Depression is a prevalent mental health condition that impacts an individual’s thoughts, behavior, and self-worth. Symptoms include prolonged feelings of sadness, loss of interest in activities, difficulty concentrating, insomnia, reduced appetite, and in severe cases, some individuals might develop thoughts of suicide and self-harm. The prevalence of depression is particularly high in today’s fast-paced society. The primary goals of treating depression clinically are to enhance patient recovery rates, improve quality of life, restore social functioning, and prevent relapses. Depression can be categorized into minor depression, major depression, and dysthymia based on severity and duration. Patients are usually prescribed antidepressants such as Fluoxetine and Escitalopram, which are selective serotonin reuptake inhibitors (SSRIs), as the first-line treatment for depression. These medications typically take 4-8 weeks to take full effect, and common side effects like agitation, headache, and indigestion usually diminish after 4 weeks. More serious side effects may include serotonin syndrome, hyponatremia, and potential Type 2 diabetes mellitus.

Additionally, these antidepressants can inhibit the enzyme Cytochrome P450 (CYP), leading to reduced drug and herb metabolism, potentially increasing the concentration of medications in the body and raising the risk of toxicity. Therefore, it is crucial to evaluate the safety and effectiveness of combining Traditional Chinese Medicine (TCM) and Western Medicine (WM) for treating depression. The objective of this research was to assess the efficacy and safety of integrating TCM and WM in the treatment of depression, using a comprehensive analysis of randomized controlled trials (RCTs), meta-analyses, and systematic reviews.

In TCM theory, depression is commonly referred to as “Yu Zheng” (郁证) and is primarily attributed to Liver qi stagnation. Common TCM prescriptions used clinically include Xiaoyaosan (逍遥散), Chaihushugansan (柴胡疏肝散), and Ganmaidazaotang (甘麦大枣汤). Our research looked at studies that combined both TCM prescriptions and WM drugs such as Escitalopram and Paroxetine among other antidepressants. Patients who had combined TCM and WM treatment exhibited a significantly greater improvement as measured with indicators such as the Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) scores. Side effects were observed, however, there was often no statistically significant difference in the occurrence of side effects between patients who took TCM and those who did not, some papers even showed that those who took TCM had milder side effects.

Nevertheless, these studies have certain limitations. These include small sample sizes, vague documentation of randomization methods, absence of placebo controls, failure to implement a holistic diagnosis and treatment approach in line with TCM theory, as well as short treatment courses without long-term follow-up to assess sustained effectiveness and recovery rates with the combined use of TCM and WM. Recognizing these limitations, it is imperative to conduct more comprehensive studies with larger sample sizes, placebo controls, and the integration of holistic diagnosis and treatment principles based on TCM theory to more accurately evaluate the effectiveness of an integrated treatment for depression. Furthermore, further research should be conducted on elucidating potential herb-drug interactions between TCM and WM. Given that many antidepressants inhibit CYP enzymes and may impact the metabolism of TCM substances, or vice versa, it is critical to identify and understand potential herb-drug interactions to ensure the efficacy and safety of concurrent TCM and WM treatment.

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