Shugan Jieyu capsule effects on peripheral blood micro-124, micro-132, and brain-derived neurotrophic factor in patients with mild to moderate depression

Abstract

BACKGROUND

To assess the effectiveness of Shugan Jieyu capsules on peripheral blood miR-124, miR-132, and brain-derived neurotrophic factor (BDNF) levels in patients with mild to moderate depression following coronary artery intervention [percutaneous coronary intervention (PCI)] for coronary heart disease.

AIM

To evaluate the therapeutic efficacy of Shugan Jieyu capsules and their effects on the peripheral blood levels of miR-124, miR-132, and BDNF in patients with mild to moderate depression following PCI for coronary heart disease.

METHODS

Patients with mild-to-moderate depression of the liver-qi stagnation type after PCI for coronary heart disease at the 305^th Hospital of the People’s Liberation Army were enrolled from June 2022 to November 2023 and randomly assigned to two groups: Experimental (treated with Shugan Jieyu capsules) and control (treated with escitalopram oxalate tablets). This study compared the antidepressant effects of these treatments using 17-item Hamilton Rating Scale for Depression (HAMD-17) scores, metabolic equivalents, low-density lipoprotein cholesterol, BDNF, high-sensitivity C-reactive protein levels, miR-124 and miR-132 levels, distribution of immune-related lymphocyte subsets, and traditional Chinese medicine syndrome scores before and after 6 weeks of treatment.

RESULTS

No significant difference was observed in any index between the two groups before treatment (P > 0.05). After treatment, the total efficacy rates were 93.33% and 90.00% in the experimental and control groups, respectively. Experimental group had significantly lower scores for the main and secondary syndromes compared to the control group (P < 0.05). No significant difference was observed in the metabolic equivalents between the two groups before and after treatment (P > 0.05). The levels of low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and miR-132 were significantly lower, whereas those of miR-124, BDNF, CD3+T lymphocytes, CD3+CD4+T helper lymphocytes, and CD3+CD4+/CD3+CD8+ cells were significantly higher in the experimental group compared to the control group (P < 0.05). The incidence of adverse reactions during experimental group was significantly lower than that in control group (P < 0.05).

CONCLUSION

Shugan Jieyu capsules have good efficacy in patients with mild-to-moderate depression after PCI, and its mechanism may contribute to the regulation of miR-124, miR-132, BDNF levels, and lymphoid immune cells.

Key Words: Shugan Jieyu capsule; Coronary heart disease; Depression; Escitalopram oxalate tablet; Micro-124; Micro-132; Brain-derived neurotrophic factor

Core Tip: The study examines the effects of Shugan Jieyu capsules on patients with mild to moderate depression following percutaneous coronary intervention for coronary heart disease. The results indicate significant improvements in depressive symptoms, biochemical markers such as miR-124, miR-132, and brain-derived neurotrophic factor, as well as immune function. Shugan Jieyu capsules outperformed escitalopram oxalate tablets in reducing depression severity and adverse reactions, suggesting their potential as a safer and more effective treatment alternative for post-percutaneous coronary intervention depression.

INTRODUCTION

Percutaneous coronary intervention (PCI) is a widely used medical procedure for treating coronary artery disease[1]. This treatment method is primarily employed for managing coronary heart disease, especially in cases in which coronary artery narrowing or blockage leads to insufficient blood supply to the heart. During PCI, a physician inserts a long thin catheter into the patient’s blood vessels, typically through the leg or arm arteries. The catheter was then guided into the coronary arteries of the heart. Once in place, the physician uses specialized tools, such as balloons, to dilate narrow sections of the blood vessels[2]. In many cases, a small metal mesh structure called a stent is also placed to help keep the blood vessels open. PCI primarily improves the blood supply to the myocardium, alleviates chest pain (angina), enhances the patient’s quality of life, and reduces the risk of heart attacks. Compared with traditional open-heart surgery, PCI is a less invasive option with shorter recovery times and relatively low risks[3].

