
==== Front
World J Psychiatry
WJP
World Journal of Psychiatry
2220-3206
Baishideng Publishing Group Inc

jWJP.v14.i9.pg1354
10.5498/wjp.v14.i9.1354
97896
Observational Study
Shugan Jieyu capsule effects on peripheral blood micro-124, micro-132, and brain-derived neurotrophic factor in patients with mild to moderate depression
Zhang X et al. Shugan Jieyu capsule impact on depression PCI
Zhang Xian Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Liu Yang Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Tang Hua-Fei Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Jiang Feng Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Chen Chun-Liang Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Wang Ting-Ting Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Gu Hui-Zhong Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Zhao Qiang Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China

Ma Rui Department of Pharmacy, The 305 Hospital of People’s Liberation Army, Beijing 100017, China. maruipla@126.com

Co-first authors: Xian Zhang and Yang Liu.

Co-corresponding authors: Qiang Zhao and Rui Ma.

Author contributions: Zhang X and Liu Y contributed equally to this work. Zhang X and Liu Y designed the study and performed the experiments; Tang HF, Jiang F, Chen CL, Wang TT, and Gu HZ collected the data; Zhao Q analyzed the data; Ma R prepared the manuscript, they are the co-corresponding authors of this manuscript. All the authors have read and approved the final version of the manuscript.

Supported by the 305 Hospital Independent Scientific Research Fund, 2024, No. 24ZZJJLW-022.

Corresponding author: Rui Ma, MD, Doctor, Department of Pharmacy, The 305 Hospital of People’s Liberation Army, No. A13 Wenjin Street, Xicheng District, Beijing 100017, China. maruipla@126.com

19 9 2024
19 9 2024
14 9 13541363
12 6 2024
4 7 2024
5 8 2024
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
BACKGROUND

To assess the effectiveness of Shugan Jieyu capsules on peripheral blood miR-124, miR-132, and brain-derived neurotrophic factor (BDNF) levels in patients with mild to moderate depression following coronary artery intervention [percutaneous coronary intervention (PCI)] for coronary heart disease.

AIM

To evaluate the therapeutic efficacy of Shugan Jieyu capsules and their effects on the peripheral blood levels of miR-124, miR-132, and BDNF in patients with mild to moderate depression following PCI for coronary heart disease.

METHODS

Patients with mild-to-moderate depression of the liver-qi stagnation type after PCI for coronary heart disease at the 305th Hospital of the People’s Liberation Army were enrolled from June 2022 to November 2023 and randomly assigned to two groups: Experimental (treated with Shugan Jieyu capsules) and control (treated with escitalopram oxalate tablets). This study compared the antidepressant effects of these treatments using 17-item Hamilton Rating Scale for Depression (HAMD-17) scores, metabolic equivalents, low-density lipoprotein cholesterol, BDNF, high-sensitivity C-reactive protein levels, miR-124 and miR-132 levels, distribution of immune-related lymphocyte subsets, and traditional Chinese medicine syndrome scores before and after 6 weeks of treatment.

RESULTS

No significant difference was observed in any index between the two groups before treatment (P > 0.05). After treatment, the total efficacy rates were 93.33% and 90.00% in the experimental and control groups, respectively. Experimental group had significantly lower scores for the main and secondary syndromes compared to the control group (P < 0.05). No significant difference was observed in the metabolic equivalents between the two groups before and after treatment (P > 0.05). The levels of low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and miR-132 were significantly lower, whereas those of miR-124, BDNF, CD3+T lymphocytes, CD3+CD4+T helper lymphocytes, and CD3+CD4+/CD3+CD8+ cells were significantly higher in the experimental group compared to the control group (P < 0.05). The incidence of adverse reactions during experimental group was significantly lower than that in control group (P < 0.05).

CONCLUSION

Shugan Jieyu capsules have good efficacy in patients with mild-to-moderate depression after PCI, and its mechanism may contribute to the regulation of miR-124, miR-132, BDNF levels, and lymphoid immune cells.

