Improved Resting-State Functional Dynamics in Post-stroke Depressive Patients After Shugan Jieyu Capsule Treatment

Static and dynamic interactions within the triple-network model in stroke patients with multidomain cognitive impairments

BACKGROUND

Internal capsule strokes often result in multidomain cognitive impairments across memory, attention, and executive function, typically due to disruptions in brain network connectivity. Our study examines these impairments by analyzing interactions within the triple-network model, focusing on both static and dynamic aspects.

METHODS

We collected resting-state fMRI data from 62 left (CI_L) and 56 right (CI_R) internal capsule stroke patients, along with 57 healthy controls (HC). Using independent component analysis to extract the default mode (DMN), executive control (ECN), and salience networks (SAN), we conducted static and dynamic functional network connectivity analyses (DFNC) to identify differences between stroke patients and controls. For DFNC, we used k-means clustering to focus on temporal properties and multilayer network analysis to examine integration and modularity Q, where integration represents dynamic interactions between networks, and modularity Q measures how well the network is divided into distinct modules. We then calculated the correlations between SFNC/DFNC properties with significant inter-group differences and cognitive scales.

RESULTS

Compared to HC, both CI_L and CI_R patients showed increased static FCs between SAN and DMN and decreased dynamic interactions between ECN and other networks. CI_R patients also had heightened static FCs between SAN and ECN and maintained a state with strongly positive FNCs across all networks in the triple-network model. Additionally, CI_R patients displayed decreased modularity Q.

CONCLUSION

These findings highlight that stroke can result in the disruption of static and dynamic interactions in the triple network model, aiding our understanding of the neuropathological basis for multidomain cognitive deficits after internal capsule stroke.

Analysis of radiological features in patients with post-stroke depression and cognitive impairment

Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are common complications following a stroke, significantly impacting the quality of life and survival time of survivors. Currently, the comorbidity of PSCI and PSD is receiving increasing attention, as they share some common clinical characteristics, mechanisms, risk factors, radiological features, and treatment strategies. They influence each other, with the clinical prevalence of PSD comorbid with PSCI reaching as high as 26.15 %. The prevention, screening, diagnosis, and treatment of PSD and PSCI require collaboration across clinical, radiological, and neuropsychological evaluations. This paper aims to summarize the common radiological features of both conditions from a radiological perspective, which may aid in identifying early screening and predictive imaging biomarkers.

Abnormal intrinsic functional hubs and connectivity in patients with post-stroke depression

OBJECTIVE

The present study aimed to investigate the specific alterations of brain networks in patients with post-stroke depression (PSD), and further assist in elucidating the brain mechanisms underlying the PSD which would provide supporting evidence for early diagnosis and interventions for the disease.

METHODS

Resting-state functional magnetic resonace imaging data were acquired from 82 nondepressed stroke patients (Stroke), 39 PSD patients, and 74 healthy controls (HC). Voxel-wise degree centrality (DC) conjoined with seed-based functional connectivity (FC) analyses were performed to investigate the PSD-related connectivity alterations. The relationship between these alterations and depression severity was further examined in PSD patients.

RESULTS

Relative to both Stroke and HC groups, (1) PSD showed increased centrality in regions within the default mode network (DMN), including contralesional angular gyrus (ANG), posterior cingulate cortex (PCC), and hippocampus (HIP). DC values in contralesional ANG positively correlated with the Patient Health Questionnaire-9 (PHQ-9) scores in PSD group. (2) PSD exhibited increased connectivity between these three seeds showing altered DC and regions within the DMN: bilateral medial prefrontal cortex and middle temporal gyrus and ipsilesional superior parietal gyrus, and regions outside the DMN: bilateral calcarine, ipsilesional inferior occipital gyrus and contralesional lingual gyrus, while decreased connectivity between contralesional ANG and contralesional supramarginal gyrus. Moreover, these FC alterations could predict PHQ-9 scores in PSD group.

INTERPRETATION

These findings highlight that PSD was related with increased functional connectivity strength in some areas within the DMN, which might be attribute to the specific alterations of connectivity between within DMN and outside DMN regions in PSD.

