Abstract
Background. Alternative approaches for managing depression are often sought and herbal mixtures are widely used in China. The aim of this paper was to provide an overall picture of the current evidence by analysing published systematic reviews and presenting a supplementary systematic review of trials in Western databases. Methods. Searches were conducted using AMED, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, and trial registers. Results were screened and selected trials were evaluated by two reviewers working independently. Systematic reviews were identified and assessed using key criteria. Results. Five systematic reviews were located addressing the Chinese literature, adjunctive use of Chinese herbs, and the formulae Chaihu-Shugan-San, Xiao Yao San, and Free and Easy Wanderer Plus. The supplementary review located 8 trials, 3 of which were not included in previous reviews. Positive results were reported: no significant differences from medication, greater effect than medication or placebo, reduced adverse event rates when combined or compared with antidepressants. However, limitations in methodology and reporting were revealed. Conclusions. Despite promising results, particularly for Xiao Yao San and its modifications, the effectiveness of Chinese herbal medicine in depression could not be fully substantiated based on current evidence. Further well-designed, well-reported trials that reflect practice may be worth pursuing.
Highlights
Knowledge about the use of complementary therapies by people with mental illness is increasing
Six reports of 5 systematic reviews were identi ed [21,22,23,24,25,26]. Each of these focused on a speci c aspect: trials in the Chinese literature [21], trials of the speci c herbal formulae Xiao Yao San [22, 23], Free and Easy Wanderer Plus [24], and Chaihu-Shugan-San [25], and trials of Chinese herbs as adjunctive treatment [26]
E rst of these systematic reviews included 18 trials found by searching Chinese databases [21]. e trials involved a total of 1,260 patients and included trials in depression associated with various conditions such as cancer, stroke, and the menopause. e authors concluded that there was no evidence to support a bene cial effect in depression. e ndings are difficult to interpret and the validity of the conclusions is unclear
Summary
Knowledge about the use of complementary therapies by people with mental illness is increasing. Previous studies have demonstrated that psychiatric disorders are common among those seeking to use complementary and alternative medicine (CAM) and that anxiety and depression are among the most common reasons for people to seek care from complementary practitioners [1,2,3,4]. A recent survey in England found that presence of anxiety or depression was an independent predictor of complementary therapy use [5]. For Xiao Yao San and its modi cations, the effectiveness of Chinese herbal medicine in depression could not be fully substantiated based on current evidence. Further well-designed, wellreported trials that re ect practice may be worth pursuing
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