Review Effect of nonpharmacologic therapies on depressive symptoms in patients with chronic fatigue syndrome: a network meta-analysis, 2025, Jiang et al

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

Baiyi Jiang, Mengru Cao, Xue Xia, Long Wang

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.

Web | Frontiers in Psychiatry | Abstract only ahead of publication
 

2.4 Quality assessment​

Two authors (Baiyi Jiang and Xue Xia) independently used the Cochrane risk of bias tool (ROB 2.0) to appraise the quality of eligible studies (25) in five aspects: random sequence generation, allocation concealment, blinding implementation, missing data, and selective reporting. Each aspect was rated as “high risk”, “some concerns”, or “low risk”.

If all five items were low risk or only one item was rated as some risk and the rest were rated as low risk, the article was considered low risk.

If four or more of the five items were rated as some risk or any one item was high risk, the article was considered high-risk.

In all other cases, the article was considered moderate risk.

The two authors independently completed the literature quality assessment, and any discrepancies were reviewed by a third author (Long Wang).
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Can’t say I’m very impressed by this. If one item has some risk, how can the study itself have a low risk of bias?

Only two studies had low risk of bias for all five categories:
Ma 2022 which isn’t listed in the references. It might be Ma 2023:
57. Ma Y, He J, Lu X, Sun J, Guo C, Luo Y, et al. Transcutaneous cranial-auricular acupoint electrical stimulation “regulating the hub and awakening the spirit” anti-depressant brain effect rs-f MRI study. Chin J Traditional Chin Med. (2023) 38:2048–54.
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Sathyapalan 2010 which also isn’t in the reference list.
 
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