Static and dynamic functional connectivity of the habenula in late-life depression patient with suicidal ideation

BACKGROUND

Suicide is one of the most lethal complications of late-life depression (LLD), and habenular dysfunction may be involved in depression-related suicidality and may serve as a potential target for alleviating suicidal ideation. This study aimed to investigate abnormal functional connectivity of the habenula in LLD patients with suicidal ideation.

METHODS

One hundred twenty-seven patients with LLD (51 with suicidal ideation (LLD-S) and 76 without suicidal ideation (LLD-NS)) and 75 healthy controls (HCs) were recruited. The static functional connectivity (sFC) and dynamic functional connectivity (dFC) between the habenula and the whole brain were compared among the three groups, and correlation and moderation analyses were applied to investigate whether suicidal ideation moderated the relationships of habenular FC with depressive symptoms and cognitive impairment.

RESULTS

The dFC between the right habenula and the left orbitofrontal cortex (OFC) increased in the following order: LLD-S > LLD-NS > control. No significant difference in the habenular sFC was found among the LLD-S, LLD-NS and control groups. The dFC between the right habenula and the left OFC was positively associated with global cognitive function and visuospatial skills, and the association between this dFC and visuospatial skills was moderated by suicidal ideation in patients with LLD.

CONCLUSION

The increased variability in dFC between the right habenula and left OFC was more pronounced in the LLD-S group than in the LLD-NS group, and the association between habenular-OFC dFC and visuospatial skills was moderated by suicidal ideation in patients with LLD.

Withdrawn: The altered dynamic community structure for adaptive adjustment in stroke patients with multidomain cognitive impairments: A multilayer network analysis

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Effectiveness of Shugan Jieyu capsules for psychiatric symptoms of epilepsy: a systematic review and meta-analysis

BACKGROUND

The relationship between epilepsy and depression is bidirectional. One condition exacerbates the other. However, there are no current guidelines for treating depression in epilepsy patients. In some cases, seizures worsen when antidepressants (AD) are prescribed or when they are discontinued due to adverse events. The Shugan Jieyu capsule, composed of Acanthopanax senticosus and Hypericum perforatum, is a widely used herbal medicine for treating depression. This study aimed to explore the effectiveness and safety of Shugan Jieyu capsules (SJC) in relieving depression in patients with epilepsy.

METHODS

We searched English, Korean, Japanese, and Chinese databases in October 2023 to collect all relevant randomized clinical trials (RCTs). The primary outcomes were the depression scale scores and seizure frequency. The secondary outcomes were quality of life (QoL) and adverse events.

RESULTS

Nine RCTs were included in this meta-analysis. Compared with AD, SJC showed significant differences in the improvement of depression (SMD: 3.82, 95% CI: 3.25, 4.39) and reduction in seizure frequency (MD: 0.39 times/month, 95% CI: 0.28, 0.50). SJC showed more beneficial results than antiepileptic drugs (AED) in terms of antidepressant effects (SMD: 1.10, 95% CI: 0.69, 1.51) and QoL (MD: 11.75, 95% CI: 10.55, 12.95). When patients were prescribed AED, the additional administration of SJC improved depression symptoms (SMD: 0.96, 95% CI: 0.28, 1.63). The SJC treatment group had a lower incidence of side effects than the control group. However, the difference was not statistically significant.

CONCLUSIONS

Our results suggest that SJC may be effective in treating depression in patients with epilepsy. Additionally, SJC has the potential to help reduce seizure frequency in epilepsy patients with depression.

Cool the Inflamed Brain: A Novel Anti-inflammatory Strategy for the Treatment of Major Depressive Disorder

BACKGROUND

Abundant evidence suggests that inflammatory cytokines contribute to the symptoms of major depressive disorder (MDD) by altering neurotransmission, neuroplasticity, and neuroendocrine processes. Given the unsatisfactory response and remission of monoaminergic antidepressants, anti-inflammatory therapy is proposed as a feasible way to augment the antidepressant effect. Recently, there have been emerging studies investigating the efficiency and efficacy of anti-inflammatory agents in the treatment of MDD and depressive symptoms comorbid with somatic diseases.