However, recent research indicates that a significant portion of patients undergoing PCI treatment (approximately 40%) experience postoperative mental health issues such as anxiety and depression[4]. These psychological problems may be attributed to factors such as the stress of the surgery, concerns regarding health status, and lifestyle changes[5]. This psychological stress not only affect the patient’s mental well-being but may also have a negative impact on their physical recovery. Therefore, psychological interventions and support have become crucial components in the overall management of PCI treatment. Patients may require psychological counseling, behavioral therapy, or medication to help them cope with postoperative psychological challenges[6]. To improve the condition of patients with mild-to-moderate depression following PCI for coronary heart disease, clinical treatment mainly uses Western medicine such as escitalopram oxalate; however, it may increase the occurrence of adverse reactions during treatment and even raise the probability of cardiovascular adverse events[2]. Therefore, safer and more effective medications must be sought to improve the quality of life of patients.

Research has shown that compared to Western medicine, traditional Chinese medicine (TCM) is more effective in treating patients with post-PCI depression. TCM believes that smooth circulation of blood vessels in the body is essential for the overall wellbeing of patients, and disturbances in emotions can lead to the stagnation of liver qi and blood stasis, causing blockages in the blood vessels. The “Nei Jing” (Yellow Emperor’s Inner Canon), an ancient Chinese medical text, mentions that the heart governs blood vessels and spirits[7]. Dysfunction in these functions can lead to “dual heart diseases”, where heart and emotional disorders mutually influence each other. Shugan Jieyu capsules are widely used in clinical practice because of their calming and liver qi soothing effects. With the rapid development of second-generation sequencing, microRNAs (miRNAs) have gradually become a popular topic in clinical research. Numerous studies have confirmed the abnormal expression of miR-124 and miR-132 in patients with mental disorders and their involvement in regulating vascular neogenesis[8,9]. Therefore, this study used Shugan Jieyu capsules to treat patients with mild to moderate depression following coronary intervention and analyzed their clinical efficacy as well as their impact on the levels of miR-124, miR-132, and brain-derived neurotrophic factor (BDNF), a factor influencing the occurrence of depression.

MATERIALS AND METHODS

Study design

This study was approved by the Ethics Committee of Hospital of Beijing Armed Police Forces the initiator of the multi-center joint study. Written informed consent was obtained from the patients and/or their guardians. This randomized controlled trial enrolled patients with PCI depression of liver qi stagnation and blood stasis treated at the 305^th Hospital of the People’s Liberation Army from June 2022 to November 2023. Liver qi stagnation and blood stasis were diagnosed based on TCM syndrome differentiation criteria, including symptoms such as chest and hypochondriac fullness, distending pain, depression, and restlessness. The patients were randomly divided into the experimental and control groups. The sampling method employed was consecutive sampling. Random allocation was performed using a computer-generated random number table. Allocation concealment was ensured by using sealed opaque envelopes. The “Guidelines for Rational Use of Medications for Coronary Heart Disease” were used for both groups. Based on individual underlying diseases, recommendations from various specialty departments were followed to standardize medication treatments without affecting the research. The control group was treated with escitalopram oxalate tablets (10 mg), one tablet taken on an empty stomach every morning, with a maximum dose not exceeding 20 mg/day, for 6 weeks. The experimental group was treated with Shugan Jieyu capsules (each capsule contained 0.36 g), taken twice a day, two capsules each time, divided into morning and evening doses, for 6 weeks.

Inclusion criteria included: (1) Age between 40 and 75 years; (2) Meeting the diagnosis criteria for coronary heart disease[8], coronary angiography showing coronary artery stenosis or occlusion > 50%, undergoing PCI treatment; (3) Meeting the International Classification of Diseases-10[9] diagnosis criteria for mild to moderate depression[10], with a course of at least 4 weeks; (4) Meeting the TCM syndrome differentiation diagnosis criteria for mild to moderate depression, with symptoms lasting for at least 2 weeks: Main symptoms: Chest and hypochondriac fullness, distending pain, mental depression and restlessness; (5) Secondary symptoms: Wandering pain, loss of appetite, restless sleep, thin or greasy tongue coating, and wiry and fine pulse; (6) No other drugs that could affect the trial results were used within 2 weeks before treatment; (7) Patients had clear thinking and were able to cooperate with treatment; and (8) Patients and their family members signed informed consent forms. The exclusion criteria were as follows: (1) Patients with acute myocardial infarction accompanied by hemodynamic instability; (2) Patients with severe depression; (3) Patients with severe liver or kidney dysfunction and/or other malignant primary diseases; (4) Patients with severe infections; (5) Pregnant and lactating women; (6) Patients with suspected or confirmed allergies to the relevant drugs in this study; and (7) Self-administration of other TCM treatments. The exclusion criteria were severe adverse reactions, deterioration of condition, occurrence of other life-threatening conditions requiring emergency measures, poor compliance, voluntary withdrawal from the trial, and loss to follow-up. This study was approved by the hospital Ethics Committee.

