A systematic review of Chinese randomized clinical trials of SSRI treatment of depression

BMC Psychiatry

Markus Koesters²  Yongchun Ma¹  Thomas Becker²  Ying Zhang² 

[1] Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, PR China;Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str.2, Guenzburg, 89312, Germany

关键词: Antidepressants;    China;    Risk of bias assessment;    Systematic review;   

Others  :  1123376
DOI  :  10.1186/s12888-014-0245-4

 received in 2014-07-07, accepted in 2014-08-19,  发布年份 2014

【 摘 要 】

Background

Selective serotonin reuptake inhibitors (SSRIs) have become the most frequently used antidepressants in China in recent decades. This systematic review and meta-analysis examined the efficacy and tolerability of SSRIs in Chinese studies and the quality of Chinese randomized controlled trials.

Methods

Major Western and Chinese electronic databases were searched for double-blind, parallel group randomised controlled trials (RCTs) comparing SSRIs (fluoxetine, citalopram, escitalopram, fluvoxamine, paroxetine, or sertraline) with other antidepressants such as SSRI, Selective Noradrenaline Reuptake Inhibitor (SNRI), tricyclic antidepressant (TCA), Traditional Chinese Medicine (TCM) and/or placebo. Response, remission, and dropout rates due to side effects were defined as primary outcomes. Mean total Hamilton Rating Scale of Depression (HAMD) scores at endpoint, overall dropout rates and total Treatment Emergent Symptom Scale (TESS) scores were defined as secondary outcomes. Data were combined with random effects models. Risk of bias was assessed by the Cochrane evaluation tool. Quality of reports was assessed by the fulfilment of Consolidated Standards of Reporting Trial (CONSORT) items.

Results

A total of 71 studies were included. Only one study was listed in both Chinese and Western databases. SSRIs were found to be more effective than TCAs. No significant differences were observed regarding dropout rates due to side effects. Using the Cochrane risk of bias tool, adequate methods of sequence generation were described in 16 (23%) studies. All authors failed to report trial registration. Informed consent, sources of funding, email address, protocol, and limitations were also not mentioned in most studies. However, reporting quality improved steadily between 1996 and 2013.

Conclusions

In light of the low trial quality, the findings of a significant advantage of SSRI over TCA in terms of response rate and remission rate should be replicated by large high-quality Chinese studies.

【 授权许可】

   
2014 Zhang et al.; licensee BioMed Central Ltd.