Effect of nonpharmacologic therapies on depressive symptoms in patients with chronic fatigue syndrome: a network meta-analysis.

BACKGROUND

Depression or depressive symptoms exacerbate the burden in patients with chronic fatigue syndrome (CFS). The therapeutic effects of various non-pharmacological interventions remain unclear.

OBJECTIVE

This paper aims to evaluate the effectiveness of different non-pharmacological measures in alleviating depression or depressive symptoms in patients with CFS through network meta-analysis.

METHODS

PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang, CBM, VIP, and Sinomed databases were searched for randomized controlled trials (RCTs) until March 26, 2025. The Cochrane Risk of Bias Assessment Tool 2.0 was utilized to appraise the risk of bias. A network meta-analysis was conducted using the GeMTC package in R (4.4.2). This protocol has been registered in PROSPERO (CRD420251020737).

RESULTS

47 RCTs involving 4,028 participants were included. Compared with control measures, diet therapy was most effective in improving depression or depressive symptoms in patients with CFS (SMD = -5.64, 95% CI: -8.98 to -2.29), followed by moxibustion (Mox) (SMD = -2.91, 95% CI: -4.61 to -1.22), acupuncture (Ap) + Mox + acupoint embedding (SMD = -3.16, 95% CI: -0.39 to -5.98), and Ap + Mox (SMD = -2.53, 95% CI: -1.17 to -3.91).

CONCLUSION

Diet therapy is the most effective in improving depression or depressive symptoms in patients with CFS, followed by Mox. Further carefully designed RCTs are warranted to substantiate these findings.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251020737.