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Acupuncture and Moxibustion for Subthreshold Depression: a systematic review and Bayesian network meta-analysis
Hong Luo1, Chengyu Han1, Ximei Wang2
1College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
Objectives:
Subthreshold depression (SD), a precursor stage of depression, has gained considerable interest in recent years. Acupuncture and moxibustion have unique advantages in the treatment of depressive disorders. This systematic review and Bayesian network meta-analysis (NMA) aimed to evaluate the comparative effects of acupuncture and moxibustion therapies on SD and provide clinical recommendations.
Methods:
Eight databases were searched from their inception to January 1, 2026, for randomized controlled trials (RCTs) on acupuncture and moxibustion for SD. We included 17 studies with six different therapies. The primary and secondary outcomes were scores on the Hamilton Depression Rating Scale (HAMD) and the Center for Epidemiologic Studies Depression scale (CES-D), respectively. A random-effects Bayesian NMA was conducted using the gemtc package in R.
Results:
Acupuncture + moxibustion and acupuncture alone were associated with greater reductions in HAMD scores than placebo, no treatment, and Western medicine. In addition, acupuncture + moxibustion showed greater reductions in HAMD scores than acupoint herbal patching and psychological treatment. Acupuncture + moxibustion and moxibustion were associated with greater reductions in CES-D scores than placebo. Acupuncture + moxibustion and acupuncture alone resulted in greater score reductions than no treatment. Among the included therapies, acupuncture + moxibustion therapy was ranked highest in terms of surface under the cumulative ranking curve values for both HAMD (93.56%) and CES-D (96.21%).
Conclusion:
This Bayesian NMA suggests that acupuncture + moxibustion may have a relatively favorable ranking for improving SD symptoms, providing preliminary evidence to inform future clinical research and practice. However, the generalizability and evidence quality were limited by the single-center, small-sample design of most included studies. Further high-quality RCTs are warranted to validate these findings.Systematic review registration PROSPERO, CRD42023483384 (version 2.0).