METHODS

In this narrative review, prospective clinical trials focusing on anti-inflammatory treatment for depression have been comprehensively searched and screened. Based on the included studies, we summarize the rationale for the anti-inflammatory therapy of depression and discuss the utilities and confusions regarding the anti-inflammatory strategy for MDD.

RESULTS

This review included over 45 eligible trials. For ease of discussion, we have grouped them into six categories based on their mechanism of action, and added some other anti-inflammatory modalities, including Chinese herbal medicine and non-drug therapy. Pooled results suggest that anti-inflammatory therapy is effective in improving depressive symptoms, whether used as monotherapy or add-on therapy. However, there remain confusions in the application of anti-inflammatory therapy for MDD.

CONCLUSION

Based on current clinical evidence, anti-inflammatory therapy is a promisingly effective treatment for depression. This study proposes a novel strategy for clinical diagnosis, disease classification, personalized treatment, and prognostic prediction of depression. Inflammatory biomarkers are recommended to be assessed at the first admission of MDD patients, and anti-inflammatory therapy are recommended to be included in the clinical practice guidelines for diagnosis and treatment. Those patients with high levels of baseline inflammation (e.g., CRP > 3 mg/L) may benefit from adjunctive anti-inflammatory therapy.

Relationship between temporal dynamics of intrinsic brain activity and motor function remodeling in patients with acute BGIS

Background

patients with acute basal ganglia ischemic stroke (BGIS) show changes in local brain activity represented by the amplitude of low-frequency fluctuation (ALFF), but the time-varying characteristics of this local nerve activity are still unclear. This study aimed to investigate the abnormal time-varying local brain activity of patients with acute BGIS by using the ALFF method combined with the sliding-window approach.

Methods

In this study, 34 patients with acute BGIS with motor dysfunction and 44 healthy controls (HCs) were recruited. The dynamic amplitude of low-frequency fluctuation (dALFF) was employed to detect the alterations in brain activity induced by acute BGIS patients. A two-sample t-test comparison was performed to compare the dALFF value between the two groups and a Spearman correlation analysis was conducted to assess the relationship between the local brain activity abnormalities and clinical characteristics.

Results

Compared with HCs, the activity of neurons in the left temporal pole (TP), parahippocampal gyrus (paraHIP), middle occipital gyrus (MOG), dorsolateral superior frontal gyrus (SFGdl), medial cingulate cortex (MCC), right rectus, precuneus (PCu) and right cerebellum crus1 were significantly increased in patients with BGIS. In addition, we found that there was a negative correlation (r = -0.458, p = 0.007) between the dALFF value of the right rectus and the scores of the National Institutes of Health Stroke Scale (NIHSS), and a positive correlation (r = 0.488, 0.499, p < 0.05) with the scores of the Barthel Index scale (BI) and the Fugl Meyer motor function assessment (FMA). ROC analysis results demonstrated that the area under the curves (AUC) of the right rectus was 0.880, p<0.001.

Conclusion

The pattern of intrinsic brain activity variability was altered in patients with acute BGIS compared with HCs. The abnormal dALFF variability might be a potential tool to assess motor function in patients with acute BGIS and potentially inform the diagnosis of this disease.

The clinical application of Chinese herbal medication to depression: A narrative review

Depression severely impairs psychosocial functioning and quality of life, which places a huge burden on patients and their families. However, the physiological mechanism of depression remains unknown. Treatment with existing antidepressant medications is effective in around 50% of patients according to various studies, but is associated with severe side effects including nausea and headaches. Chinese herbal medicine (CHM) has been approved and widely used for depression as an alternative medicine in Chinese culture for decades. It has certain advantages and potential in the prevention and treatment of depression. In this review, we summarize the currently available evidence for the efficacy of CHM for the treatment of depression and physiological diseases comorbid with depression. We further discuss the possible mechanisms of action of CHM and the relationships to our current understanding of depression. The majority of current evidence has suggested that the combined treatment with CHM and mainstream antidepressants improves the response rate and reduces the side effects, while CHM alone could be more effective than placebo. However, the results should be carefully interpreted due to the shortcomings of existing clinical trials and a high risk of bias in meta-analyses. Our review provides a summary of the current applications and understanding of widely used CHMs for depression.

