A systematic review of the efficacy and tolerability of selective serotonin reuptake inhibitors in the treatment of Chinese patients with depressive disorders
This is the first systematic review and meta-analysis of studies comparing Selective Serotonin Reuptake Inhibitors (SSRIs) with other antidepressants, traditional Chinese medicine (TCM), and/or placebo. The objective is to evaluate the quality of studies included and to determine the efficacy and tolerability of SSRI in the treatment of Chinese patients with depression. Major Western and Chinese databases were searched. Risk of bias was assessed. The proportions of fulfilled Consolidated Standards of Reporting Trials (CONSORT) Items were used to assess the quality of reporting. Effect size Hedges’ g was used for mean total Hamilton Rating Scale of Depression (HAMD) scores at endpoint and sum scores of Treatment Emergent Symptom Scale (TESS). Mantel-Haenszel Risk ratio (MH RR) was used for response, remission and dropout rates. Data were combined with random effects models. 62 double-blind RCTs were included. All studies were conducted in China, only two were published in English. The findings provided evidence that SSRIs, in terms of efficacy, are superior to tricyclic antidepressants (TCA). Only one study was listed in both Chinese and Western databases. There was unclear reporting in most studies included. None of the authors reported trial registration. 47 % of studies did not mention dropout. Furthermore, three pairs of publications showed striking similarities in both text and figures. Most Chinese trials recruited small patient samples, and except for studies with TCA comparator, only small numbers of trials were identified within each class of drug/TCM/placebo comparisons. In spite of these limitations, this work confirmed the poor reporting quality of Chinese studies and highlights problems of: (a) low overlap of studies included in Western and Chinese databases, (b) limited accessibility of Chinese placebo-controlled RCTs to the public, and (c) an urgent need to improve the quality of Chinese trial publications by using the CONSORT guideline.
Subject HeadingsAntidepressivum [GND]
Antidepressive agents [MeSH]
Serotonin uptake inhibitors [MeSH]