and this uncertainty has not been resolved by trials to date. Existing evaluations may however be useful for guiding decisions about the value of specific techniques for patients with depression.