Meta-analysis on the efficacy of liver-soothing formulas for perimenopausal anxiety and depression

Abstract

BACKGROUND

Perimenopausal women are prone to anxiety and depression due to fluctuating hormone levels, which significantly impair their quality of life. The current treatments have certain limitations. In traditional Chinese medicine, liver-soothing formulas are commonly prescribed for mood-related disorders, but their overall efficacy in perimenopausal anxiety and depression remains uncertain and requires verification through meta-analysis.

AIM

To provide evidence-based support for clinical decision-making and research, a meta-analysis was conducted to evaluate the effectiveness of liver-soothing formulas in treating perimenopausal anxiety and depression.

METHODS

Relevant studies published up to April 2025 were retrieved from ClinicalTrials.gov, PubMed, Web of Science, EMBASE, and the Cochrane Library. Eligible studies were screened according to predefined inclusion and exclusion criteria. Data were extracted and analyzed using the Stata 12.0 software.

RESULTS

After searching and screening, 12 articles involving 1798 patients (922 in the treatment group and 876 in the control group) were included in the analysis. Meta-analysis showed that the standardized scores for anxiety [standardized mean difference (SMD) = -0.71, 95% confidence interval (95%CI): -1.06 to -0.36] and depression (SMD = -0.67, 95%CI: -1.06 to -0.27) of the treatment group were lower than those of the control group. Subgroup analysis results revealed that for anxiety, liver-soothing formulas used alone (SMD = -0.34, 95%CI: -0.50 to -0.18) or in combination (SMD = -0.88, 95%CI: -1.43 to -0.34) both significantly reduced scores compared with the control group. For depression, monotherapy of liver-soothing formulas showed no significant statistical difference between the treatment and control groups (SMD = -0.47, 95%CI: -1.11 to 0.17), whereas combination therapy produced significantly lower standardized scale scores in the treatment group than in the control group, with a statistically significant difference (SMD = -0.83, 95%CI: -1.39 to -0.28). Regarding Greene scores, no statistically significant difference was observed with monotherapy (SMD = 0.87, 95%CI: -0.32 to 2.06), whereas combination therapy had significantly lower Greene scores (SMD = -0.24, 95%CI: -0.44 to -0.04). No statistically significant difference was found between the groups in the occurrence of adverse reactions (odds ratio = 0.90, 95%CI: 0.57-1.43). However, liver-soothing formulas did not affect estrogen levels in perimenopausal women.

CONCLUSION

Compared with placebo, conventional Western medicine, or other interventions, the monotherapy of liver-soothing formulas demonstrates superior efficacy in treating perimenopausal anxiety. When used as an adjuvant, they exert a synergistic effect in alleviating negative emotions and improving overall perimenopausal symptoms.

Keywords: Liver soothing; Traditional Chinese medicine formula; Perimenopause; Anxiety and depression; Randomized controlled trial

Core Tip: This meta-analysis evaluates the efficacy of liver-soothing formulas for perimenopausal anxiety and depression by synthesizing data from randomized controlled trials. The results show that these formulas outperform the controls (placebo and conventional Western medicine) in reducing anxiety and depression scores, with fewer adverse reactions. When combined with other interventions, they exert synergistic effects. However, the high heterogeneity and small sample sizes in some trials limit the robustness of conclusions, requiring cautious interpretation.