Efficacy and Safety of Xiaoyao Recipe in the Treatment of Poststroke Depression: A Systematic Review and Meta-Analysis

Overview

Journal Evid Based Complement Alternat Med

Specialty Rehabilitation Medicine

Date 2022 Apr 25

PMID 35463080

Authors

Dou Wang

Tao Li

Jie Ron

Meiling Mao

Yifan Yang

Yalun Feng

Yongmei Yan

Affiliations

Soon will be listed here.

Abstract

Background: Poststroke depression (PSD) is a common neuropsychiatric disorder that affects the disability, mortality, functional recovery, and quality of daily life of patients. Xiaoyao Recipe (XYR) is often used to treat PSD and has achieved good clinical effects, but it lacks reliable evidence.

Objective: This study aims to evaluate the effectiveness and safety of XYR on PSD through meta-analysis.

Methods: A comprehensive literature search was carried out in multiple databases, including PubMed, the Cochrane Library, Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and ClinicalTrials, from inception to July 1, 2021, to collect randomized controlled trials that applied XYR for patients with PSD. For a controlled trial, the search time limit was set from the time of the database's establishment to July 2021. Two experienced researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, evaluated the quality of the literature, and used RevMan 5.3 software for meta-analysis.

Results: A total of 12 studies were included in this study, involving 882 patients with PSD who were hospitalized or outpatients. The meta-analysis results showed that the total effective rate ( < 0.00001) of the test group (XYR or XYR combined with antidepressants) after treatment was high; Hamilton's Depression Scale score ( < 0.000001), Scandinavian Stroke Scale score (=0.004 < 0.05), and Barthel index ( < 0.00001) were improved; the incidence of adverse reactions ( < 0.00001) was low; and the serum serotonin content ( < 0.00001) was high.

Conclusion: Compared with antidepressant drugs, XYR is more effective and safer in the treatment of PSD patients. However, more high-quality studies are needed to further support the above conclusions.

References

Feng R, Wang P, Gao C, Yang J, Chen Z, Yang Y . Effect of sertraline in the treatment and prevention of poststroke depression: A meta-analysis. Medicine (Baltimore). 2018; 97(49):e13453. PMC: 6310584. DOI: 10.1097/MD.0000000000013453. View

Chau J, Lo S, Zhao J, Choi K, Lam S, Butt L . Factors Associated with Post-Stroke Depression in Chinese Stroke Survivors. J Stroke Cerebrovasc Dis. 2021; 30(11):106076. DOI: 10.1016/j.jstrokecerebrovasdis.2021.106076. View

Yu Y, Zhang G, Han T, Huang H . Efficacy and safety of oral traditional Chinese patent medicine in treatment of liver stagnation and spleen deficiency of depression: A protocol for systematic review. Medicine (Baltimore). 2020; 99(7):e19142. PMC: 7035078. DOI: 10.1097/MD.0000000000019142. View

Sun R, Wang K, Wu D, Li X, Ou Y . Protective effect of paeoniflorin against glutamate-induced neurotoxicity in PC12 cells via Bcl-2/Bax signal pathway. Folia Neuropathol. 2012; 50(3):270-6. DOI: 10.5114/fn.2012.30527. View

Feng Y, Gao X, Meng M, Xue H, Qin X . Multi-omics reveals the mechanisms of antidepressant-like effects of the low polarity fraction of Bupleuri Radix. J Ethnopharmacol. 2020; 256:112806. DOI: 10.1016/j.jep.2020.112806. View

Yu M, Wang L, Wang H, Wu H . The effect of early systematic rehabilitation nursing on the quality of life and limb function in elderly patients with stroke sequelae. Am J Transl Res. 2021; 13(8):9639-9646. PMC: 8430147. View

Kutlubaev M, Hackett M . Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies. Int J Stroke. 2014; 9(8):1026-36. DOI: 10.1111/ijs.12356. View

Liu M, Zhang G, Naqvi S, Zhang F, Kang T, Duan Q . Cytotoxicity of Saikosaponin A targets HEKa cell through apoptosis induction by ROS accumulation and inflammation suppression via NF-κB pathway. Int Immunopharmacol. 2020; 86:106751. DOI: 10.1016/j.intimp.2020.106751. View

Wang X, Feng S, Wang Y, Chen N, Wang Z, Zhang Y . Paeoniflorin: A neuroprotective monoterpenoid glycoside with promising anti-depressive properties. Phytomedicine. 2021; 90:153669. DOI: 10.1016/j.phymed.2021.153669. View

10.

Li L, Han Z, Li L, Han L, Yan B . Effectiveness of Paroxetine for Poststroke Depression: A Meta-Analysis. J Stroke Cerebrovasc Dis. 2020; 29(5):104664. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104664. View

11.

Babkair L . Risk Factors for Poststroke Depression: An Integrative Review. J Neurosci Nurs. 2017; 49(2):73-84. DOI: 10.1097/JNN.0000000000000271. View

12.

Man C, Li C, Gong D, Xu J, Fan Y . Meta-analysis of Chinese herbal Xiaoyao formula as an adjuvant treatment in relieving depression in Chinese patients. Complement Ther Med. 2014; 22(2):362-70. DOI: 10.1016/j.ctim.2014.02.001. View

13.

Levada O, Troyan A . Poststroke Depression Biomarkers: A Narrative Review. Front Neurol. 2018; 9:577. PMC: 6055004. DOI: 10.3389/fneur.2018.00577. View

14.

Cui M, Huang C, Wang F . Efficacy and Safety of Citalopram for the Treatment of Poststroke Depression: A Meta-Analysis. J Stroke Cerebrovasc Dis. 2018; 27(11):2905-2918. DOI: 10.1016/j.jstrokecerebrovasdis.2018.07.027. View

15.

Gutknecht L, Popp S, Waider J, Sommerlandt F, Goppner C, Post A . Interaction of brain 5-HT synthesis deficiency, chronic stress and sex differentially impact emotional behavior in Tph2 knockout mice. Psychopharmacology (Berl). 2015; 232(14):2429-41. PMC: 4480945. DOI: 10.1007/s00213-015-3879-0. View

16.

Wang C, Wu C, Yan Z, Cheng X . Ameliorative effect of Xiaoyao-jieyu-san on post-stroke depression and its potential mechanisms. J Nat Med. 2018; 73(1):76-84. DOI: 10.1007/s11418-018-1243-5. View

17.

Hackett M, Pickles K . Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies. Int J Stroke. 2014; 9(8):1017-25. DOI: 10.1111/ijs.12357. View

18.

Chen Y, Wang W, Fu X, Sun Y, Lv S, Liu L . Investigation of the antidepressant mechanism of combined Radix Bupleuri and Radix Paeoniae Alba treatment using proteomics analysis of liver tissue. J Chromatogr B Analyt Technol Biomed Life Sci. 2021; 1179:122858. DOI: 10.1016/j.jchromb.2021.122858. View

19.

Kubera M, Obuchowicz E, Goehler L, Brzeszcz J, Maes M . In animal models, psychosocial stress-induced (neuro)inflammation, apoptosis and reduced neurogenesis are associated to the onset of depression. Prog Neuropsychopharmacol Biol Psychiatry. 2010; 35(3):744-59. DOI: 10.1016/j.pnpbp.2010.08.026. View

20.

Jin X, Jiang M, Gong D, Chen Y, Fan Y . Efficacy and Safety of Xiaoyao Formula as an Adjuvant Treatment for Post-Stroke Depression: A Meta-Analysis. Explore (NY). 2018; 14(3):224-229. DOI: 10.1016/j.explore.2017.12.007. View