Before and after 6 weeks of treatment, the 17-item Hamilton Rating Scale for Depression (HAMD-17) was used to assess the efficacy of depression treatment in patients. The scale consists of 17 items with a total score of 54, with higher scores indicating more severe illness. The efficacy was assessed using the HAMD-17 score reduction rate, calculated as (pre-treatment score - post-treatment score)/pre-treatment score × 100%. Clinical control: HAMD score reduction rate ≥ 70%, significant efficacy: 50% ≤ HAMD score reduction rate < 70%, effective: 20% ≤ HAMD score reduction rate ≤ 50%, ineffective: HAMD score reduction rate ≤ 20%. Additionally, before and after 6 weeks of treatment, TCM syndrome scoring assessments were conducted for depressive symptoms in both groups of patients. The main symptoms were chest and hypochondriac fullness, distending pain, mental depression, and restlessness, while secondary symptoms included wandering pain, loss of appetite, and restless sleep. Symptom severity was divided into four levels: None, mild, moderate, and severe, with 0, 2, 4, and 6 points assigned for the main symptoms and 0, 1, 2, and 3 points for the secondary symptoms. The total score was 12 points for main symptoms and 9 points for secondary symptoms.

Before and after 6 weeks of treatment, morning fasting venous blood was drawn from the patients and centrifuged to obtain the serum, and the BDNF level was determined using an enzyme-linked immunosorbent assay. Low-density lipoprotein cholesterol (LDL-C) levels were determined using an automatic biochemical analyzer, and serum hypersensitive C-reactive protein (hs-CRP) levels were determined using the immunoturbidimetric method. After centrifugation to remove the clear upper serum layer, an appropriate amount of red blood cell lysate was added to lyse red blood cells. After centrifugation, the cells were washed once with phosphate buffered saline and then incubated with antibodies for lymphocyte subgroups (CD3, CD4, CD8, CD19, and CD56+16) in a lymphocyte subgroup reagent kit for 30 minutes. Finally, after washing once with phosphate buffered saline, the lymphocyte subgroups [CD3+T lymphocytes, CD3+CD4+T help (Th) lymphocytes, CD3+CD8+CTL lymphocytes, CD3-CD19+B lymphocytes, and CD3-CD56+16+natural killer (NK) cells] and the immune function index (CD3+CD4+/CD3+CD8+ ratio) in the peripheral blood of each patient were examined using a BD FACSCanto flow cytometer. Total RNA was extracted using the TRIzol reagent, and cDNA was synthesized using a reverse transcription kit. The reverse transcription products were used for real-time quantitative polymerase chain reaction. Reagent kits were purchased from the American company Sigma-Aldrich. U6 was used as the internal reference, and the polymerase chain reaction reaction conditions were as follows: Pre-denaturation at 95 °C for 10 minutes, denaturation at 95 °C for 15 seconds, annealing at 60 °C for 60 seconds, for a total of 40 cycles. The 2^-ΔΔCt method was used to calculate the relative expression levels of miR-124 and miR-132 in each group, and each sample was tested three times, and the average value was calculated. Primer sequences are listed in Table 1. The occurrence of adverse reactions such as rash, nausea, abdominal pain, diarrhea, dizziness, and drowsiness during the treatment period in both groups of patients was recorded.

Table 1 Primer sequences for miR-124, miR-132, and U6.

Gene	PCR primer sequences
miR-124	Forward: 5’-GCGGTGAATGCCAAAAA-3’
	Reverse: 5’-CGCAAGGATGACACGCAAATTCGT-3’
miR-132	Forward: 5’-ACCGTGGCTTTCGATTGTTA-3’
	Reverse: 5’-GGCGACCATGGCTGTAGACT-3’
U6	Forward: 5’-TTGTGGAAAGGACGAAACAC-3
	Reverse: 5'-GGCCATGCTAATCTTCTG- 3'

PCR: Polymerase chain reaction.

