ABSTRACT
CONTEXT: Chaihu Jia Longgu Muli Decoction (CLMD) is a traditional Chinese medicine for treating depression. OBJECTIVE: This study investigated the effect of CLMD combined with antidepressants on multimorbidity with depression (MMD). METHOD: Published randomized controlled trials were collected from PubMed, Web of Science, Chinese National Knowledge Infrastructure, China Science and Technology Journal, Wanfang and China Biomedical Literature Service System Databases. Participants were divided into study groups (CLMD combined with antidepressants) and control groups (antidepressants). RevMan5.4 software was used for data analysis. RESULTS: Hamilton's Depression Scale score was significantly lower (MD = -5.62, 95%CI [-5.86, -5.37], p < 0.00001), and the effective rate was significantly higher (RR = 1.23, 95%CI [1.17, 1.29], p < 0.00001) in study groups. National Institute of Health Stroke Scale score and Pittsburgh Sleep Quality Index score of study groups were significantly lower (MD = -2.82, 95%CI [-3.84, -1.81], p < 0.00001; MD = -2.26, 95%CI [-3.19, -1.34], p < 0.00001). 5-HT, DA, NE and IL-1ß level were significantly lower (SMD = 1.99, p = 0.003; SMD = 1.99, p < 0.00001; SMD = 0.86, p < 0.00001; MD = -14.64, p = 0.003) in study groups. Adverse reaction rate in study groups was significantly lower (RR = 0.47, 95%CI [0.24, 0.91], p = 0.03). The gastrointestinal tract and autonomic nervous system disorders were reduced in study groups. DISCUSSION AND CONCLUSIONS: CLMD combined with antidepressants enhances the effect of antidepressants and reduces their adverse reactions, performing a synergistic effect; it may be considered as an effective option in the treatment of MMD.
Subject(s)
Depression , Multimorbidity , Humans , Depression/drug therapy , Medicine, Chinese TraditionalABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Guizhi Fuling decoction (GZFL decoction) is a famous formula in the Synopsis of the Golden Chamber, which has a long history in treating endometriosis. However, its exact mechanism remains unclear. AIM OF STUDY: This study aims to explore the mechanism of GZFL decoction in treating endometriosis, especially in alleviating endometriosis-associated pain. MATERIALS AND METHODS: A combination of system pharmacology and pharmacodynamics was used to explore the specific mechanism of GZFL decoction in the treatment of endometriosis-associated pain. First, the TCMSP database was used to search the components of the GZFL decoction; the parameter index was set as oral bioavailability (OB) ≥ 30% and drug-likeness (DL) ≥ 0.18, while the active ingredients of the drug were screened out. The disease targets of endometriosis were obtained from the TTD, OMIM, Genecards, and DisGeNET databases; the keyword was "endometriosis pain". Network construction and analysis were performed using Cytoscape 3.7.2 software; the David database was used to enrich and analyze the pathways for alleviating endometriosis pain after GZFL decoction treatment. In addition, the network results were verified using experimental animal and cell research. RESULTS: The results showed the following targets: 76 for the effective chemical components in the prescription, 1329 for disease pain, and 278 for the intersection of drugs and endometriosis pain. The enrichment results for these targets showed that the TNF-PI3K/Akt pathway exhibited research significance. In endometriosis rat models, the GZFL decoction reduced the volume of lesions and relieved pain symptoms. It also reduced the serum levels of IL-6, IL-1ß, and TNF-α as well as their expression in the lesion tissues. The GZFL decoction also suppressed the activation of PI3K/Akt downstream signaling proteins. CONCLUSIONS: GZFL decoction could reduce the volume of lesions, suppress inflammation, and decrease the sensitivity to pain in endometriosis rat models through inhibiting PI3K/Akt pathway. This study provides a possible target for traditional Chinese medicine in treating endometriosis-associated pain.
