In this issue April 2016

This issue begins with a systematic review and metaanalysis by Zheng and colleagues about the use of a traditional Chinese medicine – Huperzine A (HupA) – as an adjunctive treatment for depression. The rationale for this treatment is that acetylcholinesterase (AChE) inhibitors may reduce the cognitive impairment that often accompanies depressive episodes and HupA is a powerful AChE inhibitor. After an exhaustive literature search in English language and Chinese language journals, the authors only found three randomized controlled trials (with a pooled sample of 238 individuals) comparing monotherapy with an antidepressant to combined treatment with an antidepressant and HupA. When pooling results, there was no significant difference between groups in the degree of improvement in depressive symptoms, but there was significantly greater improvement in cognitive functioning in the group that received adjunctive HupA (as assessed by the Wisconsin Card Sorting Test and the Wechsler Memory Scale-Revised). However, the three studies were open label (i.e., non-blinded) and only followed subjects for a mean of 6.7 weeks, so the studies were classified as ‘low-quality’. Thus, more rigorously conducted studies that follow participants longer are needed to confirm this important result. This is an example of a common problem in using Traditional Chinese Medicine (TCM): the results are often promising, but the lack of rigorous scientific proof limits the acceptance of the results in non-Chinese settings.