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Combination therapies (pharmacotherapy plus psychotherapy or acupoint stimulation) show greater efficacy than monotherapies for anxiety, depression, and panic disorder in perimenopausal women, but no single strategy is superior across all outcomes.

This network meta-analysis of 131 RCTs (11,457 perimenopausal women) found that drug_psych ranked highest for reducing HAMD (SUCRA=92.4%), KI (97.9%), SDS (94.5%), PSQI (98.1%), and FSH (96.1%), and for elevating E2 (SUCRA=0.1% for elevation). AcuStim_psych ranked highest for HAMA reduction (93.7%), psych for SAS reduction (98.9%), and drug_AcuStim for clinical efficacy (SUCRA=9.0% for inefficacy) and LH reduction (100%). Safety was highest for control (65.5%).

Last updated: Aug 5, 2026•0 RCTs•1 Meta-analyses•📖 Read as article →

Evidence Score

Evidence Score49/100
Human RCT☆☆☆☆☆
Meta-analysis★★★☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Pharmacotherapy, acupoint stimulation, and psychotherapy for perimenopausal women with anxiety, depression, and panic disorder: a systematic review and network meta-analysis of randomized controlled trials.

observational

Zhuang J, Zhou Y, Yu G, Cheng H, Chen X, Qian R · Frontiers in psychiatry (2026)

Participants: N/A
Duration: Not specified (RCTs varied)
Intervention: Pharmacotherapy, acupoint stimulation (AcuStim), psychotherapy, and their combinations (drug_psych, AcuStim_psych, drug_AcuStim) compared via network meta-analysis.
Outcome: Clinical efficacy, adverse events, HAMD, HAMA, KI, SDS, SAS, PSQI, serum hormone levels (FSH, LH, E2).
Effect Size: SUCRA values (e.g., drug_psych HAMD SUCRA=92.4%, AcuStim_psych HAMA SUCRA=93.7%, psych SAS SUCRA=98.9%)
Population: Perimenopausal women diagnosed with anxiety, depression, or panic disorder (11,457 participants from 131 RCTs).

Result:

PubMed: 42539596DOI: 10.3389/fpsyt.2026.1845876

Mechanism Graph

Perimenopausal hormonal decline (e.g., estrogen drop) contributes to emotional dysregulation.
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Pharmacotherapy (e.g., antidepressants) modulates neurotransmitter systems.
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Acupoint stimulation may regulate neuroendocrine pathways.
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Psychotherapy addresses cognitive and behavioral patterns.
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Combining modalities may synergistically improve psychological and endocrine outcomes.

Limitations

  • ⚠Network meta-analysis relies on indirect comparisons; heterogeneity across trials may affect robustness.
  • ⚠Safety outcomes favored control, suggesting potential adverse events with active treatments, but specific AE profiles were not detailed in the abstract.
  • ⚠No single treatment was superior across all outcomes, complicating direct clinical recommendations.

Frequently Asked Questions

Which treatment is best for reducing depression symptoms in perimenopausal women?▼

Combination of pharmacotherapy and psychotherapy (drug_psych) ranked highest for HAMD reduction (SUCRA=92.4%).

Is acupoint stimulation effective for anxiety in perimenopausal women?▼

Yes, combining acupoint stimulation with psychotherapy (AcuStim_psych) ranked highest for HAMA reduction (SUCRA=93.7%).

What is the safest treatment option?▼

The control group had the highest SUCRA for safety (65.5%), indicating that active treatments may have more adverse events, but specific risks were not detailed.

Does combination therapy improve sleep quality in perimenopausal women?▼

Yes, drug_psych ranked highest for PSQI improvement (SUCRA=98.1%), suggesting better sleep outcomes.

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References

  1. 1.Zhuang J, Zhou Y, Yu G, Cheng H, Chen X, Qian R. "Pharmacotherapy, acupoint stimulation, and psychotherapy for perimenopausal women with anxiety, depression, and panic disorder: a systematic review and network meta-analysis of randomized controlled trials.." Frontiers in psychiatry, 2026. PMID: 42539596 DOI: 10.3389/fpsyt.2026.1845876
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.