Efficacy and Safety of a Formulated Herbal Granula, Jiu Wei Zhen Xin, for Generalized Anxiety Disorder: A Meta-Analysis.

BACKGROUND: The traditional Chinese medicine formula Jiu Wei Zhen Xin Granula (JWZXG) is prescribed to treat generalized anxiety disorder (GAD) in China. This study was to assess the efficacy and safety of JWZXG in patients with GAD. METHOD: Data were pooled from 14 randomized controlled trials involving the assessment of mean changes of Hamilton Anxiety Rating Scale (HAMA) total scores, response rates, adverse event rates, quality, publication bias, and risk of bias. RESULTS: Pooled analysis showed no significant difference in response rate (risk ratio 1.01, 95% CI [0.93-1.08]; Z test = 0.17, P = 0.86) and no significant difference between JWZXG group and azapirones group (RR 0.69, 95% CI [0.45, 1.06]; Z test = 1.69, P = 0.09) in rate of adverse events. Though no difference exists between JWZXG group and azapirones group in HAMA total score from baseline, JWZXG group was inferior to selective serotonin reuptake inhibitors (SSRIs) group (WMD -0.93, 95% CI [-1.64, -0.23]; Z test = 2.6, P = 0.009) which had more adverse events than JWZXG group (RR 0.64, 95% CI [0.46, 0.89]; Z test = 2.63, P = 0.009). CONCLUSIONS: This meta-analysis preliminarily suggests that JWZXG is as effective as azapirones, though having the same possibility of suffering AEs. JWZXG was inferior to SSRIs but causes fewer AEs in the treatment of GAD.

Changes in regional cerebral blood flow with Chaihu-Shugan-San in the treatment of major depression.

BACKGROUND: Chaihu-Shugan-San (CHSGS) is a well-known Chinese traditional prescription used for depression. OBJECTIVE: To observe the regional cerebral blood flow (rCBF) changes in patients with major depression and to investigate rCBF and clinical response to CHSGS. MATERIALS AND METHODS: A total of 33 unmedicated patients with major depression and 12 healthy comparison subjects underwent single photon emission computed tomography (SPECT) imaging. A total of 33 unmedicated patients with major depression all met the diagnostic criteria of stagnation of liver qi of traditional Chinese medicine and were divided into two groups: CHSGS group (n = 20) and fluoxetine group (n = 13). SPECT imaging was restudied in posttreatment. RESULTS: SPECT detected abnormalities in all (100.0%) patients both in CHSGS group and fluoxetine group. All healthy subjects were normal results. The depressed patients showed rCBF decreased in the multiple regions. The semiquantitative values of bilateral frontal and left temporal lobes both in CHSGS group and fluoxetine group were lower than that in healthy group (P < 0.05). Reexamined SPECT after 8 weeks treatment with CHSGS showed the consistency between the increase in perfusion defects and the improvement of clinical cerebral symptoms. The semiquantitative values increased in posttreatment, when compared with pretreatment (P < 0.05). CONCLUSION: SPECT represents a sensitive tool to detect the major depressive disorder, which show the rCBF decreased. rCBF perfusion defects can be reversed and clinical symptoms can be improved by CHSGS treatment. CHSGS treatment is effective, well-tolerated, and safe for depression. By semiquantitative analysis, SPECT can objectively detect rCBF changes that is useful for guiding treatment.

Antidepressant-like effects of Chaihu-Shugan-San via SAPK/JNK signal transduction in rat models of depression.

BACKGROUND: Chaihu-Shugan-San (CHSGS), a traditional Chinese medicinal herbal formula, registered in Jingyue Quanshu, has been indicated that oral administration of the extract from it can remit depressive disorder. C-Jun amino-terminal kinase (JNK/SAPK) signal transduction plays a key role in the apoptosis of nerve cells, be reported closely correlated with depression. This study was designed to investigate CHSGS antidepressant-like effects in rat models of depression and probe its possible mechanism. MATERIALS AND METHODS: The classical experimental depression model chronic mild unpredictable stress (CMUS) was used to evaluate the antidepressant-like effects of CHSGS. The extracts were administered orally for 14 days, while the parallel positive control was given at the same time using fluoxetine hydrochloride. The expressions of JNK in the hippocampus were detected by real-time fluorescent quantitation PCR and Western blot assay. RESULTS: Intragastric administration of CHSGS for 14 days caused a significant improvement of weight and locomotor activity in the open-field test. In addition, CHSGS treatment inhibited the expressions of JNK in the hippocampus tissue in CMUS rats. CONCLUSION: CHSGS could obviously improve the depressive state of the model rats and its mechanism may be correlated with regulating the expressions of JNK in the hippocampus.

