Clinical Outcomes of Acupuncture Combined with Antidepressant Therapy for Major Depressive Disorder: A Propensity Score–Matched Retrospective Observational Study

Background Major depressive disorder (MDD) is a leading cause of disability. Real-world evidence for adjunctive acupuncture with antidepressants is limited. Methods We retrospectively analyzed adults with MDD, diagnosed using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), treated at Southwest Medical University Affiliated Hospital (China) from October 2024 to August 2025 who received pharmacotherapy alone or pharmacotherapy plus manual acupuncture. Propensity score matching (1:1) balanced baseline characteristics. Outcomes [17-item Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), Short Form-36 Health Survey (SF-36)] were assessed at baseline and week 8. Results After matching, 100 patients were included (50 per group) with comparable baseline scores. At week 8, the combination group showed lower HAMD-17 (11.2 ± 3.3 vs 17.0 ± 4.0), lower HAMA (9.8 ± 2.9 vs 14.5 ± 3.5), lower PSQI (8.0 ± 2.2 vs 10.9 ± 2.6), and higher SF-36 (62.8 ± 9.1 vs 56.7 ± 10.2) than those of the pharmacotherapy-alone group (HAMD-17/HAMA/PSQI all P < 0.001; SF-36 P = 0.012). Response (70.0% vs 54.0%) and remission (38.0% vs 28.0%) rates were numerically higher with combination therapy, while adverse events were similar (16.0% vs 14.0%; all P > 0.05) and mild. Benefits were consistent across key subgroups. Conclusion In this propensity score–matched real-world cohort, adjunctive acupuncture was associated with greater improvements in depressive symptoms, anxiety, sleep quality, and health-related quality of life without increased adverse events, supporting integrative care and prospective validation.