Efficacy and safety of Chinese herbal medicine for depression: A systematic review and meta-analysis of randomized controlled trials

Yong Wang; Yi-Hua Shi; Zhen Xu; Huan Fu; Hua Zeng; Guo-Qing Zheng

doi:10.1016/j.jpsychires.2019.07.003

Efficacy and safety of Chinese herbal medicine for depression: A systematic review and meta-analysis of randomized controlled trials

J Psychiatr Res. 2019 Oct:117:74-91. doi: 10.1016/j.jpsychires.2019.07.003. Epub 2019 Jul 15.

Authors

Yong Wang¹, Yi-Hua Shi¹, Zhen Xu¹, Huan Fu¹, Hua Zeng¹, Guo-Qing Zheng²

Affiliations

¹ Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
² Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China. Electronic address: gq_zheng@sohu.com.

PMID: 31326751
DOI: 10.1016/j.jpsychires.2019.07.003

Abstract

Objective: To conduct a systematic review to assess the current evidence available for the effectiveness and safety of Chinese herbal medicine (CHM) for depression.

Methods: An electronic search was conducted in eight databases from inception until April 2018. Randomized controlled trials with risk of bias (RoB) score ≥ 4 according to the Cochrane RoB tool were included for analyses. The primary outcome was the severity of depression. The secondary outcomes were total effective rate (TER) and adverse events. The minimally important difference (MID) of the severity of depression was a reduction in the Hamilton Rating Scale for Depression 17 items (HAMD-17) scores by 4. RevMan 5.3 Software was used for data analyses. GRADE system was used to assess the certainty of evidence.

Results: A total of 40 eligible studies with 3549 subjects were identified. Meta-analyses showed that CHM monotherapy had better clinically effects than placebo according to HAMD-17 score (Mean Difference (MD) = -4.53, 95% CI (-5.69, -3.37), P < 0.00001; Certainty of evidence: Moderate) and TER (Risk Ratio (RR) = 2.15, 95% CI (1.61, 2.88), P < 0.00001, Certainty of evidence: Low). Meta-analyses showed that CHM was as effective as western conventional medications (WCM) in TER (RR = 0.99, 95% CI (0.95, 1.02), P = 0.41, Certainty of evidence: High) and in reducing HAMD-17 score (MD = 0.44, 95% CI (-0.11, 0.99), P = 0.12, Certainty of evidence: Moderate). Meta-analyses showed that CHM in combination with WCM was better than WCM in TER (RR = 1.16, 95% CI (1.07, 1.27), P = 0.0004, Certainty of evidence: High), while had comparable clinically effects with WCM according to HAMD-17 score (MD = -2.51, 95% CI (-3.24, -1.77), P < 0.00001, Certainty of evidence: Moderate). In additional, CHM were associated with less adverse events than WCM, and adding CHM to WCM reduced adverse events.

Conclusion: The findings of present systematic review, at least to a certain extent, provided supporting evidence for the routine use of CHM for depression.

Keywords: Chinese herbal medicine; Depression; Meta-analysis; Systematic review; Traditional Chinese medicine.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Depression / drug therapy*
Depressive Disorder / drug therapy*
Drugs, Chinese Herbal / adverse effects
Drugs, Chinese Herbal / pharmacology*
Humans
Randomized Controlled Trials as Topic*

Substances

Drugs, Chinese Herbal