Statistical analysis

The experimental data were analyzed using Statistical Package for Social Science software (version 21.0; IBM, Armonk, NY, United States). Continuous variables that met the criteria for a normal distribution were presented as the mean ± SD, and differences between groups were compared using the independent two-sample t-test. Non-normally distributed data are presented as [M(P25, P75)], and intergroup differences were assessed using the non-parametric Mann-Whitney U test. Categorical data were expressed as percentages (%), and intergroup differences were compared using the χ² or Fisher’s exact test. Statistical significance was set at P < 0.05.

RESULTS

Sixty patients with mild-to-moderate depression of liver qi stagnation and blood stasis following PCI were enrolled between June 2022 and November 2023 at the 305^th Hospital of the People’s Liberation Army. Patients were randomly divided into experimental and control groups, with each group comprising 30 patients. As shown in Table 2, no significant differences in baseline characteristics were observed between the two groups (P > 0.05).

Table 2 Comparison of baseline characteristics between the two groups.

Characteristic	Experimental group (n = 30)	Control group (n = 30)	P value
Age (year)	60.07 ± 4.89	61.79 ± 4.53	0.232
BMI (kg/m2)	23.92 ± 2.14	24.08 ± 2.67	0.768
Males (%)	46.7	56.7	0.436
< 2 stents (%)	63.3	53.3	0.432
≥ 2 stents (%)	36.7	46.7	0.432

BMI: Body mass index.

In the comparison of depression treatment efficacy between the two groups, as shown in Table 3, there was no significant difference in the efficacy of treatment for depression between the two groups (P > 0.05). As shown in Table 4, the paired t-test analysis of the HAMD-17 scores within each group before and after treatment showed significant improvements in both groups (P < 0.05).

Table 3 Comparison of depression treatment effectiveness.

Group	Experimental	Control	χ2	P value
Number of cases	30	30
Clinical control, n (%)	9 (30.00)	6 (20.00)
Significant effect, n (%)	11 (36.67)	14 (46.67)
Effective, n (%)	8 (26.67)	7 (23.33)
Ineffective, n (%)	2 (6.67)	3 (10.00)
Total, effectiveness rate n (%)	28 (93.33)	27 (90.00)	0.218	0.640

Table 4 Paired t-test analysis of 17-item Hamilton Rating Scale for Depression score.

Characteristic	Experimental group (n = 30)	Control group (n = 30)	P value
Age (year)	60.07 ± 4.89	61.79 ± 4.53	0.232
BMI (kg/m2)	23.92 ± 2.14	24.08 ± 2.67	0.768
Males (%)	46.7	56.7	0.436
< 2 stents (%)	63.3	53.3	0.432
≥ 2 stents (%)	36.7	46.7	0.432

BMI: Body mass index.

In the comparison of TCM syndrome scores between the two groups of patients (Table 5), there was no statistically significant difference in baseline TCM syndrome scores between the two groups (P > 0.05). However, after treatment, the syndrome scores for the main and secondary symptoms in the experimental group were significantly lower than those in the control group (P < 0.05).

Table 5 Comparison of traditional Chinese medicine syndrome scores in depression (mean ± SD, points).

Group	Number of cases	Main symptoms		Secondary symptoms
		Before treatment	After treatment	Before treatment	After treatment
Experimental	30	9.51 ± 2.09	3.12 ± 0.93a	7.06 ± 1.27	2.84 ± 0.64a
Control	30	9.32 ± 2.01	4.63 ± 1.09a	7.14 ± 1.35	3.49 ± 0.72a
t		0.359	5.772	0.236	3.696
P value		0.721	< 0.001	0.814	0.001

^aP < 0.05, in comparison to before treatment.

In the comparison of exercise endurance between the two groups, there was no significant difference in METs values between the experimental and control groups before treatment [(2.69 ± 0.47) vs (2.85 ± 0.68), P > 0.05]. The METs values between the two groups did not show significant difference between the two groups after treatment [(5.71 ± 1.16) vs (5.23 ± 1.23), P > 0.05].

In the comparison of biochemical indicators between the two groups (Table 6), there were no significant differences in the levels of LDL-C, hs-CRP, BDNF, miR-124, and miR-132 between the two groups before treatment (P > 0.05). After treatment, the miR-132, LDL-C, and hs-CRP levels in the experimental group were significantly lower than those in the control group (P < 0.05), whereas the miR-124 and BDNF levels were significantly higher than those in the control group (P < 0.05).

Table 6 Comparison of biochemical indicators between the two groups (mean ± SD, n = 30).

