背景:产后抑郁症(PPD)是分娩后妇女常见的精神疾病。根据流行病学研究的数据,PPD影响全世界约5%-26.32%的产后母亲。这种情况下的生物因素是多重且复杂的,并且已经对它们在PPD中的作用进行了广泛的询问。中草药(CHM),它被广泛用作神经系统疾病的补充和替代疗法,具有多组分,多目标,多路访问,和低副作用的治疗特点。CHM已经在PPD的治疗中显示出疗效,更多的研究正在探索其潜在治疗作用的机制。
目的:这篇综述对PPD的潜在机制进行了深入和全面的概述,以及样本在研究CHM在治疗该疾病中的潜在作用方面取得的进展。
方法:在学术电子数据库中全面搜索文献,包括PubMed,WebofScience,Scopus,CNKI和万方数据,使用搜索词“产后抑郁症”,“遗传”,\"激素\",\"免疫\",“神经炎症”,\"炎症\",\"神经递质\",“神经发生”,“脑肠轴”,“中药”,“中草药”,\"herb\",以及这些术语的组合。
结果:PPD与遗传学密切相关,以及荷尔蒙,免疫炎症,和神经递质系统,神经发生,和肠道微生物,这些生物因素经常相互作用并共同作用,导致PPD。例如,炎症因子可以通过诱导色氨酸-犬尿氨酸在神经毒性方向的调节来抑制神经递质5-羟色胺的产生。许多CHM成分通过干扰上述机制来改善焦虑和抑郁样行为,并在临床上对PPD表现出良好的疗效。例如,沈琪解郁方通过提高下丘脑-垂体-肾上腺(HPA)和下丘脑-垂体-性腺(HPG)轴的激素水平,调节Treg/T辅助细胞(Th)17和Th1/Th2的失衡,调节神经递质系统发挥抗抑郁作用。参桂仁合剂干扰细胞外信号调节激酶(ERK)通路,PPD大鼠海马神经元的形态和凋亡。其他草药提取物和CHM的活性成分,比如芍药苷,金丝桃素,皂甙B-III和更多,还可以通过治疗神经内分泌系统和减少神经炎症来治疗抑郁症。
结论:PPD的发病机制复杂多样,主要发病机制不明确。尽管如此,CHM成分,像沈奇杰玉芳,生桂仁合剂,芍药苷,金丝桃素和其他中药配方,活性单体和粗提物,通过多方面的干预措施治疗PPD。因此,开发更多的CHM成分来治疗PPD是向前迈出的重要一步。
BACKGROUND: Postpartum depression (PPD) is a common psychiatric disorder in women after childbirth. Per data from epidemiologic studies, PPD affects about 5%-26.32% of postpartum mothers worldwide. Biological factors underlying this condition are multiple and complex and have received extensive inquiries for the roles they play in PPD. Chinese herbal medicine (CHM), which is widely used as a complementary and alternative therapy for neurological disorders, possesses multi-component, multi-target, multi-access, and low side effect therapeutic characteristics. CHM has already shown efficacy in the treatment of PPD, and a lot more research exploring the mechanisms of its potential therapeutic effects is being conducted.
OBJECTIVE: This review provides an in-depth and comprehensive overview of the underlying mechanisms of PPD, as well as samples the progress made in researching the potential role of CHM in treating the disorder.
METHODS: Literature was searched comprehensively in scholarly electronic databases, including PubMed, Web of Science, Scopus, CNKI and WanFang DATA, using the search terms \"postpartum depression\", \"genetic\", \"hormone\", \"immune\", \"neuroinflammation\", \"inflammation\", \"neurotransmitter\", \"neurogenesis\", \"brain-gut axis\", \"traditional Chinese medicine\", \"Chinese herbal medicine\", \"herb\", and an assorted combination of these terms.
RESULTS: PPD is closely associated with genetics, as well as with the hormones, immune inflammatory, and neurotransmitter systems, neurogenesis, and gut microbes, and these biological factors often interact and work together to cause PPD. For example, inflammatory factors could suppress the production of the neurotransmitter serotonin by inducing the regulation of tryptophan-kynurenine in the direction of neurotoxicity. Many CHM constituents improve anxiety- and depression-like behaviors by interfering with the above-mentioned mechanisms and have shown decent efficacy clinically against PPD. For example, Shen-Qi-Jie-Yu-Fang invigorates the neuroendocrine system by boosting the hormone levels of hypothalamic pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes, regulating the imbalance of Treg/T-helper cells (Th) 17 and Th1/Th2, and modulating neurotransmitter system to play antidepressant roles. The Shenguiren Mixture interferes with the extracellular signal-regulated kinase (ERK) pathway to enhance the number, morphology and apoptosis of neurons in the hippocampus of PPD rats. Other herbal extracts and active ingredients of CHM, such as Paeoniflorin, hypericin, timosaponin B-III and more, also manage depression by remedying the neuroendocrine system and reducing neuroinflammation.
CONCLUSIONS: The pathogenesis of PPD is complex and diverse, with the main pathogenesis not clear. Still, CHM constituents, like Shen-Qi-Jie-Yu-Fang, the Shenguiren Mixture, Paeoniflorin, hypericin and other Chinese Medicinal Formulae, active monomers and Crude extracts, treats PPD through multifaceted interventions. Therefore, developing more CHM components for the treatment of PPD is an essential step forward.