Shugan Jieyu capsule
Coronary heart disease
Depression
Escitalopram oxalate tablet
Micro-124
Micro-132
Brain-derived neurotrophic factor
==== Body
pmc Core Tip: The study examines the effects of Shugan Jieyu capsules on patients with mild to moderate depression following percutaneous coronary intervention for coronary heart disease. The results indicate significant improvements in depressive symptoms, biochemical markers such as miR-124, miR-132, and brain-derived neurotrophic factor, as well as immune function. Shugan Jieyu capsules outperformed escitalopram oxalate tablets in reducing depression severity and adverse reactions, suggesting their potential as a safer and more effective treatment alternative for post-percutaneous coronary intervention depression.

INTRODUCTION

Percutaneous coronary intervention (PCI) is a widely used medical procedure for treating coronary artery disease[1]. This treatment method is primarily employed for managing coronary heart disease, especially in cases in which coronary artery narrowing or blockage leads to insufficient blood supply to the heart. During PCI, a physician inserts a long thin catheter into the patient’s blood vessels, typically through the leg or arm arteries. The catheter was then guided into the coronary arteries of the heart. Once in place, the physician uses specialized tools, such as balloons, to dilate narrow sections of the blood vessels[2]. In many cases, a small metal mesh structure called a stent is also placed to help keep the blood vessels open. PCI primarily improves the blood supply to the myocardium, alleviates chest pain (angina), enhances the patient’s quality of life, and reduces the risk of heart attacks. Compared with traditional open-heart surgery, PCI is a less invasive option with shorter recovery times and relatively low risks[3].

However, recent research indicates that a significant portion of patients undergoing PCI treatment (approximately 40%) experience postoperative mental health issues such as anxiety and depression[4]. These psychological problems may be attributed to factors such as the stress of the surgery, concerns regarding health status, and lifestyle changes[5]. This psychological stress not only affect the patient’s mental well-being but may also have a negative impact on their physical recovery. Therefore, psychological interventions and support have become crucial components in the overall management of PCI treatment. Patients may require psychological counseling, behavioral therapy, or medication to help them cope with postoperative psychological challenges[6]. To improve the condition of patients with mild-to-moderate depression following PCI for coronary heart disease, clinical treatment mainly uses Western medicine such as escitalopram oxalate; however, it may increase the occurrence of adverse reactions during treatment and even raise the probability of cardiovascular adverse events[2]. Therefore, safer and more effective medications must be sought to improve the quality of life of patients.

Research has shown that compared to Western medicine, traditional Chinese medicine (TCM) is more effective in treating patients with post-PCI depression. TCM believes that smooth circulation of blood vessels in the body is essential for the overall wellbeing of patients, and disturbances in emotions can lead to the stagnation of liver qi and blood stasis, causing blockages in the blood vessels. The “Nei Jing” (Yellow Emperor’s Inner Canon), an ancient Chinese medical text, mentions that the heart governs blood vessels and spirits[7]. Dysfunction in these functions can lead to “dual heart diseases”, where heart and emotional disorders mutually influence each other. Shugan Jieyu capsules are widely used in clinical practice because of their calming and liver qi soothing effects. With the rapid development of second-generation sequencing, microRNAs (miRNAs) have gradually become a popular topic in clinical research. Numerous studies have confirmed the abnormal expression of miR-124 and miR-132 in patients with mental disorders and their involvement in regulating vascular neogenesis[8,9]. Therefore, this study used Shugan Jieyu capsules to treat patients with mild to moderate depression following coronary intervention and analyzed their clinical efficacy as well as their impact on the levels of miR-124, miR-132, and brain-derived neurotrophic factor (BDNF), a factor influencing the occurrence of depression.

