Chinese herbal medicines for the treatment of depression: a systematic review and network meta-analysis

Systematic review and Bayesian network meta-analysis of 198 randomized controlled trials including 8,923 patients with depression or depressive symptoms. The review compared multiple Chinese herbal medicines with conventional antidepressants, placebo, or no treatment.

This review evaluated a range of Chinese herbal medicine regimens used for depression, including decoctions, formulas, capsules, pills, and powders. The active interventions were compared with standard antidepressants, placebo, or no treatment across randomized trials. Named regimens highlighted as promising included Guipiwan, Ease Pill, Chaihu Jia Longgu Muli Decoction, Chai Hu Shu Gan San, Danzhi-Xiaoyao-San, Buyang Huanwu Decoction, Xiaoyao Powder, Huoxue Soup Decoction, Wendan Anshen Decoction, Wuling Capsule, Yueju Pill, Gan Mai Da Zao Decoction, and Xingnao Jieyu Decoction.

Overall, several Chinese herbal medicines appeared promising for treating depression, with multiple formulations ranking highly for efficacy and many showing lower adverse-event risk than common antidepressants. Guipiwan and Ease Pill ranked highly for response rate, while Chaihu Jia Longgu Muli Decoction, Chai Hu Shu Gan San, Danzhi-Xiaoyao-San, Gan Mai Da Zao Decoction, Buyang Huanwu Decoction, and Xingnao Jieyu Decoction were among the more favorable options for reducing HAMD scores. Xiaoyao Powder was highlighted as having the lowest adverse-event incidence and one of the best safety rankings. The authors concluded that these medicines may be beneficial, but larger, more diverse, and longer-term studies are needed to confirm efficacy and safety.

Most findings were based on network rankings and qualitative comparative statements rather than arm-specific effect sizes, p-values, or confidence intervals in the provided text. Some highly ranked interventions were supported by small samples, and the evidence likely reflects heterogeneity across herbal formulations, comparators, depression severity, and trial quality. The review also notes the need for larger, more diverse, and longer-term trials.