Wuling Capsule for Major Depressive Disorder: A Meta-analysis of Randomised Controlled Trials

In China, Wuling capsule, a traditional Chinese medicine consisting of Wuling mycelia of Xylaria nigripes (Kl.) Sacc (a rare type of fungus), is used to treat major depressive disorders. A meta-analysis of randomised controlled trials was performed to compare the efficacy and safety of Wuling capsule alone with Wuling capsule-antidepressant combination in the treatment of major depressive disorders.

Two assessors independently selected studies, extracted data, and conducted quality assessment and data synthesis. Standard mean difference, risk ratio (RR) ± 95% confidence interval (CI), the number needed to treat, and the number needed to harm were analysed.

A total of 12 randomised controlled trials (880 patients; mean age ± standard deviation, 39.7 ± 12.5 years; male patients, 41%) were identified, including 4 trials with Wuling capsule alone (n = 340) and 8 with Wuling capsule-antidepressant (sertraline, mianserin, mirtazapine, and paroxetine) combination (n = 540). The mean length of trial was 5.7 ± 1.3 weeks. Meta-analysis of symptomatic improvement at last-observation endpoint and study-defined response and remission revealed no significant differences between the Wuling capsule alone and antidepressant monotherapy. The Wuling capsule-antidepressant cotreatment was superior to antidepressant monotherapy in symptomatic improvement at last-observation endpoint (standard mean difference: -0.46, p = 0.001) as well as study-defined response (68.4% vs. 56.0%, RR = 1.23; p = 0.03) and remission (46.5% vs. 34.5%, RR = 1.35; p = 0.05). Wuling capsule was associated with fewer adverse drug reactions than antidepressant monotherapy.

Adjunctive Wuling capsule may augment the effects of antidepressants and may be associated with fewer adverse drug reactions. More large-scale and rigorously designed randomised controlled trials with large sample size are warranted to clarify the effectiveness of Wuling capsule for major depressive disorders.