The Efficacy of Chinese Herbal Medicine in the Treatment of Depression: a Systematic Review of Literature

Abstract

Major depressive disorder is a common and deadly disease affecting roughly 18% of Americans. It is the leading cause if disability in the United States and its conventional treatment options are minimally effective. As a result over 50% of sufferers seek out alternative treatments. Chinese herbal medicine is one of the most commonly sought alternative treatment strategies. In this systematic review we searched PubMed and the Cochrane central register through May 2019 for randomized controlled trials evaluating the efficacy of Chinese herbal medicine in the treatment of depression in comparison to placebo or conventional antidepressants. Our goals for this review were 3 fold: (1) to summarize the existing literature that met our quality criteria of a modified Jadad score greater than or equal to 3, (2) to examine the efficacy and safety of CHM in treating depression alone or in conjunction with antidepressants, (3) to determine the most commonly used herbs and formulas used in the treatment of depression. The most commonly used single herb was Saffron, and the most commonly used formula was Xiao Yao San. Pooled analysis showed that CHM was more effective than placebo and equivalently effective to antidepressants in reducing HAMD scores (Versus placebo: Change in HAMD: -7.95, 95% CI: +/- 2.14; HAMD at endpoint: -3.12, 95% CI: +/- 1.02; Versus antidepressants: Change in HAMD: 2.05, 95% CI: +/- 2.13; HAMD at endpoint: -0.74, 95% CI+/- 0.74). Adverse events were less common in CHM users, with antidepressant users carrying 213% higher risk of experiencing an adverse event. Overall, the results of this review indicate that CHM may be an effective and safe alternative to antidepressants in treating major depressive disorder.