Acupuncture as adjunctive treatment for schizophrenia: a systematic review and meta-analysis

Background Schizophrenia spectrum disorders significantly impair functioning and quality of life. While antipsychotic medications are the cornerstone of treatment, many patients experience persistent symptoms and adverse effects. The potential benefits of acupuncture as adjunctive treatment remain uncertain. Methods Nine databases including MEDLINE, EMBASE, and CENTRAL were searched through 15 January 2025. Randomised controlled trials comparing acupuncture plus antipsychotics versus antipsychotics alone in patients with schizophrenia spectrum disorders were included. The primary outcome was overall symptom scores (PANSS/BPRS). Secondary outcomes included adverse events, negative and positive symptom scores, response rates, social function, and quality of life. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, a random-effects model was applied for meta-analysis, and evidence certainty was evaluated using GRADE. Results Fifty-five studies with 4256 participants were included. Acupuncture plus standard-dose antipsychotics improved overall symptoms compared to antipsychotics alone (SMD −1.11, 95 % CI −1.52 to −0.70; 34 studies, 2819 participants; low certainty), but not versus sham acupuncture (MD −0.89, 95 % CI −2.72–0.95; 2 studies, 91 participants; low certainty). Adverse events were reduced versus antipsychotics alone (RR 0.44, 95 % CI 0.33–0.59; 7 studies, 862 participants; moderate certainty). Acupuncture plus low-dose antipsychotics showed little to no difference versus standard-dose antipsychotics alone (SMD −0.47, 95 % CI −1.56–0.61; 8 studies, 532 participants; very low certainty). Conclusions Acupuncture combined with standard-dose antipsychotics may provide pragmatic benefits, though lack of superiority over sham acupuncture indicates uncertainty about specific effects. High-quality trials are needed to establish definitive clinical recommendations.