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

Ying Zhang,Markus Koesters,Yongchun Ma,Thomas Becker

doi:10.1186/s12888-014-0245-4

Abstract

BackgroundSelective 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.MethodsMajor 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.ResultsA 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0245-4) contains supplementary material, which is available to authorized users.

Highlights

Selective serotonin reuptake inhibitors (SSRIs) have become the most frequently used antidepressants in China in recent decades
Summary of findings Findings analyzed in this systematic review and metaanalysis provided evidence that SSRIs, in terms of response and remission, are slightly more effective than tricyclic antidepressants (TCA), which is inconsistent with most Western meta-analyses which have indicated comparable efficacy between SSRIs and TCAs [26,27,28,29], or showed that TCAs were more effective than SSRIs [30,31]
The present study systematically assessed the quality of Chinese double-blind randomised controlled trials (RCTs) in the treatment of depression, and it determined the efficacy and tolerability of SSRIs

Summary

Introduction

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. Selective serotonin reuptake inhibitors (SSRIs) have become the first-line antidepressant drug treatment of depression and replaced tricyclic antidepressants (TCA) and monoamine oxidase inhibitors (MAOI) due to fewer side-effects and ease of use in Western countries [1,2]. Most Chinese studies are reported to be underpowered and of low reporting quality [6,7,8,9,10], many Chinese double-blind randomised controlled trials (RCTs).

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