What Can We Learn From Chinese Randomized Controlled Trials? A Systematic Review and Meta-Analysis of Chinese Venlafaxine Studies
Abstract
This systematic review evaluated Chinese trials examining the efficacy of venlafaxine in the treatment of depression. Chinese databases CNKI and VIP and western databases were searched for blinded randomized controlled trial publications comparing venlafaxine to other antidepressants or placebo (in English or Chinese). Trials had to establish diagnosis of depression according to the Chinese Classification of Mental Disorders, Diagnostic and Statistical Manual of Mental Disorders, or International Classification of Diseases. Studies were excluded if more than 20% of participants had a primary diagnosis of dysthymia or if more than 15% had a primary diagnosis of bipolar disorder. Effect sizes were calculated as Hedges' g for rating scale scores and Mantel-Haenszel risk ratios (MH RR) for response and remission data. Effect sizes were combined in a fixed-effects model. A total of 25 studies were included. Nine trials compared venlafaxine to selective serotonin reuptake inhibitor; placebo-controlled trials were lacking. Quality was at best modest, and all trials were underpowered. There were more responders (MH RR, 1.08; 95% confidence interval [CI], 1.02-1.15) and remitters (MH RR, 1.12; 95% CI, 1.02-1.24) in venlafaxine groups compared with those in tricyclic antidepressant group. Hamilton Depression Rating Scale end point scores in the venlafaxine groups were lower (Hedges' g = 0.16; 95% CI, 0.04-0.27), and venlafaxine was better tolerated than tricyclic antidepressant (Hedges' g = 0.56; 95% CI, 0.37-0.74). There were no significant differences between venlafaxine and selective serotonin reuptake inhibitor on any of these parameters. Analyses of publication bias were inconclusive. Chinese researchers have published a number of randomized controlled trials comparing venlafaxine to active comparators, but study quality was found to be low. To make optimal use of their research potential Chinese, researchers will have to improve trial reporting and the peer-review process.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The integrity of Chinese clinical studies has been under serious scrutiny because of no to extremely low drop-out rates.
“Second, the integrity of Chinese clinical studies has been under serious scrutiny because of a high proportion of studies that have reported ‘statistically significant’ results [10], no to extremely low drop-out rates [11, 12] and insufficient ethical considerations [10, 13].”
Cites
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · BMJ · doi:10.1136/bmj.b2700 · Cited by 17,648 · see citing works
Moher, D., Schulz, K. F., & Altman, D. G. (2001) · The Lancet · doi:10.1016/s0140-6736(00)04337-3 · Cited by 5,373 · see citing works
Cipriani, A., Furukawa, T. A., Salanti, G., Geddes, J. R., Higgins, J. P., Churchill, R., Watanabe, N., Nakagawa, A., Omori, I. M., McGuire, H., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60046-5 · Cited by 1,654 · see citing works
Language bias in randomised controlled trials published in English and German
Egger, M., Zellweger-Zähner, T., Schneider, M., Junker, C., Lengeler, C., & Antes, G. (1997) · The Lancet · doi:10.1016/s0140-6736(97)02419-7 · Cited by 1,028 · see citing works
Anderson, I. M. (2000) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00092-0 · Cited by 940 · see citing works
Direction and impact of language bias in meta-analyses of controlled trials: empirical study
Jüni, P., Holenstein, F., Sterne, J., Bartlett, C., & Egger, M. (2002) · International Journal of Epidemiology · doi:10.1093/ije/31.1.115 · Cited by 892 · see citing works
Do Certain Countries Produce Only Positive Results? A Systematic Review of Controlled Trials
Vickers, A. J., Goyal, N., Harland, R., & Rees, R. W. (1998) · Controlled Clinical Trials · doi:10.1016/s0197-2456(97)00150-5 · Cited by 684 · see citing works
Cook, D. J., Sackett, D. L., & Spitzer, W. O. (1995) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)00172-m · Cited by 573 · see citing works
The emergence of China as a leading nation in science
