Moxibustion for depression

BACKGROUND: Moxibustion, a traditional Chinese medicine therapy, is widely used for various diseases and has recently been applied in treating depression. This study aims to systematically assess the efficacy and safety of moxibustion, either alone or in combination with other therapies, for depression. METHODS: We conducted a comprehensive search across 7 databases from their inception to December 20, 2023, focusing on randomized controlled trials that compared moxibustion with sham treatments, no treatment, or conventional therapies. The primary outcomes were the overall effective rate and Hamilton Depression Rating Scale scores, with adverse reaction incidence as the secondary outcome. Data were analyzed with RevMan 5.4 and Stata 18, with bias risk assessed using the Cochrane Risk of Bias tool. Evidence quality was graded with GRADEpro. RESULTS: This study included 15 randomized controlled trials with 1510 patients. Meta-analysis results showed that moxibustion, alone or combined with other therapies, was more effective than other treatments for managing depression (relative risk = 1.07, 95% confidence interval [CI]: [1.03-1.10], P = .0003). Moxibustion, either alone or in combination with other treatments, significantly reduced Hamilton Depression Rating Scale scores compared to other treatments used alone (mean difference = -2.10, 95% CI: [-3.00 to -1.20]), with its efficacy comparable to that of antidepressant medications (mean difference = -0.60, 95% CI [-1.31 to 0.12], P = .10). Additionally, in terms of safety, the incidence of adverse reactions associated with moxibustion alone or in combination with other therapies for depression is relatively low (relative risk = 0.57, 95% CI: [0.39-0.84], P = .005). However, the overall quality of the evidence was assessed as low to very low. CONCLUSION: Moxibustion has been shown to alleviate depressive symptoms, particularly when combined with other therapies, offering both enhanced efficacy and safety. However, further high-quality studies are necessary to confirm its effectiveness.