NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Hempel S, Taylor SL, Solloway MR, et al. Evidence Map of Acupuncture [Internet]. Washington (DC): Department of Veterans Affairs (US); 2014 Jan.

Cover of Evidence Map of Acupuncture

Evidence Map of Acupuncture [Internet].

Show details


The results for mental health indications are presented in the bubble plot and text summary below. The bubble plot represents 17 systematic reviews summarizing evidence for 9 clinical indications relevant to mental health [search date: March 2013].

Legend: The bubble plot shows an estimate of the evidence base for mental health-related indications judging from systematic reviews and recent large trials

Legend: The bubble plot shows an estimate of the evidence base for mental health-related indications judging from systematic reviews and recent large trials. The plot depicts the estimated size of the literature (y-axis, number of RCTs included in largest review), the estimated effect (x-axis), and the confidence in the estimate (bubble size).

The figure provides a broad visual overview of the evidence base of acupuncture for mental health. The bubble plot depicts the estimated research volume based on the number of acupuncture RCTs included in the largest review for each of the 10 depicted clinical indications, the estimated treatment effect of acupuncture compared to passive control, and the confidence in the effect estimate, judging from published systematic reviews. Effect sizes based on specific individual reviews, as well as reason for classifying the evidence bases as inconclusive, are reported in the narrative synthesis. The evidence map used the clinical topics as addressed in existing reviews and individual research studies may have contributed to a number of included reviews and clinical indications. All 3 depicted dimensions (literature size, effect, and confidence) are estimates and can only provide a broad overview of the evidence base.


As shown in the bubble plot, acupuncture for the treatment of depression has been evaluated in a large number of studies; a 2010 systematic review on acupuncture therapy in depressive disorders included 35 RCTs meeting an initial quality threshold.103 Across studies and across the most recent of the 5 identified systematic reviews positive effects were shown. However, effects depend on the comparator – a 2010 Cochrane review reported that acupuncture may have an additive benefit when combined with medication compared with medication alone but noted inconsistent effects from acupuncture compared with a waitlist control or sham acupuncture control. The review also noted a high risk of bias in the majority of included trials and concluded that evidence to recommend the use of acupuncture for people with depression is insufficient.96 Schizophrenia has also been addressed in a number of studies; a 2009 systematic review included 13 RCTs.101 A Cochrane review with literature searches up to April 2005 reported that Brief Psychiatric Rating Scale (BPRS) data favored a combined acupuncture and antipsychotic group (WMD -4.3, 95% CI: -7.0, -1.6). However data for global state outcomes, leaving the study early, and dichotomized BPRS data (improved versus not improved) were equivocal and the review concluded that there is insufficient evidence to recommend the use of acupuncture for people with schizophrenia.164 A review on acupuncture for anxiety and anxiety disorders included 10 RCTs.147 The review reported that all studies indicated positive findings; however, the review also pointed out that studies lacked many basic methodological details and concluded that there is insufficient research evidence for firm conclusions.

Regarding topics with fewer primary research studies and positive results, a review on posttraumatic stress disorder (PTSD) was identified that included 4 RCTs. The review found that acupuncture was superior to waitlist control (posttraumatic symptom scale-self report effect size [ES] -0.98, p=0.001) and cognitive behavioral therapy alone (Revised Impact on Event Scale ES -1.56, p<0.001) based on one RCT each.31

The role of acupuncture for opiate addiction has been addressed in a substantial number of studies; a 2009 systematic review included 21 RCTs of acupuncture therapy combined with opioid receptor agonists for heroin detoxification,188 but the evidence base regarding the effectiveness of acupuncture is unclear. The largest review reported no effects on relapse rate after 6 months and the methodology of some included trials was poor; however, positive effects for withdrawal symptoms, side effects, and medication dosage were shown. A competing review concluded that the review results cannot be used to establish the efficacy of acupuncture in the treatment of opiate addiction because the majority of included studies were classified as having low quality.58 A review on auricular acupuncture for not further specified drug addiction and a review on acupuncture for chronic fatigue syndrome (CFS) showed conflicting results across included studies and did neither pool the data nor report sufficient detail for a reanalysis. The reviews included 10 or fewer studies.

Three recent reviews on cocaine addiction, including a Cochrane review last updated in 2006,162 did not support the use of acupuncture for the treatment of cocaine dependence; the largest review included 9 RCTs. A single review on alcohol dependence was identified reviewing 11 RCTs; it did not report favorable results and concluded that the existing studies do not allow any conclusion about acupuncture treatment efficacy.

In addition, 2 reviews were identified that could not be incorporated into the bubble plot. One review concluded that acupuncture was no more effective than other treatments in treating opiate addiction.159 A review comparing acupuncture and Western medicine for post-stroke depression190 found mixed results depending on the selected patient outcome.


Other titles in this collection

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...