Abstract
Objective Chaihu Jia Longgu Muli decoction (CLMD) is widely used in the treatment of poststroke depression (PSD) in China. Some evidences show that it has advantages, but there lacks reliable evidence. This study aims to systematically evaluate the efficacy and safety of CLMD in the treatment of PSD. Methods All randomized controlled trials (RCTs) of CLMD in the treatment of PSD were searched from the following databases: PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and Chinese Biomedical Literature Service System (CBM), from their inception to May 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Meta-analysis was performed using RevMan5.3 software. Results A total of 13 RCTs involving 1665 patients were finally included in this study, among which 5 RCTs were oral CLMD alone versus antidepressants, and 8 RCTs were oral CLMD with antidepressants versus antidepressants. Meta-analysis results showed that oral administration of CLMD could improve Hamilton's Depression Scale (HAMD) and the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) scores, improve the Barthel index, and have a low rate of adverse reactions, but there was no significant difference in the total effective rate (p=0.21 > 0.05) and the National Institute of Health Stroke Scale (NIHSS) score (p=0.47 > 0.05) between the antidepressants group and the oral administration of the CLMD group. Oral CLMD combined with antidepressants could improve the total effective rate, HAMD, and MESSS score, but there was no significant difference in Barthel index (p=0.06 > 0.05) and the adverse reaction rate (p=0.14 > 0.05) between the two groups. Conclusion Current evidence suggests that oral CLMD alone or with antidepressants is more effective and safer in the treatment of PSD than oral antidepressants. Due to the limitation of the quality and quantity of the included studies, more high-quality studies are needed to confirm the above conclusion.
Highlights
Poststroke depression (PSD) refers to a series of psychological and physical syndromes featured with depression, slow response, loss of interest, and other symptoms after stroke [1]. e incidence of PSD ranges from 29% to 31% [2], and it usually occurs within 1 year after stroke [3]
Risk of Bias Assessment. e randomized controlled trials (RCTs) risk of bias assessment tool recommended in the Cochrane Manual 5.1.0 was used to evaluate the quality of the 13 included studies, and the random sequence generation method was correctly used in 6 studies [15, 20, 22, 25, 26, 29]
(1) In terms of total effective rate, we found that Chaihu Jia Longgu Muli decoction (CLMD) combined with antidepressants was more effective than antidepressants alone, while there was no difference between CLMD and antidepressants alone; (2) Hamilton’s Depression Scale (HAMD) is the most commonly used in the assessment of depressive symptoms, and both CLMD alone and CLMD with antidepressants were better than antidepressants alone in reducing HAMD scores
Summary
Poststroke depression (PSD) refers to a series of psychological and physical syndromes featured with depression, slow response, loss of interest, and other symptoms after stroke [1]. e incidence of PSD ranges from 29% to 31% [2], and it usually occurs within 1 year after stroke [3]. Chaihu Jia Longgu Muli decoction (CLMD), a representative prescription for the treatment of mental diseases, is composed of Chaihu (Radix Bupleuri), Longgu (Os Draconis), Muli (Concha Ostreae), Huang Qin (Radix Scutellariae), Shengjiang (Rhizoma Zingiberis Recens), Da Zao (Fructus Jujubae), Qian Dan (Miniumite), Ren Shen (Radix Ginseng), Gui Zhi (Ramulus Cinnamomi), Fuling (Poria), Ban Xia (Rhizoma Pinelliae), and Da Huang (Radix et Rhizoma Rhei), which has the effect of soothing liver qi stagnation, regulating qi and blood, calming the mind, and relieving fright It is widely used in dementia, insomnia, anxiety, depression, and other mental diseases, and its effect is reliable [13]. Zhao et al [15] observed that CLMD combined with antidepressant has a synergistic effect in ameliorating depression, improving the ability of daily living, and reducing inflammatory cytokines, without increasing adverse reactions. ere are more and more similar reports, but it is difficult to draw a reliable conclusion due to the differences in the clinical efficacy of CLMD, research design, and course of treatment. erefore, the purpose of this systematic review is to evaluate the efficacy and safety of CLMD in the treatment of PSD and to provide a reliable treatment option and evidencebased basis for clinical work and scientific research
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