Altered frequency-specific/universal amplitude characteristics of spontaneous brain oscillations in patients with bipolar disorder

The human brain is a dynamic system with intrinsic oscillations in spontaneous neural activity. Whether the dynamic characteristics of these spontaneous oscillations are differentially altered across different frequency bands in patients with bipolar disorder (BD) remains unclear. This study recruited 65 patients with BD and 85 healthy controls (HCs). The entire frequency range of resting-state fMRI data was decomposed into four frequency intervals. Two-way repeated-measures ANCOVA was employed to detect frequency-specific/universal alterations in the dynamic oscillation amplitude in BD. The patients were then divided into two subgroups according to their mood states to explore whether these alterations were independent of their mood states. Finally, other window sizes, step sizes, and window types were tested to replicate all analyses. Frequency-specific abnormality of the dynamic oscillation amplitude was detected within the posterior medial parietal cortex (centered at the precuneus extending to the posterior cingulate cortex). This specific profile indicates decreased amplitudes in the lower frequency bands (slow-5/4) and no amplitude changes in the higher frequency bands (slow-3/2) compared with HCs. Frequency-universal abnormalities of the dynamic oscillation amplitude were also detectable, indicating increased amplitudes in the thalamus and left cerebellum anterior lobe but decreased amplitudes in the medial superior frontal gyrus. These alterations were independent of the patients' mood states and replicable across multiple analytic and parametric settings. In short, frequency-specific/universal amplitude characteristics of spontaneous oscillations were observed in patients with BD. These abnormal characteristics have important implications for specific functional changes in BD from multiple frequency and dynamic perspectives.

Hypericum perforatum: Traditional uses, clinical trials, and drug interactions

Hypericum perforatum (Hypericaceae), known as Saint John’s wort (SJW), has been used in different systems of traditional medicine such as Chinese traditional medicine, Greek traditional medicine, and Islamic traditional medicine. The plant and its active constituents such as hyperforin and hypericin have a wide range of medicinal uses, particularly as anti-depressant, wound-healing, and antibacterial agents. In recent decades, many clinical trials have been performed to investigate the safety and efficacy of this medicinal plant. However, to the best on our knowledge, there is no comprehensive review article in this regard. In the current study, we aim to have a comprehensive review of the clinical trials of SJW to evaluate its efficacy and safety as well as its application in traditional medicine. Clinical studies investigating the safety, interactions, and efficacy of SJW were identified and summarized, including contributions from 2000 until December 2021. According to the results, these clinical studies were divided into three main categories based on the type of disease: psychiatric, endocrine, and skin problems. Important details of the studies, including the type and duration of the study, the type and percentage of the effective compounds or the extract used, the number of patients, and the obtained results were also discussed. In addition, co-administration and drug interaction of SJW with other drugs were summarized. SJW is a valuable medicinal plant, especially for psychiatric disorders. However, precautions should be taken while administrating the plant.

Potential Mechanisms of Shu Gan Jie Yu Capsule in the Treatment of Mild to Moderate Depression Based on Systemic Pharmacology and Current Evidence

Background

Shu Gan Jie Yu (SGJY) capsule has a good effect on relieving depressive symptoms in China. However, the mechanism of action is still unclear. Therefore, systemic pharmacology and molecular docking approaches were used to clarify its corresponding antidepressant mechanisms.

Methods

Traditional Chinese Medicine Database and Analysis Platform (TCMSP), the Encyclopedia of Traditional Chinese Medicine (ETCM), and Swiss Target Prediction servers were used to screen and predict the bioactive components of the SGJY capsule and their antidepressive targets. Mild to moderate depression (MMD) related genes were obtained from GeneCards and DisGeNET databases. A network of bioactive components-therapeutic targets of the SGJY capsule was established by STRING 11.5 and Cytoscape 3.9.0 software. Gene function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed by utilizing Database for Annotation, Visualization, and Integrated Discovery (DAVID) platform. Active components were taken to dock with the hypothetical proteins by iGEMDOCK and SwissDock, and the docking details were visually displayed by UCSF Chimera software. Then, the related research literature of the SGJY capsule was reviewed, summarized, sorted, and analyzed, including experimental evidence and clinical experience.