MATERIALS AND METHODS

Study design

This study was approved by the Ethics Committee of Hospital of Beijing Armed Police Forces the initiator of the multi-center joint study. Written informed consent was obtained from the patients and/or their guardians. This randomized controlled trial enrolled patients with PCI depression of liver qi stagnation and blood stasis treated at the 305th Hospital of the People’s Liberation Army from June 2022 to November 2023. Liver qi stagnation and blood stasis were diagnosed based on TCM syndrome differentiation criteria, including symptoms such as chest and hypochondriac fullness, distending pain, depression, and restlessness. The patients were randomly divided into the experimental and control groups. The sampling method employed was consecutive sampling. Random allocation was performed using a computer-generated random number table. Allocation concealment was ensured by using sealed opaque envelopes. The “Guidelines for Rational Use of Medications for Coronary Heart Disease” were used for both groups. Based on individual underlying diseases, recommendations from various specialty departments were followed to standardize medication treatments without affecting the research. The control group was treated with escitalopram oxalate tablets (10 mg), one tablet taken on an empty stomach every morning, with a maximum dose not exceeding 20 mg/day, for 6 weeks. The experimental group was treated with Shugan Jieyu capsules (each capsule contained 0.36 g), taken twice a day, two capsules each time, divided into morning and evening doses, for 6 weeks.

Inclusion criteria included: (1) Age between 40 and 75 years; (2) Meeting the diagnosis criteria for coronary heart disease[8], coronary angiography showing coronary artery stenosis or occlusion > 50%, undergoing PCI treatment; (3) Meeting the International Classification of Diseases-10[9] diagnosis criteria for mild to moderate depression[10], with a course of at least 4 weeks; (4) Meeting the TCM syndrome differentiation diagnosis criteria for mild to moderate depression, with symptoms lasting for at least 2 weeks: Main symptoms: Chest and hypochondriac fullness, distending pain, mental depression and restlessness; (5) Secondary symptoms: Wandering pain, loss of appetite, restless sleep, thin or greasy tongue coating, and wiry and fine pulse; (6) No other drugs that could affect the trial results were used within 2 weeks before treatment; (7) Patients had clear thinking and were able to cooperate with treatment; and (8) Patients and their family members signed informed consent forms. The exclusion criteria were as follows: (1) Patients with acute myocardial infarction accompanied by hemodynamic instability; (2) Patients with severe depression; (3) Patients with severe liver or kidney dysfunction and/or other malignant primary diseases; (4) Patients with severe infections; (5) Pregnant and lactating women; (6) Patients with suspected or confirmed allergies to the relevant drugs in this study; and (7) Self-administration of other TCM treatments. The exclusion criteria were severe adverse reactions, deterioration of condition, occurrence of other life-threatening conditions requiring emergency measures, poor compliance, voluntary withdrawal from the trial, and loss to follow-up. This study was approved by the hospital Ethics Committee.

Before and after 6 weeks of treatment, the 17-item Hamilton Rating Scale for Depression (HAMD-17) was used to assess the efficacy of depression treatment in patients. The scale consists of 17 items with a total score of 54, with higher scores indicating more severe illness. The efficacy was assessed using the HAMD-17 score reduction rate, calculated as (pre-treatment score - post-treatment score)/pre-treatment score × 100%. Clinical control: HAMD score reduction rate ≥ 70%, significant efficacy: 50% ≤ HAMD score reduction rate < 70%, effective: 20% ≤ HAMD score reduction rate ≤ 50%, ineffective: HAMD score reduction rate ≤ 20%. Additionally, before and after 6 weeks of treatment, TCM syndrome scoring assessments were conducted for depressive symptoms in both groups of patients. The main symptoms were chest and hypochondriac fullness, distending pain, mental depression, and restlessness, while secondary symptoms included wandering pain, loss of appetite, and restless sleep. Symptom severity was divided into four levels: None, mild, moderate, and severe, with 0, 2, 4, and 6 points assigned for the main symptoms and 0, 1, 2, and 3 points for the secondary symptoms. The total score was 12 points for main symptoms and 9 points for secondary symptoms.