Group	Experimental	Control	t	P value
LDL-C (mmol/L)
Before treatment	3.21 ± 0.87	3.35 ± 0.68	0.694	0.490
After treatment	1.61 ± 0.66a	1.97 ± 0.63a	2.161	0.035
hs-CRP (mg/L)
Before treatment	8.47 ± 1.23	8.89 ± 1.56	1.157	0.252
After treatment	5.67 ± 0.59a	6.25 ± 0.67a	3.558	0.001
BDNF (ng/mL)
Before treatment	4.29 ± 0.97	4.58 ± 0.88	1.213	0.230
After treatment	13.71 ± 3.16a	10.43 ± 3.93a	3.563	0.001
miR-124
Before treatment	0.89 ± 0.25	0.93 ± 0.26	0.607	0.546
After treatment	1.22 ± 0.30a	1.01 ± 0.27a	2.850	0.006
miR-132
Before treatment	3.39 ± 0.78	3.22 ± 0.74	0.866	0.390
After treatment	1.41 ± 0.36a	1.73 ± 0.49a	2.883	0.006

^aP < 0.05, compared to before treatment within the same group.

LDL-C: Low-density lipoprotein cholesterol; hs-CRP: High-sensitivity C-reactive protein; BDNF: Brain-derived neurotrophic factor.

As shown in Figure 1 and Table 7, before treatment, there were no significant differences in the proportions of peripheral blood lymphocyte subsets (CD3+T lymphocytes, CD3+CD4+Th lymphocytes, CD3+CD8+CTL lymphocytes, CD3-CD19+B lymphocytes, CD3-CD56+16+NK cells) and the immune index (CD3+CD4+/CD3+CD8+ ratio) between the two groups (P > 0.05). However, after treatment, the proportions of CD3+T lymphocytes, CD3+CD4+Th lymphocytes, and CD3-CD56+16+NK cells, and the immune index (CD3+CD4+/CD3+CD8+ ratio) were significantly higher in the experimental group than in the control group (P < 0.05). As shown in Table 8, the incidence of adverse reactions in the experimental group was significantly lower than that in the control group (P < 0.05).

Figure 1 Flow cytometry detection of lymphocyte subpopulation distribution of immune-related cells in two groups of patients (T, T helper, CTL, B, natural killer cells). Th: T helper; NK: Natural killer.

Table 7 Comparison of lymphocyte subgroup indicators between the two groups (mean ± SD, n = 30).

Group	Experimental	Control	t	P value
CD3+T cells
Before treatment	53.45 ± 4.56	52.13 ± 5.11	0.924	0.568
After treatment	69.89 ± 5.03a,b	58.32 ± 5.25a	4.857	0.012
CD3+CD4+Th cells
Before treatment	29.23 ± 3.28	28.65 ± 3.42	0.874	0.646
After treatment	40.05 ± 3.96a,b	32.35 ± 4.17a	5.231	0.009
CD3+CD8+CTL cells
Before treatment	25.34 ± 2.92	26.76 ± 2.87	0.922	0.0324
After treatment	20.19 ± 3.18	24.24 ± 3.62	0.845	0.425
CD3-CD19+B cells
Before treatment	14.85 ± 2.33	12.56 ± 2.12	0.984	0.266
After treatment	10.63 ± 2.96	15.32 ± 3.33	1.011	0.123
CD3-CD56+16+NK cells
Before treatment	11.45 ± 2.91	12.77 ± 3.04	0.651	0.758
After treatment	15.66 ± 3.05a	13.46 ± 3.12	3.864	0.011

^aP < 0.05, compared to before treatment within the same group.

^bP < 0.05, compared to the control group.

Th: T helper; NK: Natural killer.

Table 8 Comparison of the incidence rates of adverse reactions in two groups (cases).

Group	Experimental	Control	Fisher P value
Number of cases	30	30
Abdominal pain, n (%)	0 (0.00)	2 (6.67)
Nausea, n (%)	0 (0.00)	2 (6.67)
Vomiting, n (%)	0 (0.00)	1 (3.33)
Total incidence, n (%)	0 (0.00)	5 (16.67)	0.020

DISCUSSION

Recently, the number of patients undergoing PCI has increased with the incidence of coronary heart disease[10]. Concurrently, the number of patients with comorbid anxiety and depression has also increased. Research has shown that cardiovascular diseases and patients’ psychological well-being can mutually influence each other[7]. Abnormal changes in emotions can affect the hypothalamic-pituitary-adrenal axis, leading to hormonal imbalances, which may increase the likelihood of coronary heart disease[11]. Therefore, the field of “dual cardiology and psychology” has gained attention from clinical researchers.

