Core prescription pattern of Chinese herbal medicine for depressive disorders in Taiwan: a nationwide population-based study

Quantitative proteomic analysis of the brain reveals the potential antidepressant mechanism of Jiawei Danzhi Xiaoyao San in a chronic unpredictable mild stress mouse model of depression

OBJECTIVE

To reveal the antidepressant mechanisms of Jiawei DanZhiXiaoYaoSan (,JD) in chronic unpredictable mild stress (CUMS)-induced depression in mice.

METHODS

Using the CUMS mouse model of depression, the antidepressant effects of JD were assessed using the sucrose preference test (SPT), forced swimming test (FST), and tail suspension test (TST). Tandem mass tag (TMT)-based quantitative proteomic analysis of the brain was performed following JD treatment. Hierarchical clustering, Gene Ontology function annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interactions (PPIs) were used to analyze differentially expressed proteins (DEPs), which were further validated using quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting.

RESULTS

Behavioral tests confirmed the anti-depressant effects of JD, and bioinformatics analysis revealed 59 DEPs, including 33 up-regulated and 26 down-regulated proteins, between the CUMS and JD-M groups. KEGG and PPI analyses revealed that neuro-filament proteins and the Ras signaling pathway may be key targets of JD in the treatment of depression. qRT-PCR and Western blotting results demonstrated that CUMS reduced the protein expression of neurofilament light (NEFL) and medium (NEFM) and inhibited the phosphorylation of extracellular regulated kinase 1/2 (ERK1/2), whereas JD promoted the phosphorylation of ERK1/2 and up-regulated the protein expression of NEFL and NEFM.

CONCLUSIONS

The antidepressant mechanism of JD may be related to the up-regulation of p-ERK1/2 and neurofilament proteins.

Associations of Polygenic Risk for Depression, Traditional Chinese Medicine Constitution, and Depression: A Population-Based Study in Taiwan

To comprehensively investigate the risk factors associated with depression, traditional Chinese medicine constitution (TCMC) has been found to be related to depression. However, the underlying mechanism remains unclear. This study examined the association between the concept of unbalanced TCMCs and major depressive disorder (MDD), investigated the overlapping polygenic risks between unbalanced TCMC and MDD, and performed a mediation test to establish potential pathways. In total, 11,030 individuals were recruited from the Taiwan Biobank, and the polygenic risk score (PRS) for MDD for each participant was calculated using the data from the Psychiatric Genomics Consortium. Unbalanced TCMC were classified as yang-deficiency, yin-deficiency, and stasis. The MDD PRS was associated with yang-deficiency odds ratio [OR] per standard deviation increase in standardized (PRS = 1.07, p = 0.0080), yin-deficiency (OR = 1.07, p = 0.0030), and stasis constitution (OR = 1.06, p = 0.0331). Yang-deficiency (OR = 2.07, p < 0.0001) and stasis constitutions (OR = 1.65, p = 0.0015) were associated with an increased risk of MDD. A higher number of unbalanced constitutions was associated with MDD (p < 0.0001). The effect of MDD PRS on MDD was partly mediated by yang-deficiency (10.21%) and stasis (8.41%) constitutions. This study provides evidence for the shared polygenic risk mechanism underlying depression and TCMC and the potential mediating role of TCMC in the polygenic liability for MDD.

East Asian Herbal Medicine for the Treatment of Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a mental illness that can place a significant burden on individuals, their families, and society. East Asian Herbal Medicine (EAHM) has long been used in East Asian nations to treat mental illness in children. Nevertheless, the evidence for the effectiveness of EAHM for the treatment of ADHD is insufficient. A systematic review was performed to examine the effectiveness and safety. In addition, research on core herbal combinations was also conducted to help clinicians in their prescription selection.

MATERIALS AND METHODS

This systematic review and meta-analysis were prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The following databases were searched: 4 English databases (PubMed, Cochrane Library, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE), 4 Korean databases (Korean Studies Information Service System (KISS), Research Information Service System (RISS), Oriental Medicine Advanced Searching Integrated System (OASIS), Korea Citation Index (KCI)), 2 Chinese databases (Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Data), and 1 Japanese database (CiNii) database. The publication bias was evaluated using funnel plots. GRADE pro was used to evaluate the evidence of the study. The core herb combination of EAHM used in this study was revealed using apriori algorithm-based association rule mining.

