Clinical guidelines for adolescent depression: An integrated traditional Chinese and Western medicine approach

Table 4 Efficacy and safety of combined treatment with selective serotonin reuptake inhibitors for adolescent depression

Treatment	Outcomes	Response/remission	Adverse events/rate
SSRIs + CBT vs SSRIs	Relapse rate (504, RR = 0.27, 95%CI: 0.16-0.45). HAMD (604, SMD = -1.01, 95%CI: -1.39 to -0.63). CGI (568, SMD = -0.22, 95%CI: -0.54 to -0.10)	Response (628, RR = 1.12, 95%CI: 1.04-1.21)	850, RR = 0.62, 95%CI: 0.4-0.96. Headache, nausea, hyperhidrosis, dizziness, lethargy and incidents of suicide or NSSI
SSRIs + rTMS vs SSRIs	HAMD (464, SMD = -1.50, 95%CI: -2.16 to -0.84)	Response (406, RR = 1.35, 95%CI: 1.04-1.76). Remission (306, RR = 1.35, 95%CI: 1.03-1.77)	Without increasing side effects (P = 0.14-0.82). Headache, loss of appetite, dizziness and nausea
SSRIs + syndrome-differentiated CHM vs SSRIs	HAMD (355, MD = -1.69, 95%CI: -2.79 to -0.59). HAMA (RCT, 60, MD = -3.05, 95%CI: -3.67 to -2.43). ISI (RCT, 60, MD = -3.05, 95%CI: -3.59 to -2.51). TCM syndrome scores (50, MD = -2.68, 95%CI: -3.59 to -1.77)	Response (294, RR = 1.16, 95%CI: 1.06-1.27)	TESS (190, MD = -2.21, 95%CI: -4.98 to 0.56). Loss of appetite, diarrhea, insomnia, hypersomnia
SSRIs + acupuncture vs SSRIs	HAMD (198, MD = -4.67, 95%CI: -5.24 to -4.11)	Response (120, RR = 1.16, 95%CI: 1.04-1.30)	TESS (120, MD = -6.69, 95%CI: -7.68 to -5.70)

SSRIs: Selective serotonin reuptake inhibitors; CBT: Cognitive-behavioral therapy; RR: Risk ratio; CI: Confidence interval; HAMD: Hamilton Depression Scale; SMD: Standardized mean difference; CGI: Clinical Global Impression; HAMA: Hamilton Anxiety Scale; MD: Mean difference; ISI: Insomnia Severity Index; rTMS: Repetitive transcranial magnetic stimulation; CHM: Chinese herbal medicine; RCT: Randomized controlled trial; TCM: Traditional Chinese medicine; TESS: Treatment Emergent Symptom Scale.