Before and after 6 weeks of treatment, morning fasting venous blood was drawn from the patients and centrifuged to obtain the serum, and the BDNF level was determined using an enzyme-linked immunosorbent assay. Low-density lipoprotein cholesterol (LDL-C) levels were determined using an automatic biochemical analyzer, and serum hypersensitive C-reactive protein (hs-CRP) levels were determined using the immunoturbidimetric method. After centrifugation to remove the clear upper serum layer, an appropriate amount of red blood cell lysate was added to lyse red blood cells. After centrifugation, the cells were washed once with phosphate buffered saline and then incubated with antibodies for lymphocyte subgroups (CD3, CD4, CD8, CD19, and CD56+16) in a lymphocyte subgroup reagent kit for 30 minutes. Finally, after washing once with phosphate buffered saline, the lymphocyte subgroups [CD3+T lymphocytes, CD3+CD4+T help (Th) lymphocytes, CD3+CD8+CTL lymphocytes, CD3-CD19+B lymphocytes, and CD3-CD56+16+natural killer (NK) cells] and the immune function index (CD3+CD4+/CD3+CD8+ ratio) in the peripheral blood of each patient were examined using a BD FACSCanto flow cytometer. Total RNA was extracted using the TRIzol reagent, and cDNA was synthesized using a reverse transcription kit. The reverse transcription products were used for real-time quantitative polymerase chain reaction. Reagent kits were purchased from the American company Sigma-Aldrich. U6 was used as the internal reference, and the polymerase chain reaction reaction conditions were as follows: Pre-denaturation at 95 °C for 10 minutes, denaturation at 95 °C for 15 seconds, annealing at 60 °C for 60 seconds, for a total of 40 cycles. The 2-ΔΔCt method was used to calculate the relative expression levels of miR-124 and miR-132 in each group, and each sample was tested three times, and the average value was calculated. Primer sequences are listed in Table 1. The occurrence of adverse reactions such as rash, nausea, abdominal pain, diarrhea, dizziness, and drowsiness during the treatment period in both groups of patients was recorded.

Table 1 Primer sequences for miR-124, miR-132, and U6

Gene	PCR primer sequences	
miR-124	Forward: 5’-GCGGTGAATGCCAAAAA-3’	
Reverse: 5’-CGCAAGGATGACACGCAAATTCGT-3’	
miR-132	Forward: 5’-ACCGTGGCTTTCGATTGTTA-3’	
Reverse: 5’-GGCGACCATGGCTGTAGACT-3’	
U6	Forward: 5’-TTGTGGAAAGGACGAAACAC-3	
Reverse: 5'-GGCCATGCTAATCTTCTG- 3'	
PCR: Polymerase chain reaction.

Statistical analysis

The experimental data were analyzed using Statistical Package for Social Science software (version 21.0; IBM, Armonk, NY, United States). Continuous variables that met the criteria for a normal distribution were presented as the mean ± SD, and differences between groups were compared using the independent two-sample t-test. Non-normally distributed data are presented as [M(P25, P75)], and intergroup differences were assessed using the non-parametric Mann-Whitney U test. Categorical data were expressed as percentages (%), and intergroup differences were compared using the χ2 or Fisher’s exact test. Statistical significance was set at P < 0.05.

RESULTS

Sixty patients with mild-to-moderate depression of liver qi stagnation and blood stasis following PCI were enrolled between June 2022 and November 2023 at the 305th Hospital of the People’s Liberation Army. Patients were randomly divided into experimental and control groups, with each group comprising 30 patients. As shown in Table 2, no significant differences in baseline characteristics were observed between the two groups (P > 0.05).

Table 2 Comparison of baseline characteristics between the two groups

Characteristic	Experimental group (n = 30)	Control group (n = 30)	P value	
Age (year)	60.07 ± 4.89	61.79 ± 4.53	0.232	
BMI (kg/m2)	23.92 ± 2.14	24.08 ± 2.67	0.768	
Males (%)	46.7	56.7	0.436	
< 2 stents (%)	63.3	53.3	0.432	
≥ 2 stents (%)	36.7	46.7	0.432	
BMI: Body mass index.

In the comparison of depression treatment efficacy between the two groups, as shown in Table 3, there was no significant difference in the efficacy of treatment for depression between the two groups (P > 0.05). As shown in Table 4, the paired t-test analysis of the HAMD-17 scores within each group before and after treatment showed significant improvements in both groups (P < 0.05).