The effect of Chaihu-Shugan-San and its components on the expression of ERK5 in the hippocampus of depressed rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Chaihu-Shugan-San (CSS) is a well-known, Chinese traditional medicine used to treat depression. Little is known about the antidepressant mechanism of CSS. The main aims of the this study were to evaluate the antidepressant-like effects of CSS and its components and further explore the CSS׳s effect upon signal transduction of extracellular signal-regulated kinase 5 (ERK5) expressions in the hippocampus of rats with depression induced by chronic unpredicted mild stress. MATERIALS AND METHODS: SD rats were randomly divided into six groups: Normal; Model; CSS; Component I; Component II; and Fluoxetine. Antidepressant-like effects of CSS and two of its constituents, Components I and II in aqueous extract, were assessed using rats exposed to chronic unpredictable mild stress (CUMS) by measuring weight change, observing the open-field test and measuring sucrose water consumption. Antidepressant mechanism were examined by measuring the effect of CSS, and two of its constituents, on extracellular signal-regulated kinase 5 (ERK5) expression, phosphorylation-ERK5 (p-ERK5), and ERK5 mRNA in the hippocampus by using western blotting and Real-time Polymerase Chain Reaction (PCR). Three preparations were prepared: (1) an aqueous extract of CSS (5.9 g/kg·d); (2) Component I (3.3 g/kg·d); and (3) Component II (2.6 g/kg·d). During the 28-day CUMS, the three preparations were intragastrically administered all three preparations. Simultaneously a parallel positive fluoxetine control group was given fluoxetine hydrochloride (1.8mg/kg·d). Normal and Model groups were intragastrically administered with a isovolumic distilled water (4.5 ml/kg·d). RESULTS: Depressed rats had decreased weight gain; decreased locomotor activity as measured by the open field test; and reduced sucrose consumption. The rats׳ hippocampus ERK5 activation was significantly suppressed. CSS reduced the incidence of depressive-like behaviors and increased ERK5 activation in depressed rats at the same rate as fluoxetine. Component I, and II, each had only a partial effect on the depression indicators measured. CONCLUSIONS: CSS aqueous extract has antidepressant-like effects on CUMS-induced depression model rats. The antidepressant effect of CSS is greater than that of either the two separate components measured. CSS׳s antidepressant mechanism may be mediated by reversing the stress-induced disruption of ERK5 activity.

Meranzin hydrate exhibits anti-depressive and prokinetic-like effects through regulation of the shared α2-adrenoceptor in the brain-gut axis of rats in the forced swimming test.

BACKGROUND: In recent years, the brain-gut axis theory has received increasing attention in studies of depression. However, most studies separately address potential antidepressant and prokinetic treatments. Investigations of drugs that could potentially treat comorbid depression and gastrointestinal (GI) dysfunction via a common mechanism of action have not yet been performed in detail. AIM: To find a common mechanism of action of our patented drug, meranzin hydrate (MH), in the antidepressant and prokinetic treatment. METHODS: The forced swimming test (FST) model of depression, plasma ghrelin measurement, and in vivo and in vitro measurements of GI motility were used. RESULTS: 1. Administration of MH (9 mg/kg) decreased the immobility time during the FST after acute treatment; this effect was inhibited by the alpha 2-adrenoceptor antagonist, yohimbine, but not by the alpha 1-adrenoceptor antagonist, prazosin. 2. After chronic treatment, the immobility time of rats during the FST was decreased significantly by MH (2.25 mg/kg). 3. MH (9 mg/kg) increased plasma ghrelin levels in rats subjected to the FST; this increase was enhanced by the ghrelin receptor agonist, GHRP-6. 4. MH (9 mg/kg) also promoted gastric emptying and intestinal transit in rats with or without FST. 5. In vitro, MH (10 µM) increased jejunal contractions in rats subjected to the FST; this effect was inhibited by yohimbine. Furthermore, the inhibitory effect of yohimbine was partly reversed by the ghrelin receptor agonist, GHRP-6. CONCLUSION: Our study revealed that MH from natural resources exhibits antidepressive and prokinetic-like effects through the regulation of the common mediator, the alpha 2-adrenoceptor.

