Chinese herbal medicine improves depressive symptoms and regulates hormonal levels in the treatment of menopausal depression: A systematic review and meta-analysis

To evaluate the effectiveness and safety of Chinese herbal medicine (CHM) in the treatment of menopausal depression. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, Chongqing VIP, and SinoMed were searched. All RCTs were assessed for eligibility and data extraction, subsequently assessed on the quality with the Cochrane Risk of Bias Tool. Meta-analysis was performed on RevMan Web on all included studies for the Hamilton Depression Rating Scale (HAMD), Kupperman Menopausal Index (KMI), serum levels of follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol (E2), and adverse events. The review included 27 RCTs with 2540 participants. The quality of studies included was generally poor. Nevertheless, single use of CHM or in combination with conventional medicine significantly improved HAMD and KMI scores ( p <0.0001). CHM appears to be able to complement conventional medicine in further reducing serum FSH and LH, while increasing E2 levels. Subgroup analysis revealed that 4, 6 and 8 weeks of CHM can significantly reduce HAMD score, except for 12 weeks with no significant difference; while capsules and decoction type of CHM can significantly reduce HAMD scores, unlike granules type of CHM. Adverse events were lesser reported in the group that uses CHM when compared to single use of conventional medicine. CHM has its effectiveness in menopausal depression women when being used alone or may provide additional efficacies when used in combination with conventional medicine, as well as lesser side effects were reported whenever CHM is being used.