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Review
. 2025 Jun 3:16:1539357.
doi: 10.3389/fphar.2025.1539357. eCollection 2025.

Innovative strategies for post-stroke depression: integrating traditional Chinese medicine with neurobiological insights, including the gut-brain axis

Lin Zhu #  1   2 , Ruina Han #  1 , Linxia He #  1 , Bingfa Pan  3 , Weijie Zhong  2 , Yi Li  2 , Xinru Liu  1
Affiliations
Review

Innovative strategies for post-stroke depression: integrating traditional Chinese medicine with neurobiological insights, including the gut-brain axis

Lin Zhu et al. Front Pharmacol. .

Abstract

Post-stroke depression (PSD) is a debilitating condition affecting more than one-third of stroke survivors, leading to significant impairments in mood, cognitive function, and overall quality of life. While conventional treatments like selective serotonin reuptake inhibitors (SSRIs) are commonly used, their efficacy is often limited, and they are associated with adverse side effects. Emerging research underscores the critical roles of neuroinflammation, neurotransmitter imbalances, and disruptions in the gut-brain axis in the development and progression of PSD, suggesting that targeting these pathways could lead to more effective therapeutic outcomes. Traditional Chinese Medicine (TCM) presents a promising multi-faceted approach, addressing these complex biological mechanisms by regulating neurotransmitter systems, modulating immune responses, and restoring gut microbiota balance. Key herbs such as Salvia miltiorrhiza Bunge (Lamiaceae; Dan Shen) and Bupleurum chinense DC. (Apiaceae; Chai Hu) have shown significant potential in modulating neurotransmitter levels, reducing neuroinflammation, and providing neuroprotection. Additionally, TCM formulations like Chaihu Shugan Powder (CSP) and Shugan Jieyu Capsules (SG) further enhance these effects by promoting gut microbiota homeostasis and restoring metabolic balance. This review delves into the biological mechanisms underlying PSD, with a particular focus on neuroinflammation, neurotransmitter dysregulation, and gut-brain axis dysfunction. It also explores the potential of integrating TCM with advanced multi-omics technologies-such as metabolomics, metagenomics, and transcriptomics-to develop personalized treatment strategies for PSD. By combining the holistic principles of TCM with modern Western medicine and cutting-edge omics technologies, this integrative approach offers a comprehensive framework for managing PSD, with the potential to significantly improve recovery outcomes and enhance the quality of life for stroke survivors.

Keywords: gut-brain axis; neuroinflammation; neurotransmitter; post-stroke depression (PSD); traditional Chinese medicine (TCM).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Molecular mechanisms underlying PSD.
FIGURE 2
FIGURE 2
Multi-omics approaches to optimize TCM interventions.
FIGURE 3
FIGURE 3
TCM regulates the gut-brain axis to treat PSD.
FIGURE 4
FIGURE 4
Herbal interventions for enhancing recovery in PSD.
See this image and copyright information in PMC

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