Patients with cardiovascular diseases are often treated with selective serotonin reuptake inhibitors, norepinephrine reuptake inhibitors, and other psychotropic drugs to manage depression and anxiety. However, these drugs often have significant adverse effects such as bitterness in the mouth, dry mouth, dizziness, and decreased appetite, which can lead to poor medication adherence and suboptimal treatment outcomes[12]. Studies have shown that TCM can effectively improve the psychological state of patients with coronary heart disease who undergo PCI, reduce the incidence of adverse reactions, and offer advantages owing to its multi-target, multi-level, and multi-dimensional regulation[13].

This study applied Shugan Jieyu capsules in the clinical treatment and found that, compared to escitalopram oxalate tablets, Shugan Jieyu capsules were more effective in alleviating symptoms of depression in patients with PCI and comorbid mild-to-moderate depression[14]. They also demonstrated a more significant improvement in patients’ exercise tolerance, quality of life, and biochemical indicators, with a significant reduction in the incidence of adverse reactions. Although there was no significant difference in the METs values between the two groups, other indicators suggested a positive trend in exercise tolerance, contributing to an overall improvement in the quality of life.

The “Expert Consensus on Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Dual Cardiac Diseases” summarizes the causes of dual cardiac diseases into three aspects: Emotional discomfort leading to meridian blockage, dietary irregularities affecting the spleen and stomach, and prolonged cardiovascular disease leading to loss of confidence and heart blood depletion[15]. Shugan Jieyu capsules, mainly composed of Guan Ye Jin Si Tao and Ci Wu Jia, are used to treat liver qi stagnation in the cases of deficiency and weakness, demonstrating effects such as soothing the liver, relieving depression, clearing heat, and promoting dampness.

The results of this study suggest that the antidepressant effects of Shugan Jieyu capsules are comparable to those of escitalopram oxalate tablets. Capsules primarily focus on supplementing deficiencies and purging excesses while regulating the patient’s spirit, resulting in fewer adverse reactions and better relief from clinical symptoms. Multiple studies have also indicated that Shugan Jieyu capsules can alleviate clinical symptoms in patients with coronary heart disease and mild-to-moderate comorbid depression, improve TCM syndrome scores, and align with the results of this study[16].

Furthermore, studies have shown a correlation between the serotonin transporter gene and the occurrence of coronary heart disease combined with depression[17,18]. Patients with coronary heart disease and comorbid mood disorders often have elevated levels of inflammatory factors, such as CRP and abnormal blood lipids, which can lead to vascular endothelial dysfunction. The research by Guo et al[19] found that after treating patients with coronary heart disease with PCI, who also had comorbid anxiety and depression, with Shugan Lishpi capsules, there was a significant decrease in the levels of hs-CRP and a significant increase in BDNF levels, with greater changes than those in the group treated with fluoxetine maleate. The results of this study also showed that after treatment, miR-132 levels in the experimental group significantly decreased, whereas miR-124 and BDNF levels significantly increased compared to those in the control group. This suggests that Shugan Jieyu capsules may regulate oxidative stress, cytokines, and energy metabolism to reduce inflammatory responses and regulate lipid metabolism, while improving depressive symptoms.

In summary, Shugan Jieyu capsules demonstrated good efficacy in patients with mild-to-moderate depression following PCI. They improve the patients’ physical fitness, immune capabilities, and quality of life, thereby significantly reducing the incidence of adverse reactions. This effect may be related to the downregulation of miR-132 and upregulation of miR-124 and BDNF levels.

CONCLUSION

The findings of this study demonstrate that Shugan Jieyu capsules have a significant therapeutic effect in patients with mild-to-moderate depression following PCI for coronary heart disease. This treatment effectively reduced depressive symptoms, improved biochemical indicators, and enhanced immune function. Compared with escitalopram oxalate tablets, Shugan Jieyu capsules showed a lower incidence of adverse reactions, making them safer alternatives for treating post-PCI depression. Therapeutic mechanisms may involve the regulation of miR-124, miR-132, and BDNF levels, as well as modulation of the immune system. These results suggest that Shugan Jieyu capsules could be a valuable addition to the treatment regimens for patients with depression after PCI.