Results

Seven active components and 45 intersection targets were included in the study. PPI network had genuinely uncovered the potential therapeutic targets, such as AKT1, HSP90AA1, ESR1, EGFR, and PTGS2. KEGG pathway analysis showed that the mechanism of the SGJY capsule on MMD was mainly involved in the PI3K-Akt signaling pathway.

Conclusions

In this study, we have successfully predicted the biochemically active constituents, potential therapeutic targets, and comprehensively predicted the related drug-gene interaction of the SGJY capsule for treating MMD and provided a basis for subsequent experiments.

Notable efficacy of Shugan Jieyu capsule in treating adult with post-stroke depression: A PRISMA-compliant meta-analysis of randomized controlled trials

ETHNOPHARMACOLOGICAL RELEVANCE

Post stroke depression (PSD), which happens in 40%-60% stroke patients, is one of the most common complications after cerebrovascular accident. Shugan Jieyu Capsule (SGJYC), a traditional Chinese medicine, has been widely prescribed for PSD in China.

AIM OF THE STUDY

This study designed and conducted a PRISMA compliant meta-analysis to evaluate the efficacy of SGJYC in treating adults with PSD of randomized controlled trials (RCTs) under the condition that none PRISMA-compliant systematic evaluation or meta-analysis was conducted to fully evaluate the efficacy of SGJYC.

METHODS

The study protocol has been registered in PROSPERO with registration number CRD42021250162. PubMed, ScienceDirect, CNKI, and Wanfang Databases were systematically searched to include eligible RCTs which used SGJYC and other antidepressants or placebo for the treatment of PSD adults with the Hamilton Depression Scale (HAMD). The Cochrane Risk of Bias 2 (RoB2) tool was used to evaluate the quality of included RCTs. Outcome measures including HAMD continuous data, efficacy data, and remission data were extracted for meta-analysis on a random-effects model. Adequate essential analyses including subgroup analysis, sensitivity analysis, and meta-regression analysis were performed according to the characteristics of RCTs to test the reliability and robustness of the overall effect sizes. Publication bias was detected with funnel plot, Egger's test, and Begg's test. The evidence strength of this meta-analysis was assessed with the GRADE method.

RESULTS

A total of 63 eligible RCTs and 6036 participants were included. The RoB2 found that the overall risk of included RCTs was high. The MD of continuous data was 3.59 (95% CI: [2.63, 4.55]) with statistical significance (P < 0.00001) and significant heterogeneity (Chi² = 2083.77, I² = 97%, p < 0.00001). The OR of efficacy data was 2.12 (95% CI: [1.82, 2.47]) with statistical significance (P < 0.00001) and insignificant heterogeneity (Chi² = 60.52, I² = 22%, P = 0.09). The OR of remission data was 1.66 (95% CI: [1.45, 1.91]) with statistical significance (P < 0.00001) and insignificant heterogeneity (Chi² = 26.45, I² = 0%, P = 0.96). Adequate essential analyses found consistent results of overall effect sizes and most publication bias analyses found insignificant results. The overall evidence strength was assessed as moderate.

CONCLUSION

The moderate evidence strength from this PRISMA-compliant meta-analysis found that SGJYC has notable efficacy in treating adults with PSD, although the quality of included RCT was low. The high-quality RCTs with large-sample, multi-centers, and long follow-up periods are still warranted to improve the evidence quality of SGJYC for PSD in further study.

Efficacy and Safety of Shuganjieyu Capsule Alone or in Combination with Other Antidepressants in the Treatment of Postpartum Depression: A Meta-Analysis

Objective

To evaluate the efficacy and safety of Shuganjieyu capsule alone or in combination with other antidepressants in the treatment of postpartum depression.

Methods

Related control and randomized studies till August 1, 2021, were retrieved from the following databases: PubMed, Cochrane, CNKI, CMB, Wan-Fang, and VIP. Outcomes included HAMD reduction from baseline, response rate, and adverse events rate. Review Manager 5.3 was used in the present meta-analysis.

