The most frequently prescribed antidepressants in China

Background/Objectives: More than 26 million patients in China suffer from depression. Usage of antidepressants increased over the past decades in China. At the same time, the number of Chinese research articles has increased rapidly. However, this research is largely disregarded in Western reviews. The present systematic review investigates prescription of antidepressants in China and the efficacy of major Selective Serotonin Reuptake Inhibitors (SSRIs) in Chinese populations.

Methods: Major Western and Chinese electronic databases, namely Medline, Embase, VIP and CNKI were searched without language restriction. Evaluation of prescription patterns included only studies reporting defined daily doses (DDDs) for at least one year. DDDs, province and year of the study were extracted from the primary studies. The ranking of antidepressants were made using absolute value of DDDs. To evaluate efficacy of major SSRIs, double blind randomised clinical trials (RCTs) comparing these with other pharmacotherapies and/or placebo were searched. Final mean HAM-D scores and response rates were extracted and combined using a random-effects model. Subgroup analyses by drug class were performed to assess further differences.

Results: 76 studies published between 2000 and 2010 reporting antidepressant prescriptions between 1996 and 2008 were included. All included studies were published in Chinese, with most of them having an English abstract. Most of the included studies were conducted in urban areas in the South and East of China. 29 drugs were reported in included studies. Using DDDs, the most frequently prescribed antidepressants were: Deanxit (a combination of an antipsychotic drug and a tricyclic antidepressant), Fluoxetine, and Paroxetine. 47 double blind RCTs with at best modest quality were found comparing Fluoxetine and Paroxetine with other SSRIs, Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs), or Traditional Chinese Medicine (TCM). Mean final HAMD scores were significantly lower in the Fluoxetine or Paroxetine groups compared to TCA, but not in comparison to groups treated with SSRIs, SNRIs, or TCM. Furthermore, there was no significant difference in efficacy between Fluoxetine and Paroxetine. These findings were confirmed by analyses of response rates.

Discussion/Conclusions: The results suggest that Deanxit, Paroxetine, and Fluoxetine are currently the most prescribed antidepressants in China. Similar to Western studies, no significant difference was found between SSRIs, but the results have to be interpreted in the light of the modest study quality.

Funding: None declared.

Keywords: Treatment efficacy, prescription, Selective Serotonin Reuptake Inhibitors.