Effect and Safety of Wuling Capsules Combined with rTMS in Regulating the HPA Axis for the the Treatment of Depression in the Elderly

NIU Weifang; ZHAO Long; LIU Qiang; ZHENG Junran; ZHANG Xujing

doi:10.3969/j.issn.1002-3429.2025.12.019

Abstract：Objective To explore the effect and safety of Wuling capsules combined with repetitive transcranial mag-netic stimulation(rTMS)in regulating the hypothalamic-pituitary-adrenal(HPA)axis in the treatment of depression in the elderly.Methods A total of 120 elderly patients with depression admitted from January 2022 to December 2023 were selected and randomly divided into the combination group,the capsule group and the rTMS group using computer randomization,with 40 patients in each group.All three groups were given Venlafaxine Hydrochloride sustained-release tablets.On this basis,the combination group was treated with Wuling capsules combined with rTMS,the capsule group was treated with Wuling capsules,and the rTMS group was treated with rTMS.The treatment lasted for 2 consecutive months.The therapeutic effects,safety,and scores of HPA axis hormones,NOD-like receptor protein 3(NLRP3)inflammasome-related proteins,Hamilton Depression Scale 24 items(HAMD-24),Pittsburgh Sleep Quality Index(PSQI),and Mini-Mental State Examination(MMSE)before and after treatment in the three groups were statistically analyzed and compared.Results The total effective rate of the combination group was 90.00%(36/40),which was higher than that of the capsule group[70.00%(28/40)]and the rTMS group[65.00%(26/40)],(P<0.05).After treatment,the contents of serum adrenocorticotropic hormone,cortisol and adrenocorticotropin-releasing hor-mone in the combination group were lower than those in the capsule group and the rTMS group,and lower in the capsule group than in the rTMS group(P<0.05).After treatment,the protein expression levels of NLRP3,cysteine protease-1,interleukin-1 β and interleukin-18 in peripheral blood mononuclear cells of the combination group were lower than those of the capsule group and the rTMS group,and lower in the capsule group than in the rTMS group(P<0.05).After treatment,the HAMD-24 and PSQI scores of the combination group were lower than those of the capsule group and the rTMS group,while the MMSE score was higher than that of the capsule group and the rTMS group(P<0.05).There was no difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Wuling Capsule combined with rTMS can improve the depressive symptoms of elderly patients with depression,regulate the hormone level of the HPA axis,reduce the expression of NLRP3 inflammasome-related proteins,improve the sleep quality and cognitive function of patients,and has a relatively high safety.