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

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• 作者：Ying Zhang (1)
  Thomas Becker (1)
  Yongchun Ma (2)
  Markus Koesters (1)
  
  1. Department of Psychiatry II ; Ulm University ; Ludwig-Heilmeyer-Str.2 ; 89312 ; Guenzburg ; Germany
  2. Tongde Hospital of Zhejiang Province ; 234 Gucui Road ; 310012 ; Hangzhou ; PR China
  
• 关键词：Systematic review ; Risk of bias assessment ; China ; Antidepressants
• 刊名：BMC Psychiatry
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：845 KB
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• 刊物主题：Psychiatry; Psychotherapy;
• 出版者：BioMed Central
• ISSN：1471-244X

文摘

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.