Ping, Z., & Loet Leydesdorff, A. (2005) · Research Policy · doi:10.1016/j.respol.2005.08.006 · Cited by 541 · see citing works
Moher, D., Fortin, P. R., Jadad, A. R., Jüni, P., Klassen, T. P., LeLorier, J., Liberati, A., Penna, A., & Linde, K. (1996) · The Lancet · doi:10.1016/s0140-6736(96)90538-3 · Cited by 539 · see citing works
Smith, D. D., Dempster, C., Glanville, J., Freemantle, N., & Anderson, I. M. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.180.5.396 · Cited by 537 · see citing works
Correll, C. U., Rummel-Kluge, C., Corves, C., Kane, J. M., & Leucht, S. (2008) · Schizophrenia Bulletin · doi:10.1093/schbul/sbn018 · Cited by 397 · see citing works
Comprehensive Analysis of Remission (COMPARE) with Venlafaxine versus SSRIs
Nemeroff, C. B., Entsuah, R., Benattia, I., Demitrack, M. A., Sloan, D. M., & Thase, M. E. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.06.027 · Cited by 161 · see citing works
Comprehensive Analysis of Remission (COMPARE) with Venlafaxine versus SSRIs
Nemeroff, C. B., Entsuah, R., Benattia, I., Demitrack, M. A., Sloan, D. M., & Thase, M. E. (2010) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.8.4.foc592 · Cited by 126 · see citing works
Bauer, M., Tharmanathan, P., Volz, H., Moeller, H., & Freemantle, N. (2009) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-008-0849-0 · Cited by 109 · see citing works
Five large Chinese biomedical bibliographic databases: accessibility and coverage
Xia, J., Wright, J., & Adams, C. E. (2008) · Health Information & Libraries Journal · doi:10.1111/j.1471-1842.2007.00734.x · Cited by 105 · see citing works
An assessment of the quality of randomised controlled trials conducted in China
Zhang, D., Yin, P., Freemantle, N., Jordan, R., Zhong, N., & Cheng, K. (2008) · Trials · doi:10.1186/1745-6215-9-22 · Cited by 75 · see citing works
Xu, L., Li, J., Zhang, M., Ai, C., & Wang, L. (2008) · Contemporary Clinical Trials · doi:10.1016/j.cct.2008.05.003 · Cited by 66 · see citing works
Re-evaluation of the efficacy and tolerability of venlafaxine vs SSRI: meta-analysis
Weinmann, S., Becker, T. M., & Koesters, M. (2007) · Psychopharmacology · doi:10.1007/s00213-007-0975-9 · Cited by 61 · see citing works
Self-citationFang, Y., Yuan, C., Xu, Y., Chen, J., Wu, Z., Cao, L., Yi, Z., Hong, W., Wang, Y., Jiang, K., et al. (2010) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3181e7784f · Cited by 54 · see citing works
Citation indexes do not reflect methodological quality in lung cancer randomised trials.
Berghmans, T., Meert, A. P., Mascaux, C., Paesmans, M., Lafitte, J. J., & Sculier, J. P. (2003) · Annals of Oncology · doi:10.1093/annonc/mdg203 · Cited by 38 · see citing works
Ng, C. H., Norman, T. R., Naing, K. O., Schweitzer, I., Ho, B. K. W., Fan, A., & Klimidis, S. (2006) · International Clinical Psychopharmacology · doi:10.1097/01.yic.0000188214.46667.3f · Cited by 31 · see citing works
Sim, K., Lee, N. B., Chua, H. C., Mahendran, R., Fujii, S., Yang, S., Chong, M., Si, T., He, Y. L., Lee, M. S., et al. (2006) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2006.02780.x · Cited by 30 · see citing works
van den Broek, W. W., Mulder, P., van Os, E., Birkenhäger, T., Pluijms, E. M., & Bruijn, J. A. (2008) · Journal of Psychopharmacology · doi:10.1177/0269881108089821 · Cited by 16 · see citing works
周敏娟, & 姚立旗 (2005) · Chin J Psychiatry · doi:10.3760/j:issn:1006-7884.2005.03.009 · Cited by 2 · see citing works
A control study of venlafaxine and amitriptyline in senile depression
Heyu, D. (2005) · Cited by 1 · see citing works
The controlled study on venlafaxine and fluoxetine in depression
Sheng-zhong, W. (2006) · Nervous Diseases and Mental Health · Cited by 1 · see citing works
Lan, M. (2003) · Medical Journal of Chinese People Heacth · Cited by 1 · see citing works
Flagged first, then by citations
3 of the 32 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Tong, Z., Li, F., Ogawa, Y., Watanabe, N., & Furukawa, T. A. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0554-2 · Cited by 61 · see citing works
Bradley, A. J., & Lenox‐Smith, A. (2013) · Journal of Psychopharmacology · doi:10.1177/0269881113494937 · Cited by 41 · see citing works
Schizophrenia trials conducted in African countries: a drop of evidence in the ocean of morbidity?
