title: Comparison between herbal medicine and fluoxetine for depression: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate the effectiveness and safety of Chinese herbal medicine (CHM) versus fluoxetine on depression.
  
  
  METHODS
  A systematic review of randomized controlled trials (RCTs).
  
  
  METHODS
  RCT with two parallel groups that compared CHM and fluoxetine on treatment of depression with reported decreased Hamilton Depression Scale (HAMD) and adverse events during treatment were included after searching through six electric-databases. The methodological quality of RCTs was assessed according to the Cochrane risk of bias tool. Meta-analysis was conducted using RevMan 5.3 software with pooled mean difference (MD) or risk ratio (RR) and their 95% confidence interval (CI) if no significant heterogeneity was detected. A SOF table was generated using GRADEPro software to evaluate the overall quality of the evidence.
  
  
  RESULTS
  Twenty-six trials with 3294 participants were included in the review. Most of them had high risk of bias during conducting and reporting. The results achieved weak evidence which showed CHM had similar effect to fluoxetine (20mg/day) on relieving depression according to HAMD assessment (for primary depression: MD=-0.08, 95%CI -0.98-0.82; for secondary depression: MD=-0.36, 95%CI -1.55-0.83), but fewer incidences of adverse events than the drug (for primary depression: RR=0.31, 95%CI 0.17-0.59; for post-stroke depression: RR=0.04, 95%CI 0.00-0.25). No serious adverse event was found in neither CHM nor fluoxetine group.
  
  
  CONCLUSIONS
  Due to the poor quality of included trials and the potential publication bias of this review, no confirmed conclusion could be draw to evaluate the effectiveness and safety of CHM for depression compared with fluoxetine.
authors.affiliation: Department of Neurology, Dongzhimen Hospital, The First Affiliate Hospital of Beijing University of Chinese Medicine, Beijing 100029, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Department of Neurology, The Third Affiliate Hospital of Beijing University of Chinese Medicine, Beijing 100029, China.
authors.forename: Chenjun
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Department of Respiration, The Third Affiliate Hospital of Beijing University of Chinese Medicine, Beijing 100029, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Acupuncture and Moxibustion, Dongfang Hospital, The Second Affiliate Hospital of Beijing University of Chinese Medicine, Beijing 100029, China. Electronic address: zrw123@sina.com.
authors.forename: Ruwen
authors.initials: R
authors.lastname: Zheng
authors.affiliation: Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China. Electronic address: huijuancao327@hotmail.com.
authors.forename: Huijaun
authors.initials: H
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D004365:Drugs, Chinese Herbal; D005473:Fluoxetine
keywords: Chinese herbal medicine; Depression; Fluoxetine; Randomized controlled trial; Systematic review