The involvement of AMPA-ERK1/2-BDNF pathway in the mechanism of new antidepressant action of prokinetic meranzin hydrate.

It was recently discovered that ketamine can relieve depression in a matter of hours through an action on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors. This is much more rapid than the several weeks required for the available antidepressants to show therapeutic efficacy. However, ketamine has negative side effects. The aim of this study was to determine whether the natural prokinetic drug meranzin hydrate (MH) has a fast-acting antidepressant effect mediated by AMPA receptors. By means of in vivo and in vitro experiments, we found that (1) treatment of rats with MH at 9 mg/kg decreased immobility time in a forced swimming test (FST), as did the popular antidepressant fluoxetine and the AMPA receptor positive modulator aniracetam. Pretreatment of rats with NBQX (10 mg/kg), an antagonist of AMPA receptors, blocked this effect of MH. (2) MH increased number of crossings of forced swimming rats in the open field test. (3) FST enhanced hippocampal ERK1/2, p-ERK1/2 and BDNF expression levels. MH (9 mg/kg) treatment further up-regulated hippocampal p-ERK1/2 and BDNF expression levels, and this effect was prevented by NBQX. (4) MH-increased BDNF expression corresponded with MH-decreased immobility time in the FST. (5) In vitro experiments, we found that incubation of rats hippocampus slices with MH (10, 20 µM respectively) increased concentrations of BDNF and p-ERK1/2. This effect of MH (20 µM) were prevented by NBQX. In conclusion, in animals subjected to acute stress, the natural prokinetic drug MH produced a rapid effect mediated by AMPA receptors and involving BDNF modulation through the ERK1/2 pathway.

[Relationship between symptom stratification and syndrome differentiation of traditional Chinese medicine for depressive episode].

On the basis of medical literature review and clinical research experience, the authors analyzed the reasons for low recognition rate of depression and poor progress of traditional Chinese medicine (TCM) differentiation of depression in this paper and put forward that depressive episode symptoms and the corresponding common terminology classification of Chinese and Western medicine should be the breakthrough points. Through symptom stratification and combination, as well as distinguishing between primary and secondary symptoms, the comprehensive integrative medicine clinical assessment of depression was explored so as to further obtain expert consensus and provide a methodology reference for the TCM differentiation of depression and the research of etiology and pathogenesis.

[Effects of Chaihu Shugan San on behavior and plasma levels of corticotropin releasing hormone and adrenocorticotropic hormone of rats with chronic mild unpredicted stress depression].

OBJECTIVE: To investigate the effects of Chaihu Shugan San (CHSGS), a compound traditional Chinese herbal medicine, on behavior and plasma levels of corticotropin releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) of rats with chronic mild unpredicted stress depression. METHODS: Forty male Sprague-Dawley rats were randomly divided into 4 groups: normal control group, untreated group, fluoxetine group and CHSGS group. Except the normal control group, rats were singly housed and exposed to an unpredicted sequence of mild stressor for continuous 4 weeks to induce depression. Since the fifteenth day, rats were intragastrically administered with equal volume agents respectively for 2 weeks [normal saline for the normal control group and the untreated group, fluoxetine (1.8 mg/kg) for the fluoxetine group and CHSGS (5.9 g/kg) for the CHSGS group]. Behavioral scores of rats were detected by open-field test and sucrose preference test, and the plasma levels of CRH and ACTH in different groups were detected by radioimmunoassay. RESULTS: Compared with the normal control group, body weights of the rats in the untreated group were significantly decreased. Scores of crossing, rears and grooming in open-field test were reduced significantly. Pure water consumption in sucrose preference test was increased significantly. The levels of plasma CRH and ACTH were significantly increased. The depressive behaviors of the rats were improved significantly and the levels of plasma CRH and ACTH were obviously reduced in the CHSGS group. CONCLUSION: Chronic mild unpredicted mild stress can affect the neuroendocrine and behavior and cause depression in rats. CHSGS can regulate HPA hyperactivity of rats caused by chronic stress and has antidepressive effects.

