Seung Hye-Bin, Kwon Hui-Ju, Kwon Chan-Young, Kim Sang-Ho
College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Republic of Korea.
Department of Oriental Neuropsychiatry, Dong-Eui University College of Korean Medicine, Busan 47227, Republic of Korea.
Pharmaceuticals (Basel). 2023 Aug 18;16(8):1176. doi: 10.3390/ph16081176.
Major depressive disorder (MDD) is a medical condition involving persistent sadness and loss of interest; however, conventional treatments with antidepressants and cognitive behavioral therapy have limitations. Based on the pathogenesis of MDD, treatments using herbal medicines (HM) have been identified in animal studies. We conducted a systematic review of clinical studies to identify neurobiological outcomes and evaluate the effectiveness of HM in treating MDD. A meta-analysis was performed by searching nine databases from their inception until 12 September 2022, including 31 randomized controlled trials with 3133 participants, to examine the effects of HM on MDD using neurobiological biomarkers and a depression questionnaire scale. Quality assessment was performed using a risk of bias tool. Compared to antidepressants alone, HM combined with an antidepressant significantly increased concentrations of serotonin (SMD = 1.96, 95% CI: 1.24-2.68, < 0.00001, I = 97%), brain-derived neurotrophic factor (SMD = 1.38, 95% CI: 0.92-1.83, < 0.00001, I = 91%), and nerve growth factors (SMD = 2.38, 95% CI: 0.67-4.10, = 0.006, I = 96%), and decreased cortisol concentrations (SMD = -3.78, 95% CI: -4.71 to -2.86, < 0.00001, I = 87%). Although HM or HM with an antidepressant benefits MDD treatment through improving neuroendocrine factors, these findings should be interpreted with caution because of the low methodological quality and clinical heterogeneity of the included studies.
重度抑郁症（MDD）是一种涉及持续悲伤和兴趣丧失的医学病症；然而，抗抑郁药和认知行为疗法的传统治疗方法存在局限性。基于MDD的发病机制，在动物研究中已确定了使用草药（HM）的治疗方法。我们对临床研究进行了系统综述，以确定神经生物学结果并评估HM治疗MDD的有效性。通过检索九个数据库从其创建到2022年9月12日的数据进行荟萃分析，其中包括31项随机对照试验和3133名参与者，以使用神经生物学生物标志物和抑郁问卷量表来检验HM对MDD的影响。使用偏倚风险工具进行质量评估。与单独使用抗抑郁药相比，HM联合抗抑郁药显著提高了血清素浓度（标准化均数差[SMD]=1.96，95%置信区间[CI]：1.24 - 2.68，P<0.00001，I²=97%）、脑源性神经营养因子浓度（SMD = 1.38，95% CI：0.92 - 1.83，P<0.00001，I²=91%）和神经生长因子浓度（SMD = 2.38，95% CI：0.67 - 4.10，P = 0.006，I²=96%），并降低了皮质醇浓度（SMD = -3.78，95% CI：-4.71至-2.86，P<0.00001，I²=87%）。尽管HM或HM联合抗抑郁药通过改善神经内分泌因子对MDD治疗有益，但由于纳入研究的方法学质量低和临床异质性，这些发现应谨慎解释。
