Efficacy and Safety of Acupuncture Interventions for Improving Poststroke Depression Symptoms and Neurological Function Recovery: A Systematic Review and Meta-analysis

Background Poststroke depression (PSD) is a common neuropsychiatric complication after stroke, affecting about one-third of survivors and impairing rehabilitation and quality of life. Acupuncture is increasingly used as a non-pharmacological treatment for PSD, but pooled quantitative evidence remains limited. Objective To evaluate the efficacy and safety of acupuncture-based interventions for depressive symptoms and neurological recovery in patients with PSD. Methods PubMed, Embase, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed were searched from inception to February 2026. Randomized controlled trials of acupuncture-based interventions for PSD reporting both HAMD and National Institutes of Health Stroke Scale (NIHSS) outcomes were included. Barthel Index and adverse events were extracted when available. Risk of bias was assessed using RoB 2. HAMD was pooled as SMD, while NIHSS and Barthel Index were pooled as MD; model selection was based on heterogeneity. Results Eleven RCTs involving 1043 patients were included. Acupuncture-based interventions significantly improved HAMD scores (SMD = −1.03, 95% CI −1.30 to −0.75, I 2 = 76.4%, p < 0.0001), NIHSS scores (MD = −2.18, 95% CI −2.94 to −1.42, I 2 = 68.7%, p < 0.0001) and Barthel Index values (MD = 8.74, 95% CI 5.92–11.56, I 2 = 42.3%, p < 0.0001). No acupuncture-related serious adverse events were reported. Conclusions Acupuncture-based interventions were associated with improvements in PSD-related depressive symptoms, neurological deficits and daily living ability. However, given heterogeneity, comparator diversity and risk-of-bias concerns, the evidence should be interpreted as supportive rather than conclusive.