[Mechanism and protective effect of glossy ganoderma decoction on the activities of RNA polymerase in hepatocyte of rabbits with Amanita mushroom poisoning].

OBJECTIVE: To investigate the mechanism of glossy ganoderma decoction in Amanita mushroom poisoning. METHODS: Twenty male New Zealand white rabbits were randomly divided into 4 groups, including a normal control, a model poison group, and 2 treatment groups (different doses of glossy ganoderma decoction). The activities of hepatocyte RNA polymerase were measured by ultraviolet spectrophotometry and liver function were measured. RESULTS: The activities of hepatocyte RNA polymerase of the model group significantly decreased, and those of the 2 treatment groups were significantly higher than those of the model group. There was a dose-dependent manner between the 2 treatment groups ( all Ps<0.01), and the differences of liver function test including total bilirubin (TBIL), direct bilirubin (DB), total bile acid (TBA), and alanine aminotransferase (ALT) in the 4 groups were significant (P<0.01). CONCLUSION: Glossy ganoderma decoction may protect the liver from Amanita mushroom poisoning. Its mechanism may be related to the increase of the activities of hepatocyte RNA polymerase.

Clinical experience in treatment of Amanita mushroom poisoning with Glossy Ganoderma Decoction and routine Western medicines.

OBJECTIVE: To assess the effects of treatment of Amanita mushroom poisoning with Glossy anoderma Decoction (, GGD). METHODS: Twelve patients with acute Amanita mushroom poisoning received conventional treatment (penicillin and reduced glutathione) combined with oral administration of GGD (treated group), which was prepared out of 200 g Glossy ganoderma decocted in water to 600 mL, and 200 ml was given once, three times a day for 7 successive days; while conventional treatment alone was given to the other 11 patients assigned to the control group. The therapeutic efficacy and changes in serum levels of total bilirubin (TBil), bile acids (BA), alanine transaminase (ALT), and aspartate transaminase (AST) activities in the two groups were compared. RESULTS: The cured-markedly effective rate in the treated group was more significant than that in the control group (P<0.01). Elevation in TBil, BA, ALT, and AST activities were observed in both groups 3 days after poisoning, which progressively increased thereafter in the control group. In the treated group, they reached their peak on the 3rd day and then declined gradually. The differences between pre-treatment and post-treatment in both groups were obviously significant (P<0.01), so were the differences between the two groups at corresponding time points (P<0.01). CONCLUSION: GGD shows excellent clinical efficacy in the treatment of acute Amanita mushroom poisoning and can reduce mortality significantly.

Study on the interrelationship between 5-HTTLPR/G-protein beta3 subunit (C825T) polymorphisms and depressive disorder.

OBJECTIVE: To assess whether the promoter region of the serotonin transporter gene (5-HTTLPR) and G-protein beta3-subunit (GNbeta3 C825T) polymorphisms are associated with depressive disorder and explore the genetic mechanism concerning the pathogenesis of this disorder. METHODS: The genotypes were determined with polymerase chain reaction and allele-specific restriction enzyme analysis. Patients suffering from depression (n=184) and sex and age-matched controls (n=158) were compared in this study. RESULTS: The frequencies of 5-HTTLPR SS and GNbeta3 825TT genotypes and 5-HTTLPR S and GNbeta3 825T alleles in patients suffering from depression were significantly higher than those in the controls (P<0.01). Combined genotype analysis showed that individuals with both 5-HTTLPR S and GNbeta3 825T alleles (odds ratio=3.25, P=0.002) had a risk of depressive disorder higher than those with 5-HTTLPR S (odds ratio=1.817, P=0.01) or GNbeta3 825T alleles (odds ratio=2.214, P=0.001) alone. CONCLUSIONS: These results indicated that the etiology of depressive disorder is associated with 5-HTTLPR and GNbeta3 C825T polymorphisms. Our data also suggests that an interaction effect may exist between the 5-HTTLPR S allele and GNbeta3 825T allele in increasing the risk of depressive disorder.