Table 3 Comparison of depression treatment effectiveness

Group	Experimental	Control	χ 2	P value	
Number of cases	30	30			
Clinical control, n (%)	9 (30.00)	6 (20.00)			
Significant effect, n (%)	11 (36.67)	14 (46.67)			
Effective, n (%)	8 (26.67)	7 (23.33)			
Ineffective, n (%)	2 (6.67)	3 (10.00)			
Total, effectiveness rate n (%)	28 (93.33)	27 (90.00)	0.218	0.640	

Table 4 Paired t-test analysis of 17-item Hamilton Rating Scale for Depression score

Characteristic	Experimental group (n = 30)	Control group (n = 30)	P value	
Age (year)	60.07 ± 4.89	61.79 ± 4.53	0.232	
BMI (kg/m2)	23.92 ± 2.14	24.08 ± 2.67	0.768	
Males (%)	46.7	56.7	0.436	
< 2 stents (%)	63.3	53.3	0.432	
≥ 2 stents (%)	36.7	46.7	0.432	
BMI: Body mass index.

In the comparison of TCM syndrome scores between the two groups of patients (Table 5), there was no statistically significant difference in baseline TCM syndrome scores between the two groups (P > 0.05). However, after treatment, the syndrome scores for the main and secondary symptoms in the experimental group were significantly lower than those in the control group (P < 0.05).

Table 5 Comparison of traditional Chinese medicine syndrome scores in depression (mean ± SD, points)

Group	Number of cases	Main symptoms	Secondary symptoms	
Before treatment	After treatment	Before treatment	After treatment	
Experimental	30	9.51 ± 2.09	3.12 ± 0.93a	7.06 ± 1.27	2.84 ± 0.64a	
Control	30	9.32 ± 2.01	4.63 ± 1.09a	7.14 ± 1.35	3.49 ± 0.72a	
t		0.359	5.772	0.236	3.696	
P value		0.721	< 0.001	0.814	0.001	
a P < 0.05, in comparison to before treatment.

In the comparison of exercise endurance between the two groups, there was no significant difference in METs values between the experimental and control groups before treatment [(2.69 ± 0.47) vs (2.85 ± 0.68), P > 0.05]. The METs values between the two groups did not show significant difference between the two groups after treatment [(5.71 ± 1.16) vs (5.23 ± 1.23), P > 0.05].

In the comparison of biochemical indicators between the two groups (Table 6), there were no significant differences in the levels of LDL-C, hs-CRP, BDNF, miR-124, and miR-132 between the two groups before treatment (P > 0.05). After treatment, the miR-132, LDL-C, and hs-CRP levels in the experimental group were significantly lower than those in the control group (P < 0.05), whereas the miR-124 and BDNF levels were significantly higher than those in the control group (P < 0.05).

Table 6 Comparison of biochemical indicators between the two groups (mean ± SD, n = 30)

Group	Experimental	Control	t	P value	
LDL-C (mmol/L)					
Before treatment	3.21 ± 0.87	3.35 ± 0.68	0.694	0.490	
After treatment	1.61 ± 0.66a	1.97 ± 0.63a	2.161	0.035	
hs-CRP (mg/L)					
Before treatment	8.47 ± 1.23	8.89 ± 1.56	1.157	0.252	
After treatment	5.67 ± 0.59a	6.25 ± 0.67a	3.558	0.001	
BDNF (ng/mL)					
Before treatment	4.29 ± 0.97	4.58 ± 0.88	1.213	0.230	
After treatment	13.71 ± 3.16a	10.43 ± 3.93a	3.563	0.001	
miR-124					
Before treatment	0.89 ± 0.25	0.93 ± 0.26	0.607	0.546	
After treatment	1.22 ± 0.30a	1.01 ± 0.27a	2.850	0.006	
miR-132					
Before treatment	3.39 ± 0.78	3.22 ± 0.74	0.866	0.390	
After treatment	1.41 ± 0.36a	1.73 ± 0.49a	2.883	0.006	
a P < 0.05, compared to before treatment within the same group.

LDL-C: Low-density lipoprotein cholesterol; hs-CRP: High-sensitivity C-reactive protein; BDNF: Brain-derived neurotrophic factor.

