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중풍후우울증에 대한 월국환의 효과와 안전성: 체계적 문헌고찰 및 메타분석

Efficacy and Safety of Wolgukhwan for Post-Stroke Depression: A Systemic Review and Meta-Analysis

김상호|김병진
대한한방신경정신과학회 (The Korean Society Of Oriental Neuropsychiatry)|2024.12|동의신경정신과학회지 (The Korean Society of Oriental Neuropsychiatry)|제35권 제4호|pp. 449-468|DOI 10.7231/jon.2024.35.4.449

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참고문헌

키워드

DepressionMeta-analysisStrokeHerbal medicineYueju-pillWolgukhwan
주제분류한의학

초록

Objectives: Post-stroke depression (PSD) is associated with increased mortality, exacerbated cognitive impairments, and diminished quality of life. Yueju-pill (Wolgukhwan, WGH) is a traditional herbal medicine from East Asia traditionally utilized for the treatment of depression. The objective of this review was to provide credible evidence regarding the efficacy and safety of WGH in the context of post-stroke depression. Methods: Thirteen electronic databases were systematically searched until September 14, 2024, and randomized controlled trials (RCTs) evaluating WGH for PSD were reviewed. The Cochrane Risk of Bias Tool version 5.1.0 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool were employed for quality assessment. A meta-analysis was performed to assess the efficacy and safety of WGH for PSD. Results: A total of 16 RCTs involving 1,247 participants were included in the analysis. WGH was found to significantly reduce Hamilton Depression Scale (HAMD) scores (standardized mean difference [SMD]=-1.98, 95% confidence interval [CI]=-3.28 to -0.67, p=0.003) and improve the total effective rate (TER) (risk ratio [RR]=1.17, 95% CI=1.07 to 1.27, p=0.0004) in comparison to antidepressants. Furthermore, WGH combined with antidepressants led to a greater reduction in HAMD scores (SMD=-1.37, 95% CI=-1.73 to -1.01, p<0.00001) and improves TER (RR=1.18, 95% CI=1.08 to 1.29, p=0.0002) compared to antidepressants. Moreover, WGH had a lower risk of adverse events compared to antidepressants. No severe adverse events were reported. The overall risk of bias was high. The quality of evidence was low to moderate. Conclusions: The findings of the study suggest that WGH may offer therapeutic benefits for individuals experiencing PSD. Nevertheless, given the clinical heterogeneity and low methodological quality of the studies included, these results should be interpreted with caution. Therefore, further research on this subject is necessary.

Abstract

Objectives: Post-stroke depression (PSD) is associated with increased mortality, exacerbated cognitive impairments, and diminished quality of life. Yueju-pill (Wolgukhwan, WGH) is a traditional herbal medicine from East Asia traditionally utilized for the treatment of depression. The objective of this review was to provide credible evidence regarding the efficacy and safety of WGH in the context of post-stroke depression. Methods: Thirteen electronic databases were systematically searched until September 14, 2024, and randomized controlled trials (RCTs) evaluating WGH for PSD were reviewed. The Cochrane Risk of Bias Tool version 5.1.0 and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool were employed for quality assessment. A meta-analysis was performed to assess the efficacy and safety of WGH for PSD. Results: A total of 16 RCTs involving 1,247 participants were included in the analysis. WGH was found to significantly reduce Hamilton Depression Scale (HAMD) scores (standardized mean difference [SMD]=-1.98, 95% confidence interval [CI]=-3.28 to -0.67, p=0.003) and improve the total effective rate (TER) (risk ratio [RR]=1.17, 95% CI=1.07 to 1.27, p=0.0004) in comparison to antidepressants. Furthermore, WGH combined with antidepressants led to a greater reduction in HAMD scores (SMD=-1.37, 95% CI=-1.73 to -1.01, p<0.00001) and improves TER (RR=1.18, 95% CI=1.08 to 1.29, p=0.0002) compared to antidepressants. Moreover, WGH had a lower risk of adverse events compared to antidepressants. No severe adverse events were reported. The overall risk of bias was high. The quality of evidence was low to moderate. Conclusions: The findings of the study suggest that WGH may offer therapeutic benefits for individuals experiencing PSD. Nevertheless, given the clinical heterogeneity and low methodological quality of the studies included, these results should be interpreted with caution. Therefore, further research on this subject is necessary.

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