Systematic Review and Meta-Analysis of Salt Valproate Preventing Switch Associated with Antidepressants in Chinese Patients With Depressive Episodes.

Objective: This overview of systematic reviews (SRs) and meta-analyses aims to critically appraise the methodology and reporting quality of relevant SRs and meta-analyses with the aim of identifying whether or not the use of valproate can prevent the switch to mania associated with antidepressant treatment in Chinese patients with depressive episodes. Methods: Electronic databases China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database) and Wanfang Database were searched for related SRs and meta-analyses from inception to the search date within Chinese restrictions. A total of 2 reviewers independently selected SRs and meta-analyses and collected related data, and a third reviewer was introduced if any disagreement occurred during the assessment. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and the US Agency for Healthcare Research and Quality (AHRQ) were employed to evaluate quality of the reporting and methodology. Results: The switch rate in the sodium valproate group by 99% and was significantly lower than in the antidepressant-only group (0% vs 5.7%; OR = 0.18; 95% CI, 0.04-0.84; Z = 2.18; P = .03). The magnesium valproate group was similar to the sodium valproate group in switch rate; the switch rate in the antidepressant group was (2.2% vs 16.92%; OR = 0.11; 95% CI, 0.03-0.39; Z = 3.47; P = .0005). The switch rate in the salt valproate combined with a selective serotonin reuptake inhibitor (SSRI) group was lower than in the SSRI group (0.51% vs 8.4%; OR = 0.15; 95% CI, 0.04-0.51; Z = 3.01; P = .003). The switch rate in the valproate combined with serotonin noradrenaline reuptake inhibitor (SNRI) group was similar to the valproate combined with SNRI group (2.3% vs 17.5%; OR = 0.12; 95% CI, 0.03-0.53; Z = 2.79; P = .05). Conclusion: Salt valproate can reduce the switch rate related to antidepressant treatment in patients with depression.

Traditional Chinese Medicine Syndrome Types Among Single-Syndrome Bipolar Mania Cases Described in Chinese Literature.

PRIMARY OBJECTIVE: The aim of this study was to identify and understand the syndromes of mania in traditional Chinese medicine (TCM), as described in Chinese literature on the integrated treatment of mania using TCM and Western medicine. METHODS: A literature search conducted in Chinese databases identified 27 articles that were included in a statistical analysis to determine the proportion of mania cases represented by various TCM syndromes. RESULTS: After combining similar syndromes, we found that the TCM syndromes of mania could be categorized as phlegm-fire disturbance of the mind (Tanhuoraoshen), phlegm-heat stagnation (Tanreyujie), qi stagnation and blood stasis (Qizhixueyu), liver qi stagnation (Gandanyure), and fire injury Yin (Huoshengshnagyin). These syndrome categories accounted for 55.6%, 18.5%, 14.8%, 7.4% and 3.7% of mania cases, respectively. Manic symptom severity scores differed significantly among phlegm-fire disturbance of the mind (26.8 ± 1.6), phlegm-heat stagnation (31.1 ± 1.9), and qi stagnation and blood stasis (23.5 ± 2.2). CONCLUSION: The largest proportion of mania cases involved phlegm-fire disturbance of the mind, phlegm-heat stagnation, or qi stagnation and blood stasis. Cumulatively, these syndromes accounted for 88.9% of cases; the severity of manic symptoms different significantly among the 3 syndrome categories. Smaller proportions of cases represented liver qi stagnation or fire injury Yin.

Preventive Effects of Lithium Carbonate on Antidepressant-Induced Switch During Depressive Episodes: Chinese Data Analysis.

CONTEXT: Some patients experiencing depressive episodes can switch to mania or become mania during treatment with antidepressants. Avoiding a switch is an important part of any therapeutic plan, whether a patient suffers from unipolar or bipolar depression. One method of avoiding switching is use of a mood stabilizer, such as lithium carbonate. DESIGN: The research team performed a narrative review by searching Chinese electronic databases: the Chinese Biomedical Database (CBM), the China National Knowledge Infrastructure (CNKI), WANFANG, and the Chinese Social Sciences Citation Index (VIP). The search used the keywords depression-bipolar depression and depressive episode-and lithium carbonate. Results such as comments, letters, reviews, and case reports were excluded. SETTING: The study took place at Jinhua Second Hospital, China. RESULTS: A random effect model was used to account for the data, using Revman 5.2. The switch rate for the intervention groups was 8.28% or 29 out of 351 participants and of the control groups was 25.29% or 87 out of 344 participants (OR = 0.25, 95% CI: 0.16 to 0.39). Lithium carbonate reduced the switch rate by 67.25% [(25.29%-8.28%) /25.29%]. In the bipolar depression group, lithium carbonate reduced the switch rate by 68.11% [(25.84%-8.24%) /25.84%]. In the depression and unipolar depression groups, lithium carbonate reduced the switch rate by 67.07% [(25.29%-8.26%) /25.29%]. In the group of patients treated with selective serotonin reuptake inhibitors (SSRIs), lithium reduced the switch rate by 60.3% [(29.85%-11.85%) /29.85%]. In group of patients treated by tricyclic antidepressants (TCAs), lithium carbonate reduced the switch rate by 73.14% [(22.28%-6.01%) /22.28%]. CONCLUSIONS: As typical mood stabilizer, lithium carbonate can reduce the antidepressant-induced switch rates in patients with depressive episodes regardless of the type of antidepressant and the type of depressive episode. Further research should compare the effectiveness of lithium carbonate to that of other mood stabilizers in preventing switching associated with antidepressants.