Purgato, M., Adams, C. E., & Barbui, C. (2012) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-6-9 · Cited by 18 · see citing works
Randomized Trials Published in Chinese or Western Journals
Purgato, M., Cipriani, A., & Barbui, C. (2012) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0b013e3182546ef6 · Cited by 9 · see citing works
A systematic review of Chinese randomized clinical trials of SSRI treatment of depression
Zhang, Y., Becker, T., Ma, Y., & Koesters, M. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0245-4 · Cited by 8 · see citing works
Self-citationProblems in determining efficacy and effectiveness of antidepressants.
Möller, H. ‐., & Fountoulakis, K. Ν. (2011) · PubMed · Cited by 3 · see citing works
Leucht, S., Siafis, S., Schneider‐Thoma, J., Tajika, A., Priller, J., Davis, J. M., & Furukawa, T. A. (2024) · Schizophrenia · doi:10.1038/s41537-024-00442-8 · Cited by 2 · see citing works
Ethische Implikationen der psychiatrischen Versorgungsforschung
Becker, T. M., Kilian, R., Kösters, M., & Krumm, S. (2013) · Springer eBooks · doi:10.1007/978-3-642-35055-9_7 · Cited by 2 · see citing works
Self-citationDong, Y., Wang, J., Guan, S., Zhu, Y., Qin, M., Rodolico, A., Siafis, S., Bighelli, I., Davis, J. M., Priller, J., et al. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.06.022 · Cited by 1 · see citing works
Forty-five years of schizophrenia trials in Italy: a survey
Purgato, M., Adams, C. E., & Barbui, C. (2012) · Trials · doi:10.1186/1745-6215-13-35 · Cited by 1 · see citing works
- Authors
- Koesters, M., Zhang, Y., Chun, Y., Weinmann, S., Becker, T., & Jin, W. D.
- Affiliations
- Universität Ulm (DE)
- Tongde Hospital of Zhejiang Province (CN)
- Charité – Universitätsmedizin Berlin (DE)
- Corresponding author
- Koesters, Markus
- Zhang, Ying
- Becker, Thomas
- Venue
- Journal of Clinical Psychopharmacology
- Published
- 2011-04
- Volume
- 31
- Issue
- 2
- Pages
- 194-200
- ISSN
- 0271-0749 (ISSN-L)
- OpenAlex
- W2031777299
- Semantic Scholar
- 84a3afc98740ed9502729b46297c07879cdacf88
- Cited by
- 10
- References
- 32
- Citations by year
- 2026: 1 · 2024: 1 · 2018: 1 · 2014: 1 · 2013: 2 · 2012: 3
- FWCI
- 0.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- venlafaxine, depression, antidepressant efficacy, tricyclic antidepressants, selective serotonin reuptake inhibitors, trial quality, publication bias, drug tolerability, remission
- MeSH terms
- Venlafaxine Hydrochloride, Cyclohexanols, Depressive Disorder, Humans, Randomized Controlled Trials as Topic, Asian People
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
