JMIR Publications

ABSTRACT

Background:

Major Depressive Disorder (MDD) is a complex, heterogeneous condition with a significant global impact. Current diagnosis primarily relies on symptom-based assessments, which often lead to varied treatment responses. While data-driven approaches have attempted to identify subtypes of MDD, their clinical applicability remains limited. Traditional Chinese Medicine (TCM) provides a complementary, theory-driven classification system that categorizes MDD into distinct patterns, such as deficiency and excess syndromes. These TCM-based classifications may offer valuable insights into the biological mechanisms underlying MDD and inform more personalized treatment strategies.

Objective:

This systematic review and meta-analysis aim to investigate the neural mechanisms associated with TCM-based deficiency and excess patterns in MDD, utilizing various fMRI modalities, including resting-state and task-based fMRI, Diffusion Tensor Imaging (DTI), and Magnetic Resonance Spectroscopy (MRS). By examining differences in brain activity across these TCM patterns, the study seeks to identify potential neurobiological distinctions within MDD subtypes as conceptualized by TCM.

Methods:

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P), we will conduct a comprehensive search of seven databases for studies published up to October 2024. Eligible studies will be screened by two independent reviewers based on predefined inclusion criteria, followed by data extraction and quality assessment. For meta-analysis, resting-state fMRI studies will be analyzed in MNI space using Seed-based d Mapping-Permutation of Subject Images (SDM-PSI) V.6.21 software (www.sdmproject.com), enabling a focused evaluation of brain activity differences in deficiency and excess MDD patterns.

Results:

As of November 2024, a primary search has not yet been conducted. The existing evidence on neuroimaging techniques related to TCM diagnostic classifications of MDD will be summarized both narratively and quantitatively. Meta-analysis results will be presented in tables and neuroimaging figures.

Conclusions:

The results of this study may help to explain the neural mechanisms of depression's neurobiological subtypes from the perspective of TCM. Clinical Trial: Trial Registration Number: CRD42023475178.