title: Wuling Capsule for Major Depressive Disorder: A Meta-analysis of Randomised Controlled Trials.
abstract: BACKGROUND
  In China, Wuling capsule, a traditional Chinese medicine consisting of Wuling mycelia of Xylaria nigripes (Kl.) Sacc (a rare type of fungus), is used to treat major depressive disorders. A meta-analysis of randomised controlled trials was performed to compare the efficacy and safety of Wuling capsule alone with Wuling capsule-antidepressant combination in the treatment of major depressive disorders.
  
  
  METHODS
  Two assessors independently selected studies, extracted data, and conducted quality assessment and data synthesis. Standard mean difference, risk ratio (RR) ± 95% confidence interval (CI), the number needed to treat, and the number needed to harm were analysed.
  
  
  RESULTS
  A total of 12 randomised controlled trials (880 patients; mean age ± standard deviation, 39.7 ± 12.5 years; male patients, 41%) were identified, including 4 trials with Wuling capsule alone (n = 340) and 8 with Wuling capsule-antidepressant (sertraline, mianserin, mirtazapine, and paroxetine) combination (n = 540). The mean length of trial was 5.7 ± 1.3 weeks. Meta-analysis of symptomatic improvement at last-observation endpoint and study-defined response and remission revealed no significant differences between the Wuling capsule alone and antidepressant monotherapy. The Wuling capsule-antidepressant cotreatment was superior to antidepressant monotherapy in symptomatic improvement at last-observation endpoint (standard mean difference: -0.46, p = 0.001) as well as study-defined response (68.4% vs. 56.0%, RR = 1.23; p = 0.03) and remission (46.5% vs. 34.5%, RR = 1.35; p = 0.05). Wuling capsule was associated with fewer adverse drug reactions than antidepressant monotherapy.
  
  
  CONCLUSIONS
  Adjunctive Wuling capsule may augment the effects of antidepressants and may be associated with fewer adverse drug reactions. More large-scale and rigorously designed randomised controlled trials with large sample size are warranted to clarify the effectiveness of Wuling capsule for major depressive disorders.
authors.affiliation: The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China.
authors.forename: W
authors.initials: W
authors.lastname: Zheng
authors.affiliation: The National Clinical Research Center for Mental Disorders, Beijing, China & Center of Depression, Beijing Institute for Brain Disorders, PR China; Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, PR China.
authors.forename: Y F
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China.
authors.forename: H Q
authors.initials: HQ
authors.lastname: Zhong
authors.affiliation: The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China.
authors.forename: S M
authors.initials: SM
authors.lastname: Mai
authors.affiliation: The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, PR China.
authors.forename: X H
authors.initials: XH
authors.lastname: Yang
authors.affiliation: Unit of Psychiatry, Faculty of Health Sciences, University of Macao, Macao SAR, PR China.
authors.forename: Y T
authors.initials: YT
authors.lastname: Xiang
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002681:China; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D017374:Paroxetine / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D004365:Drugs, Chinese Herbal; C533472:wuling; D008803:Mianserin; D017374:Paroxetine; D000078785:Mirtazapine; D020280:Sertraline
keywords: Antidepressive agents; Depressive disorder, major; Drugs, Chinese herbal