As shown in Figure 1 and Table 7, before treatment, there were no significant differences in the proportions of peripheral blood lymphocyte subsets (CD3+T lymphocytes, CD3+CD4+Th lymphocytes, CD3+CD8+CTL lymphocytes, CD3-CD19+B lymphocytes, CD3-CD56+16+NK cells) and the immune index (CD3+CD4+/CD3+CD8+ ratio) between the two groups (P > 0.05). However, after treatment, the proportions of CD3+T lymphocytes, CD3+CD4+Th lymphocytes, and CD3-CD56+16+NK cells, and the immune index (CD3+CD4+/CD3+CD8+ ratio) were significantly higher in the experimental group than in the control group (P < 0.05). As shown in Table 8, the incidence of adverse reactions in the experimental group was significantly lower than that in the control group (P < 0.05).

Figure 1 Flow cytometry detection of lymphocyte subpopulation distribution of immune-related cells in two groups of patients (T, T helper, CTL, B, natural killer cells). Th: T helper; NK: Natural killer.

Table 7 Comparison of lymphocyte subgroup indicators between the two groups (mean ± SD, n = 30)

Group	Experimental	Control	t	P value	
CD3+T cells					
Before treatment	53.45 ± 4.56	52.13 ± 5.11	0.924	0.568	
After treatment	69.89 ± 5.03a,b	58.32 ± 5.25a	4.857	0.012	
CD3+CD4+Th cells					
Before treatment	29.23 ± 3.28	28.65 ± 3.42	0.874	0.646	
After treatment	40.05 ± 3.96a,b	32.35 ± 4.17a	5.231	0.009	
CD3+CD8+CTL cells					
Before treatment	25.34 ± 2.92	26.76 ± 2.87	0.922	0.0324	
After treatment	20.19 ± 3.18	24.24 ± 3.62	0.845	0.425	
CD3-CD19+B cells					
Before treatment	14.85 ± 2.33	12.56 ± 2.12	0.984	0.266	
After treatment	10.63 ± 2.96	15.32 ± 3.33	1.011	0.123	
CD3-CD56+16+NK cells					
Before treatment	11.45 ± 2.91	12.77 ± 3.04	0.651	0.758	
After treatment	15.66 ± 3.05a	13.46 ± 3.12	3.864	0.011	
a P < 0.05, compared to before treatment within the same group.

b P < 0.05, compared to the control group.

Th: T helper; NK: Natural killer.

Table 8 Comparison of the incidence rates of adverse reactions in two groups (cases)

Group	Experimental	Control	Fisher P value	
Number of cases	30	30		
Abdominal pain, n (%)	0 (0.00)	2 (6.67)		
Nausea, n (%)	0 (0.00)	2 (6.67)		
Vomiting, n (%)	0 (0.00)	1 (3.33)		
Total incidence, n (%)	0 (0.00)	5 (16.67)	0.020	

DISCUSSION

Recently, the number of patients undergoing PCI has increased with the incidence of coronary heart disease[10]. Concurrently, the number of patients with comorbid anxiety and depression has also increased. Research has shown that cardiovascular diseases and patients’ psychological well-being can mutually influence each other[7]. Abnormal changes in emotions can affect the hypothalamic-pituitary-adrenal axis, leading to hormonal imbalances, which may increase the likelihood of coronary heart disease[11]. Therefore, the field of “dual cardiology and psychology” has gained attention from clinical researchers.

Patients with cardiovascular diseases are often treated with selective serotonin reuptake inhibitors, norepinephrine reuptake inhibitors, and other psychotropic drugs to manage depression and anxiety. However, these drugs often have significant adverse effects such as bitterness in the mouth, dry mouth, dizziness, and decreased appetite, which can lead to poor medication adherence and suboptimal treatment outcomes[12]. Studies have shown that TCM can effectively improve the psychological state of patients with coronary heart disease who undergo PCI, reduce the incidence of adverse reactions, and offer advantages owing to its multi-target, multi-level, and multi-dimensional regulation[13].