[Anti-depressive effect of Baisong tablets on the chronic mild unpredicted stress depression in rats].

OBJECTIVE: To investigate the effect of Baisong tablets on the nerve-biochemistry and neuroendocrine of chronic mild unpredicted stress depression in rats. METHODS: Sixty male Sprague-Dawley rats were randomly allocated to 4 groups: a normal control (NC), a model control (MC), a fluoxetine control (FC) and a Baisong tablet treatment group (BST). All rats except the control group were singly housed and exposed to an unpredicted sequence of mild stressor. The levels of serotonin (5-HT), glutamate (Glu) and gama-aminobutyric acid (GABA) of the hippocampus were measured by high-performance liquid chromatography. The concentration of corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH) and cortisol (CORT) in the plasma of the rats were detected by radio-immunity. The CRHmRNA expressions in the hypothalamus and prefrontal cortex were semiquantified by RT-PCR method. The differences of BDNF and TrkB protein expression in CA1 and CA3 pyramidal and dentate gyrus granule cells layers of hippocampus were investigated with immunohistochemistry technique. RESULTS: In comparison with NC group, the levels of 5-HT, and GABA of the hippocampus in MC rats reduced significantly (P<0.01), and the concentration of CRH, ACTH, and CORT of the plasma and the level of Glu of the hippocampus and CRH mRNA expression in the brain increased significantly. Fluoxetine or Baisong could significantly regulate the abnormal changes of all the above. CONCLUSION: Chronic mild unpredicted stress can affect neuroendoerine and cause depression, and Baisong tablet has antagonism against it.

[Anti-tumor effect and mechanism of Paeonol on the hepatocellular carcinoma cell line Bel-7404].

OBJECTIVE: To investigate the anti-tumor effect of Paeonol (Pae) on the hepatocellular carcinoma cell line Bel-7404 and its molecular mechanisms. METHODS: Hepatocellular carcinoma cell line Bel-7404 was treated by Pae in various concentrations and different time points respectively; and then the cell proliferation was assayed by light microscope, MTT method. DNA agarose gel electrophoresis and TUNEL were used to detect the apoptosis. The expression of PTEN and Akt were examined by RT-PCR and immunocytochemical ABC method. RESULTS: Compared with the control groups Pae obviously increased the inhibitory and apoptosis rate of hepatocellular carcinoma cell line Bel-7404. It also showed a typical apoptotic morphology and DNA depicted a ladder pattern characteristic of the apoptosis, indicating the presence of DNA fragmentation. RT-PCR and immunocytochemical ABC assay showed that Pae could increase the expression of PTEN and decrease the expression of Akt. CONCLUSION: Pae can increase the anti-hepatocellular carcinoma effect, and its mechanism may be the increase of apoptosis-inducing effect which is regulated by phosphatidylinositol-3-kinase.

[Effect of BST on synapse protein SYT and SYN in the hippocampus of chronic stress depression in rats].

OBJECTIVE: To explore the effects of Baisong tablets (BST) on synapse protein synatotagmin (SYT) and synaptophysin (SYN) of hippocampus in chronic stress depression in rats. METHODS: Twenty eight male Sprague-Dawley rats were randomly allocated to 4 groups: a normal control group,a model group,a fluoxetine (FXT) group and a BST group. The normal control rats were fed in a natural environment. Rats of the model, FXT and BST groups were singly housed and given an chronic unpredicted sequence of mild stressors. The distribution and expression differences of SYT and SYN in the hippocampus of rats in different groups were investigated with in situ hybridization and immunoblotting. RESULTS: Expressions of SYT and SYN in the hippocampus of model rats were significantly reduced, compared with that of the normal control (P<0.05); and the expressions of SYT and SYN were significantly increased in the hippocampus of the FXT and BST groups, compared with that of the model group (P<0.05). CONCLUSION: The expressions of SYT and SYN protein and their mRNA decrease in the hippocampus of stress-model rats. BST can up-regulate their expression.

[Effect of chronic stress on PKA and P-CREB expression in hippocampus of rats and the antagonism of antidepressors].

