Rule-Based Chatbots Outperform LLMs in Depressive Symptom Management: A Systematic Review and Meta-Analysis

MedXY Editorial Team•Dec 23, 2025•AI

Rule-based chatbots demonstrate a small but statistically significant effect in alleviating depressive symptoms (g=0.266), whereas LLM-based chatbots currently lack robust evidence for efficacy.
The critical intervention window for rule-based chatbots is identified as 4 to 8 weeks, showing the most pronounced effects in the medium term.
Neither rule-based nor LLM-based chatbots demonstrated statistically significant efficacy in reducing anxiety symptoms in the pooled analysis.
The current clinical utility of LLM-based chatbots is hindered by wide confidence intervals and a lack of large-scale, controlled clinical trials.

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This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

Rule-based chatbots demonstrate a small but statistically significant effect in alleviating depressive symptoms (g=0.266), whereas LLM-based chatbots currently lack robust evidence for efficacy.
The critical intervention window for rule-based chatbots is identified as 4 to 8 weeks, showing the most pronounced effects in the medium term.
Neither rule-based nor LLM-based chatbots demonstrated statistically significant efficacy in reducing anxiety symptoms in the pooled analysis.
The current clinical utility of LLM-based chatbots is hindered by wide confidence intervals and a lack of large-scale, controlled clinical trials.