Effectiveness and safety of traditional East Asian herbal medicine for major depressive disorder with anxiety: a systematic review and meta-analysis

Objectives: Traditional East Asian herbal medicine (TEAHM) has been used for centuries to treat depression and anxiety. However, conventional psychopharmacological treatments for major depressive disorder (MDD) and anxiety have limitations. This systematic review aimed to provide evidence for the effectiveness and safety of TEAHM in patients with MDD and anxiety.Methods: Eleven electronic databases were searched until July 22, 2024, for randomized controlled trials (RCTs) using TEAHM to treat MDD and anxiety. The Cochrane risk of bias tool was used for quality assessment. TEAHM’s effectiveness and safety were evaluated in a meta-analysis.Results: Seventeen RCTs involving 1,730 participants were included. TEAHM alone significantly improved the Hamilton Anxiety Scale (HAMA) scores compared to those with the use of antidepressants alone ((MD = -1.52, 95% CI: -1.96 to -1.08, P < 0.00001, I² = 95%). Their combination significantly improved the HAMA scores (MD = -1.29, 95% CI: -1.49 to -1.09, P < 0.00001, I² = 97%). Compared with antidepressants alone, TEAHM alone or in combination significantly improved Hamilton Depression Scale scores. The risk with TEAHM alone and combination therapy was similar to that with antidepressants alone. No severe adverse events were observed. Overall, the risk of bias was high. The quality of the evidence ranged from low to moderate.Conclusions: TEAHM or combination therapy may be beneficial for treating patients with MDD and anxiety. However, these findings should be interpreted cautiously due to low methodological quality and clinical heterogeneity of the included studies. Higher-level clinical trials are required in the future.