Yeung Wing-Fai, Chung Ka-Fai, Ng Ka-Yan, Yu Yee-Man, Ziea Eric Tat-Chi, Ng Bacon Fung-Leung
School of Chinese Medicine, University of Hong Kong, Hong Kong, China.
Department of Psychiatry, University of Hong Kong, Hong Kong, China.
J Psychiatr Res. 2014 Oct;57:165-75. doi: 10.1016/j.jpsychires.2014.05.016. Epub 2014 Jun 12.
Chinese herbal medicine (CHM) is one of the commonly used complementary and alternative medicine therapies for major depressive disorder. The objective of this study was to review the efficacy, safety and types of CHM for depression. We systematically searched key databases (9 Chinese and 7 English) up until May 2013 for randomized controlled trials (RCTs) and examined 7 systematic reviews for additional articles. Methodological quality was assessed by modified Jadad scale and Cochrane's risk of bias assessment. Only studies with moderate methodological quality, defined as modified Jadad scale score ≥3, were included in meta-analysis for efficacy. Of the 296 RCTs that were assessed in details, 278 (93.9%) had modified Jadad scale score < 3, and only 21 scored ≥ 3. The frequently used formulas were Xiao Yao decoction, Chaihu Shugan decoction and Ganmai Dazao decoction; while Chaihu, Bai Shao and Fu Ling were the frequently used single herb. Meta-analyses showed that CHM monotherapy was better than placebo and as effective as antidepressants in reducing Hamilton Depression Rating Scale (HDRS) score (CHM vs. placebo: mean difference: -7.97, 95% CI: -10.25 to -5.70, P < 0.00001, 2 studies; CHM vs. antidepressants: mean difference: 0.01, 95% CI: -0.28 to 0.30, P = 0.95, 7 studies). CHM were associated with less adverse events than antidepressants, and adding CHM to antidepressants reduced adverse events. Despite the overall positive results, due to the small number of studies with sufficient methodological quality, it is premature to accurately conclude the benefits and risks of CHM for depression.
中药是治疗重度抑郁症常用的补充和替代医学疗法之一。本研究的目的是回顾中药治疗抑郁症的疗效、安全性及类型。我们系统检索了截至2013年5月的主要数据库（9个中文数据库和7个英文数据库），以查找随机对照试验（RCT），并查阅了7篇系统评价以获取更多文章。采用改良Jadad量表和Cochrane偏倚风险评估对方法学质量进行评估。只有方法学质量为中等（定义为改良Jadad量表评分≥3）的研究才纳入疗效的Meta分析。在详细评估的296项RCT中，278项（93.9%）改良Jadad量表评分<3，只有21项评分≥3。常用方剂为逍遥散、柴胡疏肝散和甘麦大枣汤；常用单味药为柴胡、白芍和茯苓。Meta分析表明，中药单药治疗在降低汉密尔顿抑郁量表（HDRS）评分方面优于安慰剂，且与抗抑郁药疗效相当（中药与安慰剂比较：平均差值：-7.97，95%CI：-10.25至-5.70，P<0.00001，2项研究；中药与抗抑郁药比较：平均差值：0.01，95%CI：-0.28至0.30，P=0.95，7项研究）。与抗抑郁药相比，中药的不良事件较少，在抗抑郁药中加用中药可减少不良事件。尽管总体结果呈阳性，但由于方法学质量足够的研究数量较少，目前准确得出中药治疗抑郁症的益处和风险还为时过早。