This study applied Shugan Jieyu capsules in the clinical treatment and found that, compared to escitalopram oxalate tablets, Shugan Jieyu capsules were more effective in alleviating symptoms of depression in patients with PCI and comorbid mild-to-moderate depression[14]. They also demonstrated a more significant improvement in patients’ exercise tolerance, quality of life, and biochemical indicators, with a significant reduction in the incidence of adverse reactions. Although there was no significant difference in the METs values between the two groups, other indicators suggested a positive trend in exercise tolerance, contributing to an overall improvement in the quality of life.

The “Expert Consensus on Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Dual Cardiac Diseases” summarizes the causes of dual cardiac diseases into three aspects: Emotional discomfort leading to meridian blockage, dietary irregularities affecting the spleen and stomach, and prolonged cardiovascular disease leading to loss of confidence and heart blood depletion[15]. Shugan Jieyu capsules, mainly composed of Guan Ye Jin Si Tao and Ci Wu Jia, are used to treat liver qi stagnation in the cases of deficiency and weakness, demonstrating effects such as soothing the liver, relieving depression, clearing heat, and promoting dampness.

The results of this study suggest that the antidepressant effects of Shugan Jieyu capsules are comparable to those of escitalopram oxalate tablets. Capsules primarily focus on supplementing deficiencies and purging excesses while regulating the patient’s spirit, resulting in fewer adverse reactions and better relief from clinical symptoms. Multiple studies have also indicated that Shugan Jieyu capsules can alleviate clinical symptoms in patients with coronary heart disease and mild-to-moderate comorbid depression, improve TCM syndrome scores, and align with the results of this study[16].

Furthermore, studies have shown a correlation between the serotonin transporter gene and the occurrence of coronary heart disease combined with depression[17,18]. Patients with coronary heart disease and comorbid mood disorders often have elevated levels of inflammatory factors, such as CRP and abnormal blood lipids, which can lead to vascular endothelial dysfunction. The research by Guo et al[19] found that after treating patients with coronary heart disease with PCI, who also had comorbid anxiety and depression, with Shugan Lishpi capsules, there was a significant decrease in the levels of hs-CRP and a significant increase in BDNF levels, with greater changes than those in the group treated with fluoxetine maleate. The results of this study also showed that after treatment, miR-132 levels in the experimental group significantly decreased, whereas miR-124 and BDNF levels significantly increased compared to those in the control group. This suggests that Shugan Jieyu capsules may regulate oxidative stress, cytokines, and energy metabolism to reduce inflammatory responses and regulate lipid metabolism, while improving depressive symptoms.

In summary, Shugan Jieyu capsules demonstrated good efficacy in patients with mild-to-moderate depression following PCI. They improve the patients’ physical fitness, immune capabilities, and quality of life, thereby significantly reducing the incidence of adverse reactions. This effect may be related to the downregulation of miR-132 and upregulation of miR-124 and BDNF levels.

CONCLUSION

The findings of this study demonstrate that Shugan Jieyu capsules have a significant therapeutic effect in patients with mild-to-moderate depression following PCI for coronary heart disease. This treatment effectively reduced depressive symptoms, improved biochemical indicators, and enhanced immune function. Compared with escitalopram oxalate tablets, Shugan Jieyu capsules showed a lower incidence of adverse reactions, making them safer alternatives for treating post-PCI depression. Therapeutic mechanisms may involve the regulation of miR-124, miR-132, and BDNF levels, as well as modulation of the immune system. These results suggest that Shugan Jieyu capsules could be a valuable addition to the treatment regimens for patients with depression after PCI.

Data sharing statement

The data presented in this study are available on request from the corresponding author.

Institutional review board statement: This study was approved by the Ethics Committee of Hospital of Beijing Armed Police Forces the initiator of the multi-center joint study.

