A systematic review of Chinese randomized clinical trials of SSRI treatment of depression
Open accessAbstract
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) have become the most frequently used antidepressants in China in recent decades. This systematic review and meta-analysis examined the efficacy and tolerability of SSRIs in Chinese studies and the quality of Chinese randomized controlled trials. METHODS: Major Western and Chinese electronic databases were searched for double-blind, parallel group randomised controlled trials (RCTs) comparing SSRIs (fluoxetine, citalopram, escitalopram, fluvoxamine, paroxetine, or sertraline) with other antidepressants such as SSRI, Selective Noradrenaline Reuptake Inhibitor (SNRI), tricyclic antidepressant (TCA), Traditional Chinese Medicine (TCM) and/or placebo. Response, remission, and dropout rates due to side effects were defined as primary outcomes. Mean total Hamilton Rating Scale of Depression (HAMD) scores at endpoint, overall dropout rates and total Treatment Emergent Symptom Scale (TESS) scores were defined as secondary outcomes. Data were combined with random effects models. Risk of bias was assessed by the Cochrane evaluation tool. Quality of reports was assessed by the fulfilment of Consolidated Standards of Reporting Trial (CONSORT) items. RESULTS: A total of 71 studies were included. Only one study was listed in both Chinese and Western databases. SSRIs were found to be more effective than TCAs. No significant differences were observed regarding dropout rates due to side effects. Using the Cochrane risk of bias tool, adequate methods of sequence generation were described in 16 (23%) studies. All authors failed to report trial registration. Informed consent, sources of funding, email address, protocol, and limitations were also not mentioned in most studies. However, reporting quality improved steadily between 1996 and 2013. CONCLUSIONS: In light of the low trial quality, the findings of a significant advantage of SSRI over TCA in terms of response rate and remission rate should be replicated by large high-quality Chinese studies.
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Recent investigations into the quality of Chinese clinical trials have been based only on the published reports.
“However, recent investigations into the quality of Chinese clinical trials have been based only on the published reports [1–4, 16, 17], which may not always accurately reflect the actual conduct of the trials because of poor reporting [11, 16, 17].”
There has been an exponential surge in studies published in China in psychiatry that examined new generation antidepressants and antipsychotics.
“We particularly note the exponential surge in studies published in China in the field of psychiatry that examined new generation antidepressants and antipsychotics [4].”
Many Chinese trials can be accessed only through searches in Chinese databases and have not been adequately integrated into the world medical literature.
“However, many Chinese trials can be accessed only through searches in the Chinese databases [4] and have not been adequately integrated into the world medical literature.”
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- Authors
- Zhang, Y., Becker, T., Ma, Y., & Koesters, M.
- Affiliations
- Universität Ulm (DE)
- Tongde Hospital of Zhejiang Province (CN)
- Corresponding author
- Zhang, Ying
- Venue
- BMC Psychiatry
- Published
- 2014-08-27
- Volume
- 14
- Issue
- 1
- Pages
- 245-245
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4149207
- OpenAlex
- W2154005563
- Cited by
- 8
- References
- 24
- Citations by year
- 2026: 1 · 2020: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 1
- FWCI
- 0.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- selective serotonin reuptake inhibitors, depression, antidepressant efficacy, antidepressant tolerability, trial quality, reporting quality, tricyclic antidepressants, fluoxetine, citalopram, escitalopram, paroxetine, sertraline, fluvoxamine, treatment discontinuation, risk of bias
- MeSH terms
- Antidepressive Agents, Antidepressive Agents, Tricyclic, China, Depressive Disorder, Double-Blind Method, Fluoxetine, Humans, Citalopram, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors, Paroxetine, Sertraline
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