RESULTS

This review assessed 42 studies that evaluated 3484 children and adolescents. In meta-analysis, EAHM monotherapy had a similar clinical efficacy rate to conventional medicine (CM) (n = 2166; random effects RR 1.09, 95% CI 1.05 to 1.13; heterogeneity χ2= 25.08, df = 23, p = 0.35, I²=8%). EAHM-combined therapy showed a better clinical efficacy rate than when conventional therapy was used alone (n = 746; fixed effects RR 1.19, 95% CI 1.12 to 1.26; heterogeneity χ2= 11.80, df = 9, p = 0.22, I²=24%). For adverse events, EAHM had a lower incidence than conventional therapy. In GRADE pro, each outcome varied from moderate to very low quality. The constituents of the herb combinations with consistent association rules were Fossilia Ossis Mastodi, Polygalae Radix, and Acori Graminei Rhizoma.

CONCLUSION

EAHM monotherapy has similar effects to CM but with fewer side effects. Hence, it will be helpful for children with ADHD suffering from the side effects of CM. EAHM-combined therapy has a better effect than conventional therapy. Accordingly, it will be useful for children with ADHD who do not respond to treatment with conventional therapy. Nevertheless, more well-designed studies will be needed to confirm this in the future.

Efficacy and safety of Gyejibokryeong-hwan (GBH) in major depressive disorder: study protocol for multicentre randomised controlled trial

Background

Gyejibokryeong-hwan (GBH) is an herbal medicine composed of five herbs. It has been widely used to treat gynaecological diseases in traditional East Asian medicine. Recent animal studies suggest antidepressant effects of GBH. In this trial, we explore the efficacy and safety of GBH in patients with major depressive disorder and to identify the optimal dose for the next phase III trial.

Methods

This trial will enrol 126 patients diagnosed with major depressive disorder and not treated with antidepressants. Participants will be randomised to receive a high or a low dose of GBH or placebo granules. The study drugs will be administered three times a day, for 8 weeks. The 17-item Hamilton Depression Rating Scale (HDRS) will be used to measure the severity of depressive symptoms at weeks 2, 4, 6, 8, and 12. The primary efficacy endpoint is the change from baseline in HDRS-17 total score post-treatment at week 8. Analysis of covariance will be based on the baseline HDRS-17 total score and site as the covariates. Safety assessment will be based on the frequency of adverse events. The severity and causality of the study drug will be assessed.

Discussion

This study is designed to evaluate the efficacy and safety of GBH granules compared with placebo in patients with major depressive disorder.

Trial registration

Clinical Research Information Service KCT0004417. Registered on November 1, 2019 (prospective registration)

Identification of absorbed compounds of Xiao Yao San Jia Wei and pharmacokinetic study in depressed rats by force swimming stress

Xiao-Yao-San-Jia-Wei (XYSJW) is a commonly prescribed formulation for depression and anorexia in the Jiang Su Province Hospital of Chinese Medicine. Unfortunately, the proper dosage of this formulation is still unclear due to its limited chemical and pharmacokinetic profiles. Thus, in the present study, a sensitive, precise, and rapid procedure for the identification of absorbed compounds (Cs) in the plasma of depressed rats together with a pharmacokinetic analysis was established with the help of ultra-flow liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UFLC-Q-TOF MS/MS) and ultra-flow liquid chromatography coupled with electrospray ionization triple quadrupole tandem mass spectrometry (UFLC-QQQ MS/MS). Based on the characteristic fragmentation, neutral loss, mass defect filter, relevant literature and reference standards, 225 Cs in the XYSJW extract and 20 Cs in the plasma of the depressed rats were tentatively recognized via UFLC-Q-TOF MS/MS and UFLC-QQQ MS/MS. Then, the 12 major absorbed Cs in the depressed rats after oral XYSJW administration were chosen to further investigate its pharmacokinetic profile by UFLC-QQQ MS/MS. This study provides a systematic approach for the rapid and qualitative analysis of absorbed Cs in depressed rats and investigating the pharmacokinetics of XYSJW. More importantly, our work provides key information on the chemical and pharmacokinetic profiles of XYSJW in vitro and in vivo, which may benefit its therapeutic efficacy and further pharmacological studies involving this formulation.

Xiao-Yao-San-Jia-Wei (XYSJW) is a commonly prescribed formulation for depression and anorexia in the Jiang Su Province Hospital of Chinese Medicine.