Informed consent statement: Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patients to publish this paper.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Psychiatry

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade B

Novelty: Grade A

Creativity or Innovation: Grade A

Scientific Significance: Grade B

P-Reviewer: Susanto TD S-Editor: Wang JJ L-Editor: A P-Editor: Xu ZH
==== Refs
1 Saini RK Chaudhury S Singh N Chadha DS Kapoor R Depression, anxiety, and quality of life after percuataneous coronary interventions Ind Psychiatry J 2022 31 6 18 35800859
2 Dubovsky SL Ghosh BM Serotte JC Cranwell V Psychotic Depression: Diagnosis, Differential Diagnosis, and Treatment Psychother Psychosom 2021 90 160 177 33166960
3 Mujtaba SF Sial JA Karim M Depression and Anxiety in patients undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome Pak J Med Sci 2020 36 1100 1105 32704297
4 Ashour A Al-Rawashdeh S Tanash M Al-Smadi A Alshraifeen A Shajrawi A Changes in the Anxiety Levels of Patients Undergoing Percutaneous Coronary Intervention Dimens Crit Care Nurs 2023 42 15 21 36413641
5 Song R Sun N Song X The Efficacy of Psychological Capital Intervention (PCI) for Depression From the Perspective of Positive Psychology: A Pilot Study Front Psychol 2019 10 1816 31447745
6 Wang S Li H Chen X Yan N Wen D The mediating role of psychological capital in the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic: a cross-sectional study BMC Psychiatry 2023 23 398 37277718
7 Gu G Zhou Y Zhang Y Cui W Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment BMC Psychiatry 2016 16 259 27450548
8 van Dijk MR Utens EM Dulfer K Al-Qezweny MN van Geuns RJ Daemen J van Domburg RT Depression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up Eur J Prev Cardiol 2016 23 552 558 25665581
9 Patel N Kellezi B Williams AC Psychological, social and welfare interventions for psychological health and well-being of torture survivors Cochrane Database Syst Rev 2014 2014 CD009317 25386846
10 Han X Zhang S Chen Z Adhikari BK Zhang Y Zhang J Sun J Wang Y Cardiac biomarkers of heart failure in chronic kidney disease Clin Chim Acta 2020 510 298 310 32710942
11 Askin L Uzel KE Tanrıverdi O Kavalcı V Yavcin O Turkmen S The relationship between coronary artery disease and depression and anxiety scores North Clin Istanb 2020 7 523 526 33163893
12 Liang B Gu N Traditional Chinese Medicine for Coronary Artery Disease Treatment: Clinical Evidence From Randomized Controlled Trials Front Cardiovasc Med 2021 8 702110 34422929
13 Min H Xu YI Shaowei Y Xueli WU Shuoshi W Diancheng HE Gehua Jiejiu Dizhi decoction ameliorates alcoholic fatty liver in mice by regulating lipid and bile acid metabolism and with exertion of antioxidant stress based on 4DLabel-free quantitative proteomic study J Tradit Chin Med 2024 44 277 288 38504534
14 Wu T Yue T Yang P Jia Y Notable efficacy of Shugan Jieyu capsule in treating adult with post-stroke depression: A PRISMA-compliant meta-analysis of randomized controlled trials J Ethnopharmacol 2022 294 115367 35562090
15 Lue HC Su YC Lin SJ Huang YC Chang YH Lin IH Yang SP Taipei consensus on integrative traditional Chinese and Western Medicine J Formos Med Assoc 2021 120 34 47 32151487
16 Liu Z Gu C Lei J Meta-analysis of Shugan Jieyu Capsule for depression in patients with coronary heart disease Medicine (Baltimore) 2023 102 e34685 37653746
17 Bucciarelli V Caterino AL Bianco F Caputi CG Salerni S Sciomer S Maffei S Gallina S Depression and cardiovascular disease: The deep blue sea of women's heart Trends Cardiovasc Med 2020 30 170 176 31109802
18 Bozzini S Gambelli P Boiocchi C Schirinzi S Falcone R Buzzi P Storti C Falcone C Coronary artery disease and depression: possible role of brain-derived neurotrophic factor and serotonin transporter gene polymorphisms Int J Mol Med 2009 24 813 818 19885623
19 Guo M Zi MJ Xi RX Yang QN Bai RN Zhang YS Wang YH Wang PL Shi DZ Effect of Xinyue capsules on patients with coronary heart disease after percutaneous coronary intervention: study protocol for a randomized controlled trial Trials 2016 17 412 27538952
