Abstract
BackgroundPatients with cancer are vulnerable to depression or other depressive conditions. The aim of this paper was to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for the treatment of depression or depressive symptoms in cancer patients.MethodsCENTRAL, MEDLINE, EMBASE, PsycINFO, CNKI, VIP, SinoMed, and online clinical trial registry websites were searched for relevant RCTs until May 2017. The methodological quality of each included study was assessed with the “risk of bias” tool. Review Manager 5.3.5 was used to analyze the data.ResultsWe identified 18 RCTs that included data from 1441 participants. Twelve different types of Chinese herbal preparations were investigated by these studies, and they showed a better therapeutic effect in most comparisons when measured in terms of depression rating scale scores, with SMDs (95% CI) of − 2.30 (− 3.54, − 1.05) (CHM versus no treatment), − 0.61 (− 1.03, − 0.18) (CHM versus antidepressants), and − 0.55 (− 1.07, − 0.02) (CHM plus psychological treatments versus psychological treatments), or when measured in terms of treatment response rate, with RRs (95% CI) of 1.65 (1.19, 2.29) (CHM versus no treatment), 1.15 (1.03, 1.28) (CHM versus psychological treatments), 1.32 (1.07, 1.63) (CHM plus antidepressants versus antidepressants), and 1.70 (1.02, 2.85) (CHM plus psychological treatments versus psychological treatments). Compared with antidepressants, these CHMs showed borderline superiority for improving the response rate, with an RR (95% CI) of 1.08 (0.93, 1.26). Subgroup analysis based on psychiatric diagnosis (depression versus depressive symptoms) did not modify the direction of these estimates and neither could it explain the high level of heterogeneity. Patients in the CHM group experienced fewer adverse events of cardiac toxicity (P = 0.02), functional gastrointestinal disorders (P = 0.008), sleep disturbances (P = 0.02), blurred vision (P = 0.02) and fatigue (P = 0.03) than the patients in the no treatment group or the antidepressants group.ConclusionsAccording to the investigation of the twelve herbal preparations, the CHM intervention appears to alleviate depressive symptoms in cancer patients, either alone or combined with antidepressants or psychological treatments. However, a high risk of bias and high heterogeneity made the mean estimates uncertain. Well-designed trials with comprehensive and transparent reporting are warranted in the future.
Highlights
Patients with cancer are vulnerable to depression or other depressive conditions
Eligibility criteria We included RCTs in which cancer patients fulfilled the diagnostic criteria for depression as stated by a well-established diagnostic system, such as the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) [29], DSM-V [30], International Classification of Diseases 10 (ICD-10) [31], Chinese classification of mental disorders-2R (CCMD-2R) [32] and Chinese Classification of Mental Disorders (CCMD)-3 [33], or presented with depressive symptoms as indicated by specialized depression rating scales (e.g., the Hamilton Rating Scale for Depression (HAMD) [34], the Zung Self-Rating Depression Scale (ZSDS) [35], the Hospital Anxiety and Depression Scale (HADS) [36], the Beck Depression Inventory (BDI) [37], or the Center for Epidemiologic Studies–Depression Scale (CES-D) [38]) with evidence of adequate validity and reliability
Subgroup analysis based on psychiatric diagnosis did not modify the direction of these estimates and neither could it explain the high level of heterogeneity
Summary
Patients with cancer are vulnerable to depression or other depressive conditions. The aim of this paper was to evaluate the efficacy and safety of Chinese herbal medicine (CHM) for the treatment of depression or depressive symptoms in cancer patients. Survival after cancer has improved over the past three decades [1], and approximately 67% of patients live for at least 5 years after diagnosis [2]. Despite these gains in cancer treatment, long-term behavioral co-morbidities, such as depression or other depressive conditions, are prominent.
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