Results

16 studies including 1409 participants were included in the present study. In comparison of single Shuganjieyu capsule versus regular antidepressant, 8, 6, and 4-week HAMD reduction of the Shuganjieyu group were significantly higher (8-week MD: 3.1 (1.54, 4.66), p < 0.0001; 6-week MD: 0.71 (0.10, 1.31), p=0.02; and 4-week MD: 0.82 (0.34, 1.30), p=0.0008), response rates were comparable for the two groups (OR: 1.51 (0.87, 2.63), p=0.014), and the adverse event rate of the Shuganjieyu group was significantly lower (OR: 0.22 (0.15, 0.32), p < 0.00001). In comparison of combination of Shuganjieyu capsule with regular antidepressant versus regular antidepressant alone, the 8, 6, 4, 2, and 1-week HAMD reduction and response rate of combination of Shuganjieyu with the regular antidepressant group were significantly larger (8-week MD: 3.2 (1.34, 5.06), p=0.0007; 6-week MD: 4.00 (2.72, 5.28), p < 0.00001; 4-week MD: 3.33 (1.94,4.73), p < 0.00001; 2-week MD: 2.69 (1.34, 4.03), p < 0.0001; 1-week MD: 2.27 (0.69, 3.86), p=0.005; and response rate OR: 4.69 (2.27, 9.68), p < 0.0001) and the adverse event rate was comparable for the two groups (OR: 1.26 (0.73, 2.17), p=0.41).

Conclusion

Compared with regular antidepressants, single Shuganjieyu capsule has similar efficacy and better safety profile; when Shuganjieyu capsule is combined with regular antidepressants, the efficacy is improved significantly without increasing adverse events. Therefore, Shuganjieyu capsule was effective and safe for postpartum, making it worth further investigation and popularization.

Antidepressant Shugan Jieyu Capsule Alters Gut Microbiota and Intestinal Microbiome Function in Rats With Chronic Unpredictable Mild Stress -Induced Depression

Shugan Jieyu Capsule (SG) has been widely used in China to treat mild to moderate depression. Hypericum perforatum L. (St John’s Wort, SJW) is the main ingredient of SG and has been used as herbal medicine to treat depression in western countries. However, it is known that SJW has low bioavailability and does not easily get through the blood-brain barrier. Therefore, how SG plays an antidepressant effect in the central nervous system (CNS) remains an urgent problem to be solved. Mounting research has described the relationship between antidepressants and intestinal microbiota to illuminate antidepressive mechanisms in the CNS. We aimed to investigate the effects of therapy with SG on the function of gut microbiota and intestinal microbiota in rats with chronic unpredictable mild stress (CUMS)-induced depression. The psychophysiological state and the hypothalamic-pituitary-adrenal axis function of rats are evaluated through behavioral experiments, corticosterone levels, serotonin levels, and adrenal index measurements. 16S rDNA amplicon sequencing is used to test the changes in gut microbiota and make functional predictions of genes. With treatment of SG, the depression-like behaviors of CUMS-induced rats were reversed; the corticosterone levels and the adrenal index decreased significantly; the level of serotonin increased significantly; and the alpha and beta diversity analysis of microbiota showed an increase in the richness and uniformity of the flora were increased. SG regulated the relative abundance of Actinobacteria, Erysipelotrichaceae, Bifidobacteriaceae, Atopobiaceae, Dubosiella, and Bifidobacterium; Linear discriminant analysis effect size analysis demonstrated that Lactobacillaceae (family level), Lactobacillus (genus level), Lactobacillales (order level), Bacilli (class level), and Lactobacillus-reuteri (species level) were biomarkers in the SG group samples, and also likely to modulate metabolic pathways, such as those involved in carbohydrate metabolism, amino acid metabolism, and signal transduction. These data clearly illustrated the effect of SG on gut microbiome, thus laying the foundation for uncovering more insights on the therapeutic function of the traditional Chinese antidepressants. The potential of SG on mechanisms of antidepression to alter gut microbiota and intestinal microbiome function exposed to CUMS can be explored.

