Objective:

To systematically compare pharmacotherapy, AcuStim, and psychotherapy for perimenopausal anxiety, depression, and panic disorder, assessing clinical efficacy, adverse events, and changes in various psychological and endocrine outcomes.

Approach:

• Search Strategy: The study searched multiple databases for randomized controlled trials (RCTs) from inception to June 14, 2026.
• Analysis Method: A Bayesian network meta-analysis (NMA) was performed, calculating the Surface Under the Cumulative Ranking Curve (SUCRA).

Key Findings:

• The study included 131 RCTs with 11,457 perimenopausal women diagnosed with emotional disorders.
• Drug_psych showed the highest SUCRA probabilities for HAMD, KI, SDS, PSQI, and FSH reduction.
• AcuStim_psych had the highest SUCRA for HAMA reduction.
• Psychotherapy ranked highest for SAS reduction.
• Combination therapies generally showed more favorable efficacy than single-modality interventions.

Interpretation:

Pharmacological, acupoint stimulation, and psychological interventions each demonstrated therapeutic benefits for perimenopausal women with emotional disorders, with combination therapies often being more effective.

Limitations:

• Methodological limitations in acupuncture research, including small sample sizes and difficulty in implementing double-blinding.
• Psychotherapy does not improve endocrine indicators and requires high patient compliance.

Conclusion:

No single treatment strategy was consistently superior across all outcomes, suggesting the need for individualized treatment selection based on patients' characteristics and goals.

Sources:

• Systematic Review Registration