OBJECTIVE: To observe the effect of chronic unpredicted sequence of mild stress on the expression of cAMP-dependent protein kinase A(PKA) and phosphorylated cAMP-responsive element binding protein (P-CREB) in hippocampus of rats and the antagonism of antidepressors (fluoxetine). METHODS: Thirty-six male Sprague Dawley rats were randomly and equally allocated to 3 groups: A normal control group, a model group, and a fluoxetine group. All rats except the control group were singly housed and exposed to an unpredicted sequence of mild stressors. The different distribution and expression of PKA and P-CREB in the hippocampus of rats in different groups were investigated with immunohistochemistry and Westernblot technique. RESULTS: The positive PKA and P-CREB cells in the hippocampus of normal controls were the pyramidal cells and the granule cells. The PKA and P-CREB protein expression levels in the hippocampus of model rats were significantly lower than those of the normal controls (P<0.05). The PKA and P-CREB protein expression levels in the hippocampus of the fluoxetine group were significantly higher than those of the model group (P<0.05). CONCLUSION: Chronic unpredicted mild stress can affect the PKA and P-CREB expression in hippocampus of rats and fluoxetine has antagonism against it.

[Comparative study on two methods of back propagation network test in TCM syndrome typing of depression].

OBJECTIVE: To compare the effect of the two methods of back propagation network (BPN) test on TCM syndrome typing of depression. METHODS: Test was carried out by two methods as following: (1) Cross train-test method: 1731 patients with depression typed to 5 syndrome types were randomly divided into 2 groups, and they were trained and tested in turn; (2) Round-Robin method: Test was conducted in an altered cycle mode, that is, in a cycle, one out of the 1731 patients were selected to be tested, while the others were trained, the next cycle started when the test on the selected patient was finished and another one for test was selected. In this way, one cycle after the other, until all patients had been tested. RESULT: The total training sensitivity of the two methods was 97.9% and 98.2% respectively, and the total testing sensitivity was 72.7% and 74.2% respectively. CONCLUSION: (1) The five TCM syndrome types of depression could be well differentiated by BPN, which is valuable for TCM syndrome typing in certain extent; (2) The sensitivity of Round-Robin method is slightly higher than that of Cross train-test method, but in comparison between them no remarkable significance was shown.

[Effects of baisong tablets on the behavior and levels of norepinephrine and dopamine in the brain of stress rats].

OBJECTIVE: To explore the effects of baisong tablets on the behavior and contents of norepinephrine and dopamine in the brain of stress rats. METHODS: Forty adult Sprague-Dawley male rats were randomly divided into 4 groups: the control group, the depression model group, the baisong tablet group and the fluoxetine group. The depression model was replicated by chronic unpredictable mild stress and single house in 21 days. Ten rats as a group were treated with baisong tablets or fluoxetine hydrochloride. Changes of behaviors were observed by open-field test and the volume of sugar-solution the rat drank in 24 hours. The weight increase was also observed. The levels of norepinephrine and dopamine in the brain in each group were detected with high-pergomance liquid chromatography. RESULTS: Compared with the model group, baisong tablets could improve the depressive behaviors significantly, and increase the levels of norepinephrine and dopamine in the rat brain. CONCLUSION: Baisong tablets can improve the depressive behaviors and increase the levels of 5-hydroxytryptaimne and dopamine in the brain of stress rats.

[The effects of Baisong tablet on the behaviors and CRHmRNA expression in the brain of rats following chronic stress].

OBJECTIVE: To investigate the effects of Baisong tablet on the behaviors and CRHmRNA expression in the chronic stress rats. METHOD: Rats were exposed to different ways of chronic stress. Body weight and behaviors were investigated during the whole procedure, the CRHmRNA expressions in the hypothalamus and prefrontal cortex were semiquantified by the RT-PCR method. RESULT: In comparision with the normal group, rats exposed to chronic stress showed decreased body weight and a significant reduction of consumption of sucrose solution, and the duration of immobility during the forced swimming test was increased significantly. The chronic stress rats was in depression of behavior. CRHmRNA expression in the brain of the chronic stress rats was upregulated significantly, while it was downregulated in the groups of Baisong tablet and the group of fluoxetin. CONCLUSION: Baisong tablet has the effect of antidepressant, and it may be related to the effect of the downregulated CRHmRNA expression in brain.