Improving Depressive Symptoms of Post-stroke Depression Using the Shugan Jieyu Capsule: A Resting-State Functional Magnetic Resonance Imaging Study

Regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation (fALFF) were used to detect the neuroimaging mechanism of Shugan Jieyu Capsule (SG) in ameliorating depression of post-stroke depression (PSD) patients. Fifteen PSD patients took SG for 8 weeks, completed the 24-item Hamilton Depression Scale (HAMD) assessment at the baseline and 8 weeks later, and underwent functional magnetic resonance imaging (fMRI) scanning. Twenty-one healthy controls (HCs) underwent these assessments at the baseline. We found that SG improved depression of PSD patients, in which ReHo values decreased in the left calcarine sulcus (CAL.L) and increased in the left superior frontal gyrus (SFG.L) of PSD patients at the baseline. The fALFF values of the left inferior parietal cortex (IPL.L) decreased in PSD patients at the baseline. Abnormal functional activities in the brain regions were reversed to normal levels after the administration of SG for 8 weeks. Receiver operating characteristic (ROC) analysis found that the changes in three altered brain regions could be used to differentiate PSD patients at the baseline and HCs. Average signal values of altered regions were related to depression in all subjects at the baseline. Our results suggest that SG may ameliorate depression of PSD patients by affecting brain region activity and local synchronization.

Distinct Functional Cortico-Striato-Thalamo-Cerebellar Networks in Genetic Generalized and Focal Epilepsies with Generalized Tonic-Clonic Seizures

This study aimed to delineate cortico-striato-thalamo-cerebellar network profiles based on static and dynamic connectivity analysis in genetic generalized and focal epilepsies with generalized tonic-clonic seizures, and to evaluate its potential for distinguishing these two epilepsy syndromes. A total of 342 individuals participated in the study (114 patients with genetic generalized epilepsy with generalized tonic-clonic seizures (GE-GTCS), and 114 age- and sex-matched patients with focal epilepsy with focal to bilateral tonic-clonic seizure (FE-FBTS), 114 healthy controls). Resting-state fMRI data were examined through static and dynamic functional connectivity (dFC) analyses, constructing cortico-striato-thalamo-cerebellar networks. Network patterns were compared between groups, and were correlated to epilepsy duration. A pattern-learning algorithm was applied to network features for classifying both epilepsy syndromes. FE-FBTS and GE-GTCS both presented with altered functional connectivity in subregions of the motor/premotor and somatosensory networks. Among these two groups, the connectivity within the cerebellum increased in the static, while the dFC variability decreased; conversely, the connectivity of the thalamus decreased in FE-FBTS and increased in GE-GTCS in the static state. Connectivity differences between patient groups were mainly located in the thalamus and cerebellum, and correlated with epilepsy duration. Support vector machine (SVM) classification had accuracies of 66.67%, 68.42%, and 77.19% when using static, dynamic, and combined approaches to categorize GE-GTCS and FE-GTCS. Network features with high discriminative ability predominated in the thalamic and cerebellar connectivities. The network embedding of the thalamus and cerebellum likely plays an important differential role in GE-GTCS and FE-FBTS, and could serve as an imaging biomarker for differential diagnosis.

Shugan Jieyu Capsule in Post-Stroke Depression Treatment: From Molecules to Systems

Post-stroke depression (PSD) is the most common non-cognitive neuropsychiatric complication after stroke, and about a third of patients with stroke have depression. Although a great deal of effort has been made to treat PSD, the efficacy thereof has not been satisfactory, due to the complex pathological mechanism underlying PSD. In Traditional Chinese Medicine (TCM) theory, PSD is considered to be a combination of “stroke” and “Yu Zheng.” The holistic, multi-drug, and multi-objective nature of TCM is consistent with the treatment concept of systems medicine for PSD. TCM has a very long history of being used to treat depression, and various TCM prescriptions have been clinically proven to be effective in improving depression. Among the numerous prescriptions for treating depression, Shugan Jieyu capsule (SG) is one of the classic prescriptions. Additionally, clinical studies have increasingly confirmed that using SG alone or in combination with Western medicine can significantly improve the psychiatric symptoms of PSD patients. Here, we reviewed the mechanism of antidepressant action of SG and its targets in PSD pathologic systems. This review provides further insights into the pharmacological mechanism, drug interaction, and clinical application of TCM prescriptions, as well as a basis for the development of new drugs to treat PSD.

