Moxibustion and depression: a promising signal, but weak evidence

What the researchers compared

This review brings together 15 randomized trials of moxibustion, used alone or alongside other treatments for depression. The literature search covered seven databases through December 20, 2023.

The planned comparators included a sham intervention, no treatment or conventional treatments. The researchers examined Hamilton Depression Rating Scale scores and the frequency of adverse events, among other outcomes.

The dossier provides access only to the PubMed abstract, not the full text. It does not specify the duration of the interventions, detailed patient characteristics or the breakdown of the different comparators.

Lower scores, without demonstrated equivalence

In the analysis pooling moxibustion used alone or in combination, Hamilton scores were an average of 2.10 points lower than those in the comparator groups. The 95% confidence interval ranged from −3.00 to −1.20 points. This finding suggests an effect on symptoms, but the abstract does not allow a clear assessment of its clinical importance for patients.

The comparison with antidepressants calls for a different interpretation. The mean difference was −0.60 points, with a confidence interval ranging from −1.31 to 0.12. This interval includes no difference. That does not demonstrate that the two approaches are equivalent, even though the authors describe their effectiveness as comparable.

Pooling a practice used alone with the same practice added to other care also limits interpretation: the overall result does not tell us precisely what role moxibustion might play in treatment.

Safety remains insufficiently documented

The authors report fewer adverse events in the groups receiving moxibustion, with a relative risk of 0.57 and a confidence interval of 0.39 to 0.84. However, the abstract does not provide absolute frequencies, the nature of the events or the monitoring periods. This finding therefore cannot be translated into a number of events avoided or a guarantee of safety.

The main caveat concerns the findings as a whole: the authors rate the quality of the evidence as low to very low. The abstract does not provide enough detail on trial biases to explain this assessment precisely. Funding and conflicts of interest could not be verified in the dossier provided.

What we can take away

This meta-analysis provides a signal worth investigating further, not a solid basis for replacing depression treatment with moxibustion.