Comparison between herbal medicine and fluoxetine for depression: A systematic review of randomized controlled trials

•This is a systematic review (with meta-analysis) of randomized controlled trials.•Chinese herbal medicine may have similar effect as fluoxetine (20 mg/day) on relieving depression according to HAMD assessment (difference less than 1 score).•Chinese herbal medicine had fewer (4-50%) incidences of adverse events than drug.•No confirmed conclusion could be draw due to the low methodological quality of included trials.

ObjectiveTo evaluate the effectiveness and safety of Chinese herbal medicine (CHM) versus fluoxetine on depression.DesignA systematic review of randomized controlled trials (RCTs).MethodsRCT 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.ResultsTwenty-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 (20 mg/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.ConclusionsDue 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.