Xu MY, Lu Y, Shi GM, Yao J, Ding CQ, Zhou RJ. Clinical efficacy and effects on hypothalamic-pituitary-adrenal axis function of proscar combined with selective serotonin reuptake inhibitor in post-stroke depression. World J Psychiatry 2026; 16(1): 112139 [DOI: 10.5498/wjp.v16.i1.112139]
Corresponding Author of This Article
Chun-Qin Ding, Associate Chief Physician, Department of Neurology, Yangzhou University Affiliated Taixing Hospital, No. 1 Changzheng Road, Taixing 225400, Jiangsu Province, China. myxu1986@foxmail.com
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Psychiatry
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Retrospective Study
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Jan 19, 2026 (publication date) through Dec 31, 2025
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World Journal of Psychiatry
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Xu MY, Lu Y, Shi GM, Yao J, Ding CQ, Zhou RJ. Clinical efficacy and effects on hypothalamic-pituitary-adrenal axis function of proscar combined with selective serotonin reuptake inhibitor in post-stroke depression. World J Psychiatry 2026; 16(1): 112139 [DOI: 10.5498/wjp.v16.i1.112139]
World J Psychiatry. Jan 19, 2026; 16(1): 112139 Published online Jan 19, 2026. doi: 10.5498/wjp.v16.i1.112139
Clinical efficacy and effects on hypothalamic-pituitary-adrenal axis function of proscar combined with selective serotonin reuptake inhibitor in post-stroke depression
Ming-Yang Xu, Yi Lu, Guo-Mei Shi, Jun Yao, Chun-Qin Ding, Ru-Juan Zhou
Ming-Yang Xu, Jun Yao, Chun-Qin Ding, Ru-Juan Zhou, Department of Neurology, Yangzhou University Affiliated Taixing Hospital, Taixing 225400, Jiangsu Province, China
Yi Lu, Department of Catheter Room of Interventional, Yangzhou University Affiliated Taixing Hospital, Taixing 225400, Jiangsu Province, China
Guo-Mei Shi, Department of Psychology, Yangzhou University Affiliated Taixing Hospital, Taixing 225400, Jiangsu Province, China
Co-corresponding authors: Chun-Qin Ding and Ru-Juan Zhou.
Author contributions: Xu MY designed the research study and wrote the manuscript; Xu MY, Lu Y, Shi GM, and Yao J performed the research; Lu Y contributed new reagents and analytical tools; Shi GM and Yao J analyzed the data; Ding CQ and Zhou RJ served as co-corresponding authors, overseeing the study design, supervising research execution, and revising the manuscript. All authors read and approved the final version.
Supported by Open Project of Jiangsu Province Key Laboratory of Integrated Traditional Chinese and Western Medicine for the Prevention and Treatment of Geriatric Diseases, No. 202232.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Taixing People’s Hospital (approval No. K-W2023001).
Informed consent statement: All study participants and their legal guardians provided written informed consent prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Qin Ding, Associate Chief Physician, Department of Neurology, Yangzhou University Affiliated Taixing Hospital, No. 1 Changzheng Road, Taixing 225400, Jiangsu Province, China. myxu1986@foxmail.com
Received: August 15, 2025 Revised: September 15, 2025 Accepted: October 28, 2025 Published online: January 19, 2026 Processing time: 137 Days and 17.4 Hours
Abstract
BACKGROUND
Post-stroke depression (PSD) is associated with hypothalamic-pituitary-adrenal (HPA) axis dysfunction and neurotransmitter deficits. Selective serotonin reuptake inhibitors (SSRIs) are commonly used, but their efficacy is limited. This study investigated whether combining SSRIs with traditional Chinese medicine (TCM) Free San could enhance their therapeutic effects.
AIM
To evaluate the clinical efficacy and safety of combining SSRIs with Free San in treating PSD, and to assess its impact on HPA axis function.
METHODS
Ninety-two patients with PSD were enrolled and randomly divided into control groups (n = 46) and study groups (n = 46). The control group received the SSRI paroxetine alone, whereas the study group received paroxetine combined with Free San for 4 weeks. Hamilton Depression Scale and TCM syndrome scores were assessed before and after treatment. Serum serotonin, norepinephrine, cortisol, corticotropin-releasing hormone, and adrenocorticotropic hormone were measured. The treatment responses and adverse reactions were recorded.
RESULTS
After treatment, the Hamilton Depression Scale and TCM syndrome scores were significantly lower in the study group than in the control group (P < 0.05). Serum serotonin and norepinephrine levels were significantly higher in the study group than in the control group, whereas cortisol, corticotropin-releasing hormone, and adrenocorticotropic hormone levels were significantly lower (P < 0.05). The total efficacy rates were 84.78% and 65.22% in the study and control groups, respectively (P < 0.05). No significant differences in adverse reactions were observed between the two groups (P > 0.05).
CONCLUSION
Combining SSRIs with Free San can enhance therapeutic efficacy, improve depressive symptoms, and regulate HPA axis function in patients with PSD with good safety and clinical application value.
Core Tip: Combining selective serotonin reuptake inhibitors with the traditional Chinese medicine Free San significantly improves the treatment efficacy for post-stroke depression. The novel combination therapy not only alleviated depressive symptoms more effectively than selective serotonin reuptake inhibitors alone but also normalized hypothalamic-pituitary-adrenal axis dysfunction, as evidenced by reduced cortisol and corticotropin-releasing hormone levels. This approach has a good safety profile, suggesting that it is a promising integrative treatment strategy for post-stroke depression.