MicroRNA-124: A Key Player in Microglia-Mediated Inflammation in Neurological Diseases

Neurological disorders are mainly characterized by progressive neuron loss and neurological deterioration, which cause human disability and death. However, many types of neurological disorders have similar pathological mechanisms, including the neuroinflammatory response. Various microRNAs (miRs), such as miR-21, miR-124, miR-146a, and miR-132 were recently shown to affect a broad spectrum of biological functions in the central nervous system (CNS). Microglia are innate immune cells with important roles in the physiological and pathological activities of the CNS. Recently, abnormal expression of miR-124 was shown to be associated with the occurrence and development of various diseases in CNS via regulating microglia function. In addition, miR-124 is a promising biomarker and therapeutic target. Studies on the role of miR-124 in regulating microglia function involved in pathogenesis of neurological disorders at different stages will provide new ideas for the use of miR-124 as a therapeutic target for different CNS diseases.

Shared and specific dynamics of brain segregation and integration in bipolar disorder and major depressive disorder: A resting-state functional magnetic resonance imaging study

BACKGROUND

When bipolar disorder (BD) presents as the depressive state, it is often misdiagnosed as major depressive disorder (MDD). However, few studies have focused on dynamic differences in local brain activity and connectivity between BD and MDD. Therefore, the present study explored shared and specific patterns of abnormal dynamic brain segregation and integration in BD and MDD patients.

METHODS

BD Patients (n = 106), MDD patients (n = 114), and 130 healthy controls (HCs) underwent resting state functional magnetic resonance imaging (fMRI). We first used a sliding window analysis to evaluate the dynamic amplitude of low-frequency fluctuations (dALFF) and, based on the altered dALFF, further analyzed the dynamic functional connectivity (dFC) using a seed-based approach.

RESULTS

Both the BD and MDD groups showed decreased temporal variability of the dALFF (less dynamic segregation) in the bilateral posterior cingulate cortex (PCC)/precuneus compared with the HCs. The MDD group showed increased temporal variability of the dALFF (more dynamic segregation) in the left putamen compared with the controls, but there was no significant difference between the BD and HCs. The dFC analysis also showed that both the BD and MDD groups had reduced dFC (less dynamic integration) between the bilateral PCC/ precuneus and the left inferior parietal lobule compared with the HCs.

LIMITATIONS

This study was cross-sectional and did not examine data from remitted BD and MDD patients.

CONCLUSION

Our findings indicated disrupted dynamic balance between segregation and integration within the default mode network in both BD and MDD. Moreover, we found MDD-specific abnormal brain dynamics in the putamen.

Dynamic Alterations of Amplitude of Low-Frequency Fluctuations in Patients With Drug-Naïve First-Episode Early Onset Schizophrenia

Abnormalities in static neural activity have been widely reported in early onset schizophrenia (EOS). However, dynamic brain activity alterations over time in EOS are unclear. Here, we investigated whether temporal dynamic changes in spontaneous neural activity are influenced by EOS. A total of 78 drug-naïve first-episode patients with EOS and 90 healthy controls (HCs) were enrolled in this study. Dynamic amplitude of low-frequency fluctuations (dALFF) was performed to examine the abnormal time-varying local neural activity in EOS. Furthermore, we investigated the relationships between abnormalities in dALFF variability and clinical characteristics in EOS patients. Compared to HCs, EOS patients showed significantly decreased dALFF variability in the bilateral precuneus, right superior marginal gyrus, right post-central gyrus and increased dALFF in the right middle temporal gyrus (MTG). Moreover, increased dALFF variability in MTG was negatively associated with negative symptoms in EOS. Our findings reveal increased dynamic local neural activity in higher order networks of the cortex, suggesting that enhanced spontaneous brain activity may be a predominant neural marker for brain maturation. In addition, decreased dALFF variability in the default mode network (DMN) and limbic system may reflect unusually dynamic neural activity. This dysfunctional brain activity could distinguish between patients and HCs and deepen our understanding of the pathophysiological mechanisms of EOS.