抑郁症是一种发病机制复杂的精神疾病，其主要为多种发病机制相互关联，高度复杂。传统中药在其治疗中的潜力日益受到关注。最新研究表明，中药通过多靶点机制发挥抗抑郁作用，包括调节单胺类神经递质（如5-羟色胺、去甲肾上腺素和多巴胺）以恢复突触传递平衡。此外，中药可增强脑源性神经营养因子的表达，促进神经可塑性和神经元存活。通过调控下丘脑-垂体-肾上腺轴，进一步缓解应激诱导的过度激活，改善糖皮质激素失调。还能通过平衡促炎与抗炎因子水平减轻神经炎症，并通过改善线粒体功能障碍增强能量代谢、减少氧化应激。值得注意的是，微生物-肠-脑轴作为关键调节途径，中药通过恢复肠道菌群稳态、增强肠道屏障完整性，从而调控脑-肠双向通讯。同时，中药靶向表观遗传修饰可实现对抑郁相关基因表达的长期调控。这种整体性策略凸显了中药通过多系统协同干预治疗抑郁症异质性病理的独特优势，为开发循证整合疗法提供了新思路。通过中药对抑郁症研究现状进行综述，旨在探讨中药治疗抑郁症的有效性和机制。

Depression is a complex psychiatric disorder characterized by intricate interactions among multiple pathogenic mechanisms. Growing attention has been directed toward the therapeutic potential of traditional Chinese medicine (TCM) in its management. Recent advances demonstrate that TCM exerts antidepressant effects through multi-target mechanisms, including modulation of monoamine neurotransmitters (5-hydroxytryptamine, norepinephrine, and dopamine) to restore synaptic transmission balance. Additionally, TCM enhances brain-derived neurotrophic factor expression, thereby promoting neuroplasticity and neuronal survival. By regulating the hypothalamic-pituitary-adrenal axis, the excessive activation induced by stress is further alleviated and the glucocorticoid imbalance is improved. The neuroprotective effects extend to mitigating neuroinflammation through balancing pro-/anti-inflammatory cytokines and improving mitochondrial dysfunction to enhance energy metabolism while reducing oxidative stress. Significantly, TCM modulates the microbiota-gut-brain axis by restoring gut microbial homeostasis and reinforcing intestinal barrier integrity, thereby regulating bidirectional gut-brain communication. Concurrently, TCM achieves long-term regulation of depression-associated gene expression through targeting epigenetic modifications. This holistic approach underscores TCM’s unique advantage in synergistic multi-system interventions against heterogeneous depression pathology, providing novel perspectives for developing evidence-based integrated therapies. This review synthesizes current research on TCM in depression treatment, aiming to elucidate its therapeutic efficacy and underlying mechanisms in treatment of depression.

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山西省留学人员科技活动择优资助项目（普通）（20240055）；山西省应用基础研究计划面上自然基金项目（202403021211045）；山西省高等学校